Inspection on 06/07/07 for Tower House [Teignmouth]

This inspection was carried out on 6th July 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 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] 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 09/07/2008.

CARE HOME ADULTS 18-65 Tower House 34 Higher Brimley Road Teignmouth Devon TQ14 8JU