Inspection on 07/09/06 for Tova

This inspection was carried out on 7th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tova 14/11/05

Tova 07/02/05

Tova 14/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Ezra Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ Lead Inspector Susan Cledwyn-Davies Unannounced Inspection 7th September 2006 9:15 Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ezra Address Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344 755549 01344 7731714 ezra@norwood.org.uk bucketsandspades@norwood.org.uk Norwood Ravenswood Ltd T/A Norwood Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Martin Rowe Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2005 Brief Description of the Service: Ezra cares for eight adults with learning and associated physical disabilities. It is set in Ravenswood Village, which is a Jewish community. Ezra’s underpinning ethos is derived from the Jewish faith and the beliefs practices and values of Judaism underpin all aspects of residents lives. The home is a bungalow and there are a variety of aids and adaptations around the building to allow residents to move about more independently. All of the bedrooms are single and none of them have ensuite facilities. There are two communal toilets and two communal bathrooms. The fees per week for the home are between £988 and £1719. Additional charges are made for chiropody, aromatherapy and magazines and papers. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 9.20am and 2.45pm, a total of five and a half hours. Prior to the inspection a preinspection questionnaire was completed and returned to CSCI. The manager also returned three questionnaires completed by service users with a lot of key worker support. Included in the site visit was a tour of the home, discussion with the manager and staff, observation of practice including lunch time, contact with service users and conversation with a relative. The service users are largely non-verbal or minimal communication in a repetitive manner. Observations are noted in the report but no comments from service users. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 An outcome group judged as good has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas for improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. The statement of purpose is up to date and available. The service user guide is in a service user-friendly format. Service users are assessed prior to admission. EVIDENCE: The statement of purpose is up to date and available. The service user guide has been prepared in a service user-friendly format. It is still difficult for service users to access and understand the document and key workers have an important role in this. All of the service users have lived in the home for some years. All service users were assessed thoroughly and this was currently demonstrated in care plans. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 An outcome group judged as good has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Care plans are well maintained and up dated. Plans are easy to access and use. Risk assessments are thorough and reviewed as necessary. The manager and staff try to improve communication with and by service users. Service users are helped to make decisions. EVIDENCE: Care plans are comprehensively completed and up to date. Each service user has a member of staff who provides individual support and maintains the care plan. This key worker prepares a monthly summary of care given and activities that have been completed. There is an independent living plan prepared for each service user to ensure that care staff know individual care needs and preferences. Annual reviews take place involving the service user, relatives, staff and other involved people as appropriate. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 9 Some of the monthly summaries were unavailable because of being sent to the admin centre for typing. The home is shortly to have its own computer and will aim to prepare summaries within the home. One key worker spoke of their key service user as liking a quieter life, liking to stay in her room with music. Service users are encouraged to make decisions about their lives. Poor communication limits the understanding of the choices and telling staff what their choice is. Staff are aiming to improve communication by using makaton and other non verbal forms of communication. Care Staff are attending training courses; one carer spoke enthusiastically about what she had learned. Additionally the staff group remain consistent so that staff can learn the likes and dislikes of each service user as well as understanding body language. Consistency of staff is very important for these service users. The Finance Dept audits finances held by the home for service users regularly. The record of the last audit was seen which included checking all service users monies held. As part of this process one service user had a refund for clothing paid for, as the clothing allowance allocated by the provider had not been spent. Risk assessments are well maintained and reviewed as a minimum annually. A senior carer is responsible for preparing and updating risk assessments and has attended health and Safety courses to assist with this. Weekly staff meetings will focus on individual service users to amend the care plan if necessary. Records demonstrated this. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 An outcome group judged as excellent has substantial strengths and a sustained track record of delivering good performance and managing improvement. Where areas for improvement emerge the service recognises and manages them well. We would expect to see the essential elements found in an outcome judged as good with further additional strengths particularly qualititative strengths. The performance does not have to be perfect to be excellent in an outcome area. The key NMS under this outcome heading are met. A large variety of activities are arranged. Staff try to extend opportunities; this includes on site and within the larger community. Family and personal relationships are supported. Service users have a healthy diet with a lot of variety. EVIDENCE: The manager and staff have put a lot of effort into trying new activities. This has included visiting physical activity centres specially set up for people in wheelchairs. Staff reported and photographs confirmed that service users had Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 11 enjoyed these different activities. The activity schedules for each service user had just been changed. Activities include swimming, music, horse and kart, cookery, gardening and sensory room and garden. Activities off site are encouraged but need to be safe for the service users. The home is established as part of village with a Jewish base. The kitchen is arranged to provide separate areas for milk and meat preparation. Food provided is prepared from fresh products and served according to service users requirements. The meal looked tasty on the day of the visit and was eaten well. Most service users are assisted, the dining room is arranged so that service users in wheelchairs can sit up to the table. Carers assisted service users sensitively. The menu showed variety. The inspector saw one event that caused thought. A junior carer closed the dining room door to prevent a service user disturbing other service users. The door was closed while the service user was close to the frame and no member of staff on the same side to prevent trapping of fingers etc. An additional member of staff should have been asked to assist. The incident was reported to the manager and he would be managing this. Relatives are involved in care in the home. Some relatives are able to visit and these visits are encouraged. During the site visit there was one service user’s father visiting who had lunch in the home. He was satisfied with the care given in the home and found the staff very helpful. Service users are also taken to visit relatives with staff escorting. