Inspection on 12/05/06 for Tower House [Teignmouth]

This inspection was carried out on 12th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tower House [Teignmouth] 01/09/08

Tower House [Teignmouth] 06/07/07

Tower House [Teignmouth] 02/11/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Tower House 34 Higher Brimley Road Teignmouth Devon TQ14 8JU Lead Inspector Sam Sly Unannounced Inspection 12th May 2006 09:45 Tower House DS0000032607.V289112.R01.S.doc Version 5.1 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 DS0000032607.V289112.R01.S.doc Version 5.1 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 DS0000032607.V289112.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tower House Address 34 Higher Brimley Road Teignmouth Devon TQ14 8JU 01626 776515 01626 776515 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) Park Care Homes (No 2) Ltd Vacancy Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: Tower House cares for eight people with learning disabilities and additional autistic spectrum disorder. It is owned by a subsidiary of Craegmoor Healthcare Limited. Tower House is located in Teignmouth, within walking distance of the town centre, bus routes and the train station. The Home is wheelchair accessible, and once inside there is a lift the ground and second floors, and additional stairs. Every bedroom is single, with all but one having an en-suite shower room. There is a relaxation room, dining room, lounge and activity room with additional kitchen on the ground floor. The ground floor is used by one specific resident, with their own lounge area. The laundry is also located on the ground floor. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was unannounced and took place during a day in May. It included discussion with staff, the acting manager and the deputy manager. Due to the communication needs of the residents, observation was used as part of the assessment of their quality of life at Tower House. Three resident’s care was tracked by reading care plans, daily records, talking to staff and discussion with the acting manager. Health and safety, and staff records were also examined, the Home’s Quality Assurance system was discussed and a tour of the premises took place. The Inspection process also included information from the pre-inspection questionnaire the acting manager had sent to the Commission, which included staff rotas and menus. A review of contact the Commission has had with Tower House since the last key inspection, and comment cards from two staff and five relatives/visitors were also included. All the required core standards were assessed during the key inspection process. What the service does well: What has improved since the last inspection? What they could do better: Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 6 Due to the communication needs and high support needs of residents, their representatives must be involved in the care planning and decision-making process. The Owner’s must put in place the financial changes they agreed with the Commission, so that residents money handled by them is protected and gives the best possible return. The Owner’s Quality Assurance system must reflect the views of residents/their representatives. The acting manager must be fully aware of her role within the local Adult Protection procedures. There must be a fire evacuation plan for Tower House, and fire training for all staff. 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. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 7 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 DS0000032607.V289112.R01.S.doc Version 5.1 Page 8 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): 2 The overall quality outcome for choice of home is good. Resident’s needs are well assessed, recorded, understood and met by staff. EVIDENCE: There had been no residents admitted to Tower House since the last Inspection. Three resident’s assessments were examined during the visit and were thorough, detailed and easy to read. The assessments described the needs of residents as described by staff and observed during the site visit. Staff were involved in producing the assessment and care plan. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 9 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 & 9 The overall quality outcome for individual needs and choices is good. There are thorough care plans and risk assessments, however no resident representation in the process, which could potentially disadvantage them. The way the Owners handled resident’s money does not give full protection or the best possible return on their savings. EVIDENCE: The deputy manager should be commended for the high quality behavioural support plans that reinforce the resident’s risk assessments. These risk assessments had been improved since the last Inspection and reflected clearly the plans examined and in place to support the three residents whose care was tracked on the visit. Three resident’s care plans were examined and found to be thorough and detailed and reflected what resident’s needs were observed to be, and what staff confirmed. However, several relatives had commented on not always being involved in the decision-making and care planning process for their relative at Tower House, and discussion with the acting manager confirmed Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 10 this did not routinely happen. Due to the high care needs and limited communication needs of the residents at Tower House it is important that care planning involves representatives to advocate for them. Also care plans did not detail the staffing needs of residents, with rotas showing fluctuating levels of staff during the day and the weekends. To clarify what residents staffing needs are and whether these needs are being met a review is recommended. Each resident had a key worker allocated, and these staff members were involved in producing the care plan and helping residents on a more personal basis. The acting manager said that Tower House was getting ready to be assessed by the Autistic Society to be accredited. For this accreditation the staff were in the process of provide a range of photographs to support decision-making. The registered manager did not know when the Owner’s improved system for handling resident’s money would be in place. However, only two of the resident have money looked after by the Owners, and records were available for the money handled by the staff. All the other residents have other financial arrangements, and one resident went to the bank during the visit to bank a cheque with support. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 11 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, 14, 15, 16 & 17 The overall quality outcome for lifestyle in good. Tower House tries hard to ensure residents lead full active, interesting lives. The meals are varied and enjoyed by residents. EVIDENCE: All the residents at Tower House had activities programmes and during the site visit every resident was out in the community at some point of the day. Activities the acting manager said happened included massage, swimming, cooking, walks, trips to local adventure parks, and tourist attractions further a field, aqua fun, horse riding and dog walking, and art and craft. Residents were unable to comment on whether they enjoyed the activities they did, but staff felt they lead active lives and the resident’s looked happy with the activities they were involved in during the site visit. One resident had returned from a week’s holiday during the site visit and staff reported that they had thoroughly enjoyed the time away, other residents had holidays and days away planned to places like Alton Towers and Finlake, based on their needs. Some activities programmes were not always backed up by Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 12 daily records to indicate whether the activity took place and was valued by the resident. Tower House has an activities co-ordinator whose job it is to find new activities for residents and organise their programmes. There is enough transport to ensure residents get out and about, they also use public transport including the train. One resident has their own car. Family links are maintained for residents and all visitors/relatives that commented said they were made welcome at Tower House. One relative/visitor said the service offered at Tower House ‘has always been excellent’ and that they were ‘more that satisfied with the care given’. Others commented that they would like to be made more aware of decisions and important matters relating to their relatives. During the visit it was observed that staff were respectful towards residents, allowing them time alone if their needs allowed, and interacting with them at all times. Staff showed genuine affection and high regard for the residents and were enthusiastic about helping them develop skills. Lunch was shared with some of the residents and staff, and was enjoyed by all. Resident’s dietary needs are well known and catered for by staff. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 13 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 & 20 The overall quality outcome for personal and healthcare support is good. Personal and health care needs are well supported and staff administer resident’s medication safely. EVIDENCE: Resident’s personal and healthcare support needs were clearly documented in the care plans case tracked. Residents had regular doctor and specialist check ups. Resident’s personal care needs were observed to be supported by staff in respectful and dignified ways. Staff are offered a range of specialist learning disability and autistic spectrum disorder training. The responsibility for overseeing medication procedures is given to one of the senior staff with the acting manager overseeing proceedings. Medication is being stored, administered and disposed of appropriately, with all those staff administering medication trained to do so. A recent incident with regard to medication practices had been dealt with swiftly and appropriately. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 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 & 23 The overall quality outcome for concerns, complaints and protection is good. Complaints and concerns at Tower House are dealt with appropriately, and staff would be able to protect residents from harm, however, the acting manager was not clear about her responsibilities. EVIDENCE: Tower House has a robust complaints procedure, and there was evidence discussed at the site visit that proved concerns and complaints are dealt with swiftly and professionally. Staff were able to demonstrate understanding of what constitutes abuse and what the procedure is for reporting abuse, all staff questioned had attended adult protection training. However, during the site visit the acting manager was unable to locate the adult protection policies and was unclear about her managerial role within the Local Authority adult protection procedures. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 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 & 30 The overall quality outcome for the environment is good. The premises are homely, comfortable and safe for residents. EVIDENCE: The environment on the day of the site visit was clean, homely and well decorated with evidence that refurbishment and renewal issues being dealt with swiftly. Tower House has a dedicated maintenance person to carry out day-to-day redecoration and repairs. Recommendations for improvement to the Home made at the last Inspection had been acknowledged and acted on. All the bedrooms were decorated individually and reflected the personalities of residents. The acting manager said there had been no visits to Tower House from the Fire Service or the Environmental Health Department since the last Inspection. Laundry facilities were clean and hygienic and there were sufficient procedures and training to ensure the control of infection. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 16 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, 33, 34 & 35 The overall quality outcome for staffing is good. Residents benefit from fit, competent, qualified staff and are protected by the recruitment procedure. EVIDENCE: Three staff files were examined and staff were spoken to at the site visit. Two staff comment cards were also received. Correct recruitment checks were carried out including CRB checks. However, it was recommended that written records of staff interviews were kept to evidence decision-making. Staff said they received a good range of specialist and mandatory training including NVQ training. Someone at the Owner’s central office audits training. The induction and foundation training seen to be provided to staff on the site visit is not of an appropriate standard. The acting manager and deputy manager have recently been on supervision training and now felt confident. Training recently attended included behavioural techniques, epilepsy, medication and manual handling. Some training was still required, but the Owner’s had plans to provide it. It was recommended that an overall training plan be provided. Equality and diversity issues were being developed with the introduction of communication systems and examples of incidents were staff have advocated access to public places which have been closed to them before, however the Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 17 acting manager was unclear about the Home’s policies and procedures and training opportunities for staff. There was a multiple-choice questionnaire available for staff. Staff supervisions and a staff meeting were being organised in the near future by the acting manager. Staff spoken to said they were getting used to the new manager and felt supported by her. The staff rotas provided showed that staffing numbers varied each day from 3 to 6 staff on between 8am-10am to 6-9 staff on duty between 1-4pm to 4-5 between 6-8pm. Staffing numbers on the rotas were lower at weekends. On the day of the site visit there were sufficient staff on duty to ensure residents were safe and active, however there was no record of resident’s staffing needs so it was impossible to assess whether needs were met at all times of the day. The acting manager and deputy manager was also not clear of the staffing needs of residents, so it was recommended that a review is made of each resident. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 18 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): The overall quality outcome for conduct and management of the Home is poor. Tower House does not have a manager who has been assessed as competent to manage, and certain health and safety issues could potentially put residents at risk. Although a robust Quality Assurance system is in place, there was no evidence in the Home that residents/their representative’s views were included. EVIDENCE: The acting manager was about to start NVQ 4 training and an application was lodged with CSCI for registration, however during discussion at the site visit it was found that she had not been given a job description to support her manager role, and was not knowledgeable about the Care Homes Regulations and National Minimum Standards. The Quality Assurance system had improved greatly since the last Inspection with audits already carried out on medication practices and health and safety and future audits planned on food safety, person centred planning and infection control. The area manager carries out monthly visits and reported Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 19 are sent to CSCI. The acting manager was unable to say how residents/their representatives and stakeholders views are gathered and inform the Quality Assurance system. The pre-inspection paperwork showed that checks on electrics, central heating, water and gas installations were carried out regularly. There was no environmental risk assessment, although hot water and surfaces had been risk assessed, and although fire checks were carried out regularly there was no evacuation plan and some staff required training. The kitchen was clean, however the food store floor wasn’t and there was food stored on the ground. The fridge temperatures showed it was often above 5°c and no reparatory action had been taken. Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 20 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 X 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 2 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 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 21 YES 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. 1. Standard YA6 Regulation 15 Requirement Resident’s representatives must be involved in the care planning process. The Owners must put into place the banking arrangements for residents that have been proposed (Previous timescale 20/07/05 & 10/12/05 - not met) The Quality Assurance system must captures the views of residents/their representatives and stakeholders. An annual report must be produced, with a copy available for the Commission and other interested people The acting manager must be fully aware of where and what the Adult Protection procedures are at Tower House, and what her role is if abusive behaviour is disclosed. There must be a fire evacuation plan, and staff must all have fire safety training. Timescale for action 20/07/06 2. YA7 20 20/07/06 3. YA39 24 20/07/06 4. YA23 13(6) 20/07/06 5. YA42 23(4) 20/07/06 Tower House DS0000032607.V289112.R01.S.doc Version 5.1 Page 22 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. 1. Refer to Standard YA14 YA33 Good Practice Recommendations Daily records should indicate whether activities have taken place so that staff are aware whether it is valued by the resident or needs to be changed. Care plans should reflect the staffing needs of residents, with the number of staff on duty matching the assessed needs of the residents at all times. Daily records should record that activities have been offered or taken place. The acting manager and staff should be fully aware, and have received training on equal opportunities and diversity issues, with policies and procedures in place. There should be an interview format to record decisionmaking about recruitment. There should be an overall staff-training plan. There should be sufficient Induction and Foundation training that meets Skills for Care specifications. 5. 6. YA37 YA42 The acting manager should have a job description and a good awareness of the Care Homes Regulations and National Minimum Standards in relation to her role There should be an environmental risk assessment in place. Fridge temperatures should be below 6° c. There should be no food stored on the floor, and the food store floor should be thoroughly cleaned regularly. 2. YA33 3. 4. 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