CARE HOME ADULTS 18-65
Tower House 34 Higher Brimley Road Teignmouth Devon TQ14 8JU Lead Inspector
Sam Sly Unannounced Inspection 27th September 2005 2:00 Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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.V255601.R01.S.doc Version 5.0 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.V255601.R01.S.doc Version 5.0 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 Mrs Emma Mai Richards Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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. 14th April 2005 Date of last inspection 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 who has his own lounge area. The laundry is also located on the ground floor. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspection was unannounced and took place during a weekday in September. Time was spent sitting with, and observing the residents, as well as talking to those able to give their views verbally. Judgements were based on observation of staff/resident interaction, written records, staff interviews, discussion with a resident’s relative, and discussion with the manager Emma Richards. A tour was also made of the premises. This was the second Inspection of the year, and for a full over-view of the service it is recommended that the previous Inspection report of 14th April 2005 is also read. What the service does well: What has improved since the last inspection?
There have been further improvements to the environment, with the activity room on the ground floor now functional, and two residents bedrooms refurbished. Residents now have information in a user-friendly format, about what they can expect whilst living at Tower House, in the form of a Service User Guide. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 Page 6 Staff are about to start Autistic Spectrum Disorder training and the home is working towards accreditation with the National Autistic Society. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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.V255601.R01.S.doc Version 5.0 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): 1&2 Potential residents and their representatives are given the information needed to make an informed choice about moving to Tower House. There is a clear assessment system so that staff can understand resident’s needs and make detailed care plans. EVIDENCE: There was now an appropriate Statement of Purpose and Service User Guide available for potential, and current residents. Three residents files were examined. There had been no new residents admitted since the last Inspection, but each current resident had received a full assessment, which was reviewed regularly. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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. Clear detailed information on resident’s needs, goals and aspirations mean staff can support them in decision-making, and risk taking enabling an independent lifestyle as possible. However, gaps in one resident’s plan could put them at risk. The way the Owners handled resident’s money did not give full protection or the best possible return on their savings. EVIDENCE: One of the staff had worked hard to systematically update and improve resident’s care plans, so they now detailed and gave clear direction to staff. The resident, family members and professionals were invited to be involved in reviewing care plans. All staff were involved in writing up and reviewing plans, and this gave responsibility to staff, which they said was good. During the Inspection a core staff meeting was held to discuss and update the care plan of one resident due to changing needs. The discussion involved proved that staff, were well aware of residents needs, and of good practice in dealing with behavioural issues. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 Page 10 One of the care plans examined did not have a plan of how the resident’s behavioural needs were being met, although it was clear that staff were working positively with the resident. There was evidence from daily records, discussion with residents, and observation during the Inspection that residents were able to make decisions about what they wanted to do each day, what they wanted to eat, and other everyday decisions. Residents continue to try new activities, and all of the residents were getting out and about in the community daily. 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, all the others have other financial arrangements. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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): 14, 15 & 16 Residents have a wide range of leisure activities, with family and friends being encouraged to be involved in their lives. EVIDENCE: A member of staff who the registered manager described as a ‘God-send’ had worked hard to ensure that there was now clear information for residents each day on what activities they could do and who they would do it with. The range of activities had increased, with real breakthroughs with one particular resident who rarely wanted to go out. On the day of Inspection one resident was going out for a coffee, another out for lunch, and one person was going to have his hair cut but decided not to. Whilst at home resident’s had started using the activity room on the ground floor for cooking and art and craft. The registered manager had purchased a bread maker and ice cream maker, which were enjoyed by residents. Staff said that the high staffing levels enabled them to take residents out whenever they wanted, or change their plans if necessary due to a resident not wanting to do an activity.