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 An outcome group judged as good has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Service users physical and emotional needs are met. Service users preferences are known. Medication is safely and well managed. The manager and staff are working on the way that individual attention is given. EVIDENCE: Service users preferences are included in the care plan. Care staff spoke of knowing service users preferences by observing them and looking for their smiles. Key workers are all experienced staff that have known service users for a long time. By observation service users were relaxed and content. One relative spoke well of the care given. One of the service user questionnaires noted that a service user did not always feel that individual attention was given. This feedback came via the key Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 13 worker. The manager and senior staff are working on ways of improving communication. See Conduct and Management of the Home. The local GP practice provides good medical care and support. Records of any visit and results are kept in the care plans. One member of the senior team manages medication. All medication is recorded on arrival and any medication unused is returned to the pharmacy. Two care staff, one trained to administer and a second as witness administer medication. Medication training is given prior to administering and annually after with the appraisal. Training records are kept. Administration records were well maintained and checked weekly. No service users are able to administer their own medication. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 An outcome group judged as good has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Complaints are well managed. There is a positive approach to service users rights providing good protection of service users. EVIDENCE: There is a complaints policy and procedure that applies to the whole village. As part of this there is service user-friendly statement explaining how service users can complain if they wish to. Key workers help service users to understand their rights and how to complain. It is difficult for these service users to understand and communicate their wishes for themselves because of their disabilities. The complaint procedure is being prepared in Widget format to assist service users understanding. Staff have completed training in protection of vulnerable adults. In discussion staff are aware service users of rights and promote these. There is an adult protection procedure in the home that is reviewed regularly and is part of the staff induction. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 An outcome group judged as good has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. The house is well maintained and improved. There is a newly designed garden that is very attractive. One of the two bathrooms has been improved. Adaptations are made to improve service users life. EVIDENCE: During a tour of the home improvements were noted. There are now two good-sized bathrooms with different baths within. The latest bath installed uses a bathing table for showering. Last year the manager and senior staff started a project to improve the garden, putting in a sensory garden. There is now a path winding around the garden and different sections marked by arches and different paving. Different plants and objects have been put into the garden to provide interest. Staff and relatives combined to fundraise for money for the garden. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 16 Each service user has their own room and key workers with service users arrange individual decoration and furnishings. Rooms are bright, cheerful and different. All of the rooms have specialist beds, some owned and some leased. The dining room contains adaptations including higher tables so that service users in specialised wheelchairs can sit up to the table. The lounge has been split to provide a sensory room and a lounge with large screen for TV and DVD. There was discussion about changing the sofas used by staff for smaller chairs and reorganising the room to make sure staff and service users sit together. The home was tidy and fresh smelling. The washing machine was broken, a new machine has been ordered and will be delivered soon. In the meantime there is a laundry on the site where washing is being taken. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34and 35 An outcome group judged as excellent has substantial strengths and a sustained track record of delivering good performance and managing improvement. Where areas for improvement emerge the service recognises and manages them well. We would expect to see the essential elements found in an outcome judged as good with further additional strengths particularly qualititative strengths. The performance does not have to be perfect to be excellent in an outcome area. The key NMS under this outcome heading are met. Staffing levels are satisfactory. Staff are well supported by the manager and senior staff as well as senior managers in the village. Training is encouraged and all staff are kept updated. Team meetings and individual supervision take place to encourage good practice. EVIDENCE: The staff rota demonstrated that sufficient staff are on duty. Staff recruitment files demonstrated that there is a thorough recruitment policy. The files included the application form, references, correspondence including contract and job description, CRB clearance and interview records. A separate record is kept for staff, as necessary, of work permits seen and the time for renewal. There has been active recruitment to fill the just over 3 vacancies in the home. Of these, one is awaiting CRB checks before starting Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 18 and existing staff is taking up some further hours. There is therefore only one and half vacancies remaining. Staff spoke of enjoying working in the home and within the village. There was a lot of support from senior staff in the home and from senior managers. Staff training is good and while basic courses are given there are opportunities to attend other courses. Over 50 of staff have achieved NVQ 2 already plus further staff are taking NVQ training. Training in learning disability is also encouraged. All staff were positive about the opportunities and support/time given to achieve the course. Staff meetings take place weekly; all staff are encouraged to attend. Records showed that these meetings are used to consider service users needs and to provide planning for future changes/activities. Individual supervision takes place and there is an annual appraisal for all staff. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 An outcome group judged as excellent has substantial strengths and a sustained track record of delivering good performance and managing improvement. Where areas for improvement emerge the service recognises and manages them well. We would expect to see the essential elements found in an outcome judged as good with further additional strengths particularly qualititative strengths. The performance does not have to be perfect to be excellent in an outcome area. The key NMS under this outcome heading are met. The manager is well qualified and experienced. EVIDENCE: The manager is well qualified, having completed the Registered Managers award and the NVQ 4 in care and management plus he has a lot of experience with this client group. Staff spoke of being well supported by the manager and senior team. There are weekly staff meetings and records kept for staff unable to attend. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 20 Individual supervision and annual appraisals take place for all staff. Records are kept of these. Quality assurance includes planning improvement in the home, e.g. more activities, recording activities on video cameras for service users and relatives to see. There is no central business plan. Other records demonstrate the forward planning and the involvement of relatives. The manager has clear views wanting to provide best quality care for service users. Three questionnaires were completed by service users with help from key workers. On one the service user noted that staff did not always give individual attention. It is to the credit of staff that this comment was credited. The difficulties in communicating prevent service users from being able to comment for themselves. The manager and senior staff are considering this response and how to improve the individual approach. There was discussion about the arrangement in the lounge. Also staff are attending communication training to try other ways of communication e.g. symbols, pictures, makaton etc. There is a safe approach to health and safety. The house is well maintained and checked. The manager, in the preinspection questionnaire, confirmed this. Monthly, there is a health and safety check of the building. Incidents and accidents were taken seriously and the manager ensures that any assessed risks are removed as necessary. Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 3 X X 3 X Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ezra DS0000033977.V307436.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!