Inspection on 01/09/08 for Tower House [Teignmouth]

This inspection was carried out on 1st September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tower House [Teignmouth] 06/07/07

Tower House [Teignmouth] 02/11/06

Tower House [Teignmouth] 12/05/06

Tower House [Teignmouth] 27/09/05

Tower House [Teignmouth] 14/04/05

Tower House [Teignmouth] 04/11/04

Tower House [Teignmouth] 10/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 Tower House [Teignmouth] 34 Higher Brimley Road Teignmouth Devon TQ14 8JU Lead Inspector Judy Hill Unannounced Inspection 1 & 4 September 2008 10:45 st th Tower House [Teignmouth] DS0000032607.V370194.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 Tower House [Teignmouth] DS0000032607.V370194.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. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower House [Teignmouth] Address 34 Higher Brimley Road Teignmouth Devon TQ14 8JU 01626 776515 01626 779474 tower.house@craegmoor.co.uk Craegmore.co.uk Park Care Homes (No 2) Ltd 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) Nigel Ian Herring Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2007 Brief Description of the Service: Tower House is registered to provide accommodation and care for a maximum of eight people who have a learning disability. The stated aim of the home is to provide a service specifically for people who are also have an autistic spectrum disorder. The registered service provider is Park Care Homes (No. 2) Limited, which is subsidiary of Craegmoor Healthcare Limited. The registered manager is Mr Nigel Herring. Tower House is in Teignmouth, Devon and is within walking distance of the town centre, which has a good range of shops and other facilities, bus and train services and the beach. Information about the service is available on request from the home in a Statement of Purpose and a Service User Guide. Copies of inspection reports are also available from the home or can be found on the CSCI website. Current fees range from £1,113.66 to £4807.79 a week and are based on the individually assessed needs of the people who use the service. Extra charges are made for damages caused by the resident to bedrooms and furniture, dry cleaning, some payment towards holidays, hairdressing, chiropody and personal glasses, homeopathic therapies, outings, activities, some day services, college courses, some meals and drinks out at restaurants, cafes and pubs, personal televisions, stereos, CDs, DVDs, clothing, toiletries, computers, internet, mobile phones, private phone lines, Sky or Freeview, public transport costs. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. A site visit was carried out as part of this key inspection by one inspector on 1st and 4th September 2008. The information contained in this report was gained from the site visit and from conversations with the staff on duty and the registered manager. Because the people who use the service have profound learning disabilities, are autistic and find it difficult to communicate with people we could not engage them in conversation. However we did meet most of them and observed the way that they interacted with each other and with the staff. Additional information was gained from an Annual Quality Assurance Assessment that had been completed by the registered manager, surveys completed for four of the people who live at the home by their relatives or representatives, the last inspection report, the homes Statement of Purpose and Service User Guide, records relating to two of the service users using a process of case tracking, staff records, notifications and an inspection of the premises. What the service does well: The written admissions procedure should ensure that prospective residents needs are properly assessed before they are offer a place at the home. Personal care is provided sensitively and takes into account the wishes and needs of the residents. A key worker system is in place to ensure that the people who use the service receive continuity of care. The people who live at Tower House are offer a choice of meals. The registered manager always lets the Commission know about accidents or incidents in the home that could have a negative impact on the people who use the service. The home is spacious and each of the residents has their own bedroom, which they can use whenever they want to be alone. A sensory room provides a good place for the residents to relax in. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 6 Only trained staff help the residents to take their medication and the medication records are regularly checked to ensure that no errors are made. Although more specialised training is needed, the provision of basic training is good and the staff are encouraged to gain National Vocational Qualifications in Care. Someone is employed to ensure that the regular maintenance work is carried out at the home. The registered manager is experienced and well qualified. The staff have access to the homes policies and procedures. What has improved since the last inspection? What they could do better: The Statement of Purpose needs to be revised to that the information provided for the people who use or are considering using the service and their representatives is accurate and up to date. The Service Users Guides need to be revised because they do not include all of the required and recommended information and some of the information that is provided is out of date. Reviews of needs assessment and care plans could be more person centred and include more risk assessments, personal achievable goals and the active support that could be provided by the staff to enable each of the residents to develop their independence and autonomy. Complaints are now always dealt with appropriately. The staffing levels are not always maintained at a level that meets the professionally assessed needs of the people who use the service. This means that the people who live at the home may not always get the support they need. Tower House aims to provide a specialist service for people who have complex needs but the provision of specialist training for the staff could be improved. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 8 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 Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. People considering using this service and their representatives do not have access to all of the information they need to make an informed decision about whether or not the home will be right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the home Statement of Purpose and Service Users Guide were provided to us on request. The Statement of Purpose was seen to contain all of the information that is required and recommended to be included, although some of the information on staffing will need to be updated due to recent changes in the staffing structure. Service User Guide were seen with the records kept about the people who use the service but the registered manager told us that these had not been given to the people who use the service because they would throw them away or destroy them. Individual risk assessments had not been carried out to support this. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 10 Reference is made in the Service Users Guide to a ‘Service Users Agreement’ but this document in not included in the Guide. The information on staffing and the address of the Commission are out of date. Information about the role of the Commission is misleading. Individual fees charged, what they cover and the method of payment of fees are not included. We asked to see contracts for two of the people who use the service but these were not available at the home for inspection. The Annual Quality Assurance Assessment tells us that there have been no new admissions since 2004 so the current pre-admission needs assessment practices could not be inspected. The report of the last key inspection tells us that the policies and procedures for admission, including initial needs assessment, were assessed as satisfactory. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. More focus on person centred planning could enable the people who use the service to develop to their individual skills and abilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The working care plans for two residents were seen. These were included in large files and the current information was difficult to find because it was kept with updated information. This was discussed with the registered manager who recognised the need to reorganised the filing system and improve access to the current plans of care. The care plans contained some evidence of Person Centred Planning but this needs to be developed to provide clear evidence that the reviews of each of persons needs and their care planning are person and not service lead and to include achievable personal goals. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 12 The daily records for two residents were seen. One of the records showed that the resident leads an active social life and that she is encouraged to contribute to the day to day running of her home. This resident was seen working with her Key Worker to produce easily identified photographs of food for use as a communication aid. The key worker, who was spoken with during the inspection, demonstrated that she had a good understanding of the persons needs and was able to work well with her. The other daily record told us that the resident, who the contracting authority has told us is funded for twenty-four hour one to one support, spends most of his time alone in his private rooms and rarely goes out. His key worker was spoken with and again demonstrated a good understanding of the persons needs. He said that the resident found it very difficult to mix with other people. A number of incidents where a resident has physically attacked another resident or staff member have been reported to the Commission. Reports tell us that the causes of this behaviour are being explored following an incident but there was insufficient evidence in the resident reviews and care plans to demonstrate that proactive solutions are being fully considered through reviews of personal needs assessments, care planning, risk assessments, staff training and professional input. The daily records and conversations with staff identified that the people who use the service are encouraged by the staff to make decisions about their lives. Examples of this include when to go to bed and when to get up, when to spend time in the company of others and when to spend time alone and the availability of choice and alternatives at meal times. Personal spending money is kept by the home for security for some of the residents. Up to date records of the money spent by the people who live at the home were not available on the first day of the inspection because these had been locked away and the staff did not have access to them. This means that the staff could not make contemporaneous entries to record money taken to give to the residents or to spend on their behalf. Conversations with the registered manager established that several of the residents had used their personal money to buy furniture and fittings for their bedrooms. The responsibility for ensure that the residents bedrooms are suitably furnished lies with the service providers and clear records must be drawn up to provide evidence that the people who use the service are aware that they do not have to pay for such purchases and only do so if they make an informed decision to do so. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 13 Some risk assessments were seen in the resident’s personal records but more could be made of the risk assessment process to enable the residents to take control of more aspects of their life within a safe framework. