CARE HOME ADULTS 18-65
Tower House 34 Higher Brimley Road Teignmouth Devon TQ14 8JU Lead Inspector
Sam Sly Announced 14 April 2005
th 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 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 Stationary 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 D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Tower House Address 34 Higher Brimley Road, Teignmouth, Devon, TQ14 8JU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01626 776515 01626 776515 info@craegmoor.co.uk Park Care Homes (No 2) Ltd Mrs Emma Mai Richards Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the Registered Manager Award Emma Richards is undertaking and the units needed from NVQ 4 are completed within the year of 2005. Date of last inspection 04/11/04 Brief Description of the Service: Tower House cares for 8 people with learning disabilities and additional autistic spectrum disorder. It is owned by Craegmoor Healthcare Limited. Tower House is located in the town of 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 from the first floor to the ground and second floor, and additional stairs. Every bedroom is a single, with all but one having an en-suite shower room. There is a relaxation room, dining room, lounge and an activity room currently being refurbished. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Inspection was an announced visit and took place over a weekday. Time was spent sitting with, and observing the residents, as most of them did not use speech to give their views. Judgements were based on observation of staff/resident interaction, written records, the pre-inspection questionnaire, staff interviews, and discussion with the manager Emma Richards, and comments received from relatives. A tour was made of the building. All of the residents had been living at the home since, at least the last visit, so the Inspector had some previous understanding of their needs. What the service does well:
There was a stable, inspirational management team and residents benefited from a well run home. All the residents observed were supported at all times by enough staff, which meant they could do activities as and when they wanted to, did not have to go out as a group if they didn’t want to, and staff were able to really get to know individuals. A relative said that they were ‘always made to feel extremely welcome’ and that it was a ‘lovely home’. Staff morale was really high, and the manager Emma Richards encouraged initiative and got staff involved in all aspects of running the Home. Staff said they felt the residents benefit from this by ‘getting out more’, ‘trying new things’ and staff now have ‘higher expectations’ of what can be achieved by the residents. Staff spoken to said they felt ‘empowered’ by the manager Emma Richards to give the residents ‘informed choices’ and were encouraged to ‘use their initiative’ when it came to improving residents experiences. All the 5 staff spoken to were enthusiastic, showed genuine feelings for the residents they cared for, and the word ‘brilliant’ was used a lot to describe their work, the residents and the manager Emma Richards. Staff could, and were, attending any training that was felt to improve the service for residents.
Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 6 The Home was clean, well decorated and a comfortable place to be. Bedrooms were individually decorated and furnished to reflect the personality of the occupant. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 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 standard(s) 1, 2, 3 and 5 Although there was information available on Tower House’s stated purpose, potential residents were still not given understandable information regarding the service prior to admission. There was a clear and consistent assessment system, so staff could make a detailed plan to meet resident’s needs. Staff were getting some training on autistic spectrum disorder and communication methods so that they could work effectively with residents. EVIDENCE: A draft of the Service User Guide had been seen before the visit, but was not yet finished with pictures that would make it more useful to the residents. A Statement of Purpose was evident. Four of the resident’s assessments were seen and discussed with Emma Richards and staff. They were detailed and reflected the needs of the residents as described by staff, recorded in professional assessments, and seen on this visit and at previous visits. Staff were getting some training from the local learning disabilities service on how to work with people with Autistic Spectrum Disorder, and Emma Richards had begun to buy books on the subject for staff. The Owners had told CSCI
Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 9 that all their homes for residents with Autistic Spectrum Disorder would be getting training from them, but as yet this had not happened. Contracts were now given to everyone, and signed by them, so residents or their representatives understood their rights and responsibilities Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 10 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 standard(s) 6,7 and 9 Care plans now had clear detailed information about what support the resident required to have a full life, including responsible risk taking and decisionmaking, so staff were clear about what they needed to do, and the resident could be more involved in decisions about their lives. The way the Owners handled resident’s money did not give full protection or the best possible return on their savings. EVIDENCE: Staff said they were all involved with writing and reviewing the plans of the residents they had responsibility for with the resident and their family. Risk assessments were detailed and used to increase the range of activities, not stop what residents did. One of the staff was now working on improving the care plans further and had felt ‘empowered’ by the manager to use his initiative. This meant that plans reflected the agreed needs of residents and would improve their experiences. There were examples in the daily records, and from staff of the resident being able to make decisions about what they wanted to do each day, and about trying new activities and enjoying them. One of the staff said that as they tried
Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 11 more activities staff had ‘higher expectations’ of what the resident could and should expect. CSCI were aware that the Owners were working on a new system for handling resident’s money, which had not yet been implemented. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 12 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 standard(s) 12,13,14 and17 There was enough staff, and a range of activities in, and out of, the Home so that the residents were given choices about what they wanted to do everyday. Meals were varied and the residents were given choices about what to eat, and where to eat it, so meals were healthy and enjoyable. EVIDENCE: All the staff said that the activities offered to the residents had increased substantially since the Emma Richards had been in post. Staff also said they had been encouraged by her to try new activities with the residents so that they could make ‘informed choices’ about what they did. Emma Richards said staff were encouraged to make flexible plans each day to suit the mood and wishes of the residents. This was confirmed by staff and written records. One resident had bought his own car, and others used the Home’s transport or buses and trains to get around. Staff said that the ‘good staffing levels’ and ‘good team spirit’ in the Home also helped get residents involved in activities. Records showed that the residents were content and sleeping well. Staff and Emma Richards put this down to being more active during the day now.
Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 13 Records and staff feedback showed that more structured meal and snack times, the choice of where to eat, and support where necessary had led to relaxed and enjoyable mealtimes. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 14 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 standard(s) 18,19 and 20 The resident’s personal and health needs were well documented and understood by staff so support could be given in their preferred way. Staff had been trained, and followed the written procedures for giving medicines to the residents so medicine was given safely. These procedure enabled residents, where appropriate, to retain, administer and control their own medication. EVIDENCE: Information in the care plans detailed how the resident liked to be supported with their personal and health care. Staff said they were key workers for individual residents, and this helped develop closer relationships with them. The residents were all dressed in clothes that reflected their ages, the time of year and their personalities. Records showed, where possible, the residents were involved in choosing their clothes increasing their individuality and independence. A community nurse or Consultant supported many of the residents, and records were kept of visits and outcomes so that resident’s health was monitored. Most of the residents were unable to look after their own medicines so staff were trained, and followed written procedures to give them
Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 15 their medicines safely. One resident was being successfully encouraged and supported by staff to take some responsibility for administering his own medicines. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 16 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 standard(s) 22 and 23 Arrangements for protecting residents and responding to their concerns were appropriate. EVIDENCE: Staff had all either attended, or were booked to attend adult protection training given by Devon County Council. One staff member was trained to train staff on adult protection in the Home. All staff spoken to were able to clearly demonstrate what they would do if they came across an abusive situation. The complaints procedure was clear and had been made as understandable as possible for the residents. The feedback from relatives about the complaints procedure was mixed. One indicated they were aware of the complaints procedure and had made a complaint. The other indicated they were unaware of the complaint procedure but had still made a complaint. Neither the Home nor CSCI had received any complaints since the last Inspection. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 17 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 standard(s) 24 and 30 The premises are suitably adapted, maintained and furnished for its stated purpose so the residents living there have a safe, comfortable home. EVIDENCE: A tour of the Home showed how the building had improved enormously in the last 12 months. Emma Richards said that is was now somewhere staff and the residents could be ‘proud of’ staff confirmed this. Each resident had their own bedroom that staff had worked hard to decorate and individualise. All the rooms in the Home were now relaxed, comfortable places to be. There was an odour problem in the front hall that the manager was aware of and was addressing. The Fire Service had visited the Home twice since the last CSCI visit; once to issue a notice of non-compliance, and once to confirm that the manager had dealt with the problems. The laundry facilities were suitable for the Home, although there were piles of laundry waiting for washing and drying. An additional dryer had been bought but there was problems connecting it, which meant it, was not being used. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 and 36 Recruitment procedures had been followed consistently so all staff employed had been properly interviewed, vetted and appointed. This meant the residents using the service were protected. Staff received a range of training, tailored to their needs and the needs of the residents they care for, so they could lead a full and active life. Support and supervision from the manager ensured staff developed confidence and skills to better support and empower the residents. EVIDENCE: The Owners now oversaw all the recruitment procedures, but copies of all information were kept in the Home and Emma Richards said she still felt involved. Several staff files, including that of a new staff member were examined and found to be comprehensive thereby protecting residents. Staff spoken to were very happy with the variety and amount of training on offer to them, which included NVQ’s, some autism and learning disability training, communication training and health and safety courses. The deputy manager was in charge of booking, and planning training for the whole staff team. Staff spoken to said the training made their jobs easier, and had given them inspiration when working with the residents.
Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 19 Regular supervision and support for all staff was in place. Staff said they valued supervision as somewhere to discuss their individual needs and issues. All the staff spoken to were highly complimentary of the Emma Richards who was described as ‘well respected’, ‘she really listens’, ‘approachable’ and ‘brilliant’. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 There was an inspirational, stable management team, which meant residents benefited from a well run home. The Owners methods for monitoring quality were not underpinned by resident’s views and did not enable them to identify, overall, what they were doing well and what needed to be improved, or inform CSCI and other interested parties. The resident’s health, safety and welfare was protected and promoted by the Owner and manager. EVIDENCE: The Owner was aware that its quality assurance system needed work as requirements had been made at the last 2 Inspections. There were some methods in place: Tower House was visited monthly by the Owners, there were regular checks on the environment and other systems, and training was monitored, but the residents views and those of other interested people were not gathered and there was no overall quality audit which showed people what
Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 21 Tower House was doing well and what needed improving. Emma Richards was unable to update on progress. The residents benefited from a stable, management team. Staff felt Emma and her deputy inspired them, and gave them confidence to use their skills. Emma Richards said she only had a few units to complete before she had finished the Registered Manager Award and NVQ 4. Records showed staff had received a range of health and safety training. The fire records were up to date and the accident book was kept properly and the residents were protected from hot water and hot surfaces. The Home environment was regularly risk assessed and any action required taken so resident’s safety and welfare was protected and promoted. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 Standard No 24 Score 3
Version 1.20 Page 22 Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score 25 26 27 28 29 30
STAFFING x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 3 x Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 23 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 1 Regulation 5 Requirement There must be a Service User Guide for the Home. Each resident must be given a copy which, as far as possible is understood by them. (Previous timescale of 9 January 2005) There must be a complete Quality Assurance system in place which captures the views of the residents and stakeholders. An annual report must be produced, with a copy available for CSCI and other interested people to see. (Previous timescale of 9 January 2005). The Owners should put into place the banking arrangements for residents that have been proposed. Timescale for action 20th July 2005 2. 39 24 20th July 2005 3. 7 20 20th July 2005 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 32 and 3 Good Practice Recommendations Staff should receive the Autism training that the Owners
D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 24 Tower House have said would be provided. 2. Tower House D54-D07 S32607 Tower House V210837 140405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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