Tower House DS0000032607.V255601.R01.S.doc Version 5.0 Page 12 A visiting parent said that his son was a very active person, and the staff were good at getting him involved in activities that burned off his energy. He also said the registered manager and staff were good at keeping him up to date with anything he needed to know about his son, and he felt able to talk to them about any concerns he had. Over the summer residents have been on lots of trips and short breaks including going to Longleat, boat trips, and staying in Exmouth. Each resident has a key worker and they make sure family contact is maintained. During the Inspection one resident was meeting a resident for coffee. Staff were noted to respect residents privacy and dignity on the day of Inspection, although staff do have to be aware of where residents are, and what they are doing the majority of the time due to their needs. Staff were observed to be interacting with residents at all times in positive, friendly ways, and residents were comfortable and content in the company of staff. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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): 20 Medication is administered safely by staff, and the Home’s procedures allow for residents, where appropriate, to control their own medication. EVIDENCE: The responsibility for overseeing medication procedures is given to one of the senior staff. Medication was being stored, administered and disposed of appropriately, with all those staff administering medication trained to do so. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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): EVIDENCE: None of these standards were looked at on this Inspection, but both were met at the Inspection on 14th April 2005. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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 The premises are homely, comfortable and safe for residents. EVIDENCE: A tour of the house showed that redecoration and refurbishment was on going, but that the premises were clean, and decorated to a good standard. The registered manager said the maintenance person dealt with maintenance issues quickly, and the Owners dealt with requests swiftly. There had been no visit to the home by either the Fire Service or the Environmental Health Department since the last Inspection. Two residents had swapped bedrooms, and their new rooms had been tastefully redecorated and furnished. One of the residents told me they liked their new bedroom very much. There was some discussion about ways to promote privacy in a bedroom where curtains were continually pulled down, how to better provide privacy than the use of outside shutters and privacy issues around a shared bathroom. The registered manager said she would look into the issues immediately. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 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): 35 Resident’s benefit from appropriately trained staff. EVIDENCE: The registered manager had an overall staff training plan, which showed that staff had moving & handling, fire safety, health & safety, COSHH, food hygiene, first aid, adult protection, infection control, equal opportunities, and challenging behaviour training. All staff had carried out an Induction and were about to start an autism awareness course. Two staff had completed NVQ 2 with 8 working towards it, and one had completed NVQ 3 with 5 working towards it. Once complete this means 16 out of 19 care staff would have an NVQ. Staff spoken to were enthusiastic, felt supported by the registered manager and team leaders, and felt they were getting good training. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 Page 17 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): 39 & 42 The Owner’s methods of monitoring quality were not underpinned by resident’s views, and did not enable them to systematically improve the service. The resident’s health, safety and welfare are protected and promoted by the Owner and manager. EVIDENCE: The registered manager had not been updated by the Owners about progress towards a suitable Quality Assurance system. The area manager did visit at least monthly though and send a report to the Commission. There were also regular checks on the environment, incidents, and staff training needs but residents views and those of other interested parties were not gathered and there was no overall quality audit. Records showed that staff received a range of health and safety training. The fire records were up to date, except the fire risk assessment, which needed reviewing. Accident and incident records were kept appropriately and radiators were covered and hot water regulated. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Tower House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x DS0000032607.V255601.R01.S.doc Version 5.0 Page 19 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. 2 Standard YA1 YA7 Regulation 15 20 Requirement Every resident must have a detailed behavioural care plan. The Owners must put into place the banking arrangements for residents that have been proposed (Previous timescale 20/07/05 not met) There must be a complete Quality Assurance system in place, which captures the views of residents and stakeholders. An annual report must be produced, with a copy available for the Commission and other interested people (Previous timescale 9/01/05 & 20/7/05 not met) Timescale for action 10/12/05 10/12/05 3 YA39 24 10/01/06 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 YA24 Good Practice Recommendations A long-term solution should be found for the shared bathroom situation.
DS0000032607.V255601.R01.S.doc Version 5.0 Page 20 Tower House 2 3 YA24 YA42 Other solutions should be found, other than curtains and shutters on the outside of the windows, to protect the privacy of the residents discussed. The Home’s fire risk assessment should be reviewed. Tower House DS0000032607.V255601.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office 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
© 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 DS0000032607.V255601.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