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. The people who use the service are encouraged to make choices about their lifestyles within their home environment but more could be done to help them to develop their life skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The level of participation in activities outside of their home varies. Of the two people whose records were inspected one had a very active social life, which included horse riding, bowling, trampoline, visits to a disco, walking and day or afternoon trips to the seaside and contributed to the general housekeeping. The daily records of the second person whose care was case tracked showed that does not go out very often. One of the stated aims of the service is to this person is to “…increase his independence skills and attendance at Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 15 activities”, but the records seen did not provide evidence that this is being achieved. There are no restrictions of visiting times and the residents are able to see their visitors in the lounge or in their bedrooms. A cordless telephone is available to the residents to enable them to make and receive telephone calls in private. Some of the people who live at the home go to visit and stay with their families. Feedback received by the Commission from the relatives of three of the residents indicates that they are happy with the home and the service provided for their sons. The residents right to make choices within their home environment is respected Daily records show that people can choose when to go to bed and when to get up and whether they want to use the communal rooms or spend time alone in their rooms. It was also demonstrated during the site visit that the residents are able to choose from the available staff who they want to assist them with their personal care. A cook is employed to prepare the main meal of the day. Records were seen to show that the people who live at the home are offered a choice of meals and that alternatives will be provided to ensure that their individual dietary needs and preferences are met. The care staff said that some of the people who live at the home occasionally help to prepare snacks and meals. The possibility of involving the residents more in the day to day running of their home and enabling them to participate in food shopping was discussed. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. The people who live at the home are given the help they need to maintain their personal hygiene and timely referrals are made to the professional healthcare services when residents are unwell. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality Assurance Assessment completed by the registered manager for the Commission identified that all of the people who live at the home need support to help them to maintain their personal hygiene. The people who were seen during the site visit looked clean and were appropriately dressed. One of the people living at the home asked for a named member of staff to help him shave and she did so. This demonstrates that the residents do have a choice about who they want to assist them. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 17 Each of the residents has a named key worker and their key worker ensures that continuity of care is provided. All of the people who use the service have learning disabilities and an autistic spectrum disorder. Their healthcare needs are monitored and timely referrals are made to their doctors, dentists and opticians as and when necessary. Specialist support is currently being provided by the local Community Learning Disability team and the registered manager said that he values this. The medication storage and administration records were inspected and seen to in good order. A member of staff said that all of the people who administer the medication had attended relevant training courses and that the records of administration were always initialled and then checked and countersigned by another member of staff. This is recognised as an example of good practice. A member of staff spoken with demonstrated that she had a very good understanding of the medicines used by the residents. A small stock of paracetamol and Ibuprofen are kept at the home for general use and the member of staff said that compatibility checks were always carried out before they were given to any of the residents. No other homely remedies are used. We were told that none of the current residents need controlled drugs. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. Complaints and concerns are not always dealt with appropriately. Safeguarding issues are taken seriously and reported to the appropriate authorities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is included in the Statement of Purpose and Service Users Guide. A representative of one of the people who use the service told us that they had made written complaints to the home on two occasions and that neither had been replied to. A record of the receipt of one letter of complaint was seen in the complaints book but no evidence was seen to show that the Complaints procedure had been followed to resolve the issues raised. Since the last inspection three allegations of abuse have been made. One was not upheld, the registered manager said that the second was still under investigation by the police and that no outcome had been received. The third issue was referred to Devon County Council by the Commission and is currently being investigated under the Safeguarding Adults procedures. The registered manager has been very good at letting the Commission know about incidents that occur at the home. A significant number of reported incidents involve attacks by some of the people who use the service on the Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 19 staff and other residents. This means that the people who live and work at the home are at risk of being physically abused. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. The people who live at Tower House need and are provided with space to move around. Some of the bedrooms need refurnishing and redecorating but the home is kept clean and hygienic. Poor access to the garden means that the residents cannot benefit from using this area independently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tower House is a large detached house, which is within walking distance of Teignmouth town centre, the beach and bus and railway stations. An inspection of the premises was carried out during the site visit and the communal areas of the home were seen to be clean and adequately decorated and furnished. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 21 One of the residents has his own self contained flat on the lower ground floor and this gives him direct access onto the garden. The door to the entrance to the flat is at the top of a flight of stairs and for safety purposes a Yale lock has been fitted. This restricts entry to the flat to key holders, but does not restrict exit from it as the door cannot be locked from the inside. The remaining residents have single bedrooms and some of these have private toilets, bathrooms or showers. Some of the bedrooms contain very few personal possessions, however it is accepted that this is because the people who use the rooms prefer them this way. Some of the furniture in the bedrooms is very badly worn and needs replacing. The communal lounge and dining room are spacious and appropriately furnished. There is also a sensory room for residents to use when they want to relax. The kitchen is kept locked but residents can use it if they are accompanied by a member of staff. It is understood that this precaution is necessary for safety purposes. There is one communal bathroom and the registered manager told us that the service provider plans to enlarge the bathroom by removing a connecting wall to an unused room. This is necessary as the existing bath cannot be accessed by the staff from both sides and could, therefore, place residents who have epilepsy at risk. The laundry facilities are adequate for the needs of the home. The garden has recently been landscaped to provide a raised veranda and a level lawn. The garden can only be accessed from the lower ground floor flat or by using the front door. As the front door is kept locked and the privacy of the resident in the ground floor flat is respected, the residents are unable to access their garden independently. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. The staff are committed to providing good care for the residents but they are not receiving the specialist training they need to look after people with such complex needs and there are times when there are not enough staff on duty to meet the assessed needs of the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of staff recruitment were inspected and provided evidence that safe practices are being used to recruit new staff to work with the residents. We spoke with three members of staff on the first day of the inspection and all three of them were very experienced. Two had worked at the home for ten years and one for four years. All three members of staff said that they liked working with the residents and that they had got to know them all very well. The staff said that they were all named Key Workers for specific residents and one of them was later seen working on a one to one basis with the resident Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 23 she was key worker for. The relationship between them was clearly very good. A record of staff training shows that most of the staff have received up to date training on Adult Abuse and the Protection of Vulnerable Adults, Basic Food Hygiene, Equality and Diversity, Fire Safety, First Aid, Health & Safety, COSHH, Infection Control, Manual Handling and Violence and Aggression (Primary). The registered manager, deputy manager and one care worker had also attended training on Person Centred Thinking. Although this record demonstrates that the basic training requirements are being met, insufficient attention appears to have been given to providing staff with the specialist expertise, skills and knowledge they need to provide a specialist service for people with profound learning disabilities and an autistic spectrum disorder. Nearly half of the care staff hold National Vocational Qualifications in Care at Level 2 and the registered manager said that he was actively encouraging more staff to work towards gaining this qualification. The registered manager said that in addition to himself there is a full-time deputy manager who spends some of her time providing direct care for the residents. There are three senior support workers and nine support workers. One of the support workers is also the ‘activities facilitator’ and one is also the ‘communications facilitator’. A cook is employed for 31 hours a week and a maintenance person for 20 hours a week. The registered manager provided us with the following information about the staffing levels maintained and a copy of the staff rota. 8am to 10am = three support workers 10am to 6pm = seven support workers 6pm to 8pm = four support workers 8pm to 10pm = two support workers 10pm to 8am = one waking night staff and one sleeping in staff There are currently seven people living at the home and all of them require a high level of support and supervision because they have profound learning disabilities and are autistic. A service contractor has told us that based on his assessed needs, they are paying for one client to receive twenty-four hour one to one support a day and the registered manager told us that a further two people have been assessed as needing and are funded for twelve hours one to one support a day each. This does suggest that the care staffing levels between 6pm and 10am cannot be high enough to meet the assessed needs of the people who live at the home. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. The registered manager is qualified and experienced and understands what needs to be done to improve the outcomes for the people who use the service. The staff are provided with health and safety related training and the buildings are safely maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered service provider is Parkcare Homes (No 2) Limited, which is owned by Craigmoor Healthcare Limited. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 25 Nigel Herring is the registered manager of Tower House and has been in post for two years. The Homes Statement of Purpose provides details of his academic and vocational qualifications, which include an NVQ in Care at Level 4 and the Registered Managers Award, training and work experience. The registered manager has works well with the Commission and always lets us know about things that happen at the home that could have a negative impact on the people who use the service. On the first day of the inspection the registered manager and deputy manager were not on duty and some of the records that need to be kept at the home and available for inspection were not accessible. We discussed this with the registered manager on the second day of the inspection and said that he was in the process of reorganising the records and would reduce the number of records that the staff could not access and look into providing a contingency plan if records needed for inspection were not accessible by the staff. Copies of reports were seen to provide evidence that regular monthly visits are being carried out on behalf of the persons in control and that they are receiving reports of these visits. The registered manager also completes regular self audits (Quality Monitoring Checklists) for the management Company. No evidence was seen to demonstrate that the home is carrying out annual quality assurance and quality monitoring that is based on seeking the views of the people who use the service, or their representatives, to enable the service providers to measure their success in achieving the aims, objectives and statement of purpose of the home. The Annual Quality Assurance Assessment completed by the registered manager identifies that all of the required and recommended policies and procedures are in place. Some of these were seen in files in the office and were accessible to the staff. This document also identifies that maintenance and servicing on electrical equipment, gas appliances and fire detection and fire fighting equipment are up to date. Staff training is provided in health and safety related topics. Accidents, injuries and incidents are recorded and the registered manager notifies the Commission of any incidents that have or may have a negative impact of the staff or the people who use the service. Several reported incidents have involved acts of aggression between the people who use the service and on the staff. Although it is accepted that physical attacks do not occur on a daily basis, the registered service providers need to ensure that the people who live and work at the home can do so safely. Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 26 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 2 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 1 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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. 1 Standard YA1 Regulation 4&5 Requirement The registered provider must revise the Statement of Purpose to ensure that all of the information provided for current and prospective residents and their representatives up to date and accurate. The Service Users Guides also need to be revised as they refer to but do not include a contract for the provision of services and facilities by the registered person to the person receiving the service, up to date information about staffing, the current address and telephone number of the Commission or information about the amount and method of payment of the fees. 2. YA22 22 The registered person must ensure that the complaints procedure is followed when a complaint is received. The registered provider must provide adequate furniture and furnishings in the bedrooms. It DS0000032607.V370194.R01.S.doc Timescale for action 01/11/08 01/10/08 3. YA19 16 01/10/08 Tower House [Teignmouth] Version 5.2 Page 28 is not acceptable to expect the residents to pay for these items unless it can be demonstrated that they have made informed decision to do so. 4. YA24 16 & 23 The registered provider must ensure that the garden is accessible and safe for the residents to use independently if they wish to do so. The registered provider must insure that the staff receive specialist training they need to enable them to provide a specialist service for people with profound leaning disabilities and autism. The registered persons must ensure that the care staffing levels are maintained at a level that meets the professionally assessed needs of the people who use the service at all times. The registered persons must ensure that a quality monitoring or quality review system is in place to gain feedback from the people who use the service and their representatives and that this is used to provide a development plan for the service. The registered persons must take action to reduce the levels of violence in the home so that the residents and staff are safe from physical attacks in their home or workplace. 01/12/08 5. YA32 18 01/03/09 6. YA33 18 01/10/08 7. YA39 24 01/03/09 8. YA42 12 01/10/08 Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Each of the residents should be given a personal copy of the Service Users Guide. If a resident does not want to accept this, their Service Users Guide should be kept on file. Reviews of individual needs assessments and care planning could be more person centred and include achievable personal goals. Records should be kept to demonstrate that the residents have made informed decisions to spend their own money items, such as suitable furniture, which should be provided by the service providers from their fees. More use could be made of risk assessments to enable the people who use the service to maintain more control of their lives with active support from the staff. Reviews of individual needs assessments and care planning could place more emphasis on the social, recreational and occupational needs of the people who do not currently lead active lives. Reviews of individual needs assessments and care planning could place more emphasis on exploring outside activities for the people who do not currently spend time in the local community. Reviews of individual needs assessments and care planning could place more emphasis on the active support that individuals will need to enable them to take more responsibility for the day to day running of their home. A more proactive approach could be taken to reducing the levels of violent incidents in the home so that the residents and staff are not at risk of being physically attacked in their home or workplace. 2. YA6 3. YA7 4. YA9 5. YA12 6. YA13 7. YA16 8. YA23 Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Tower House [Teignmouth] DS0000032607.V370194.R01.S.doc Version 5.2 Page 31 - 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. 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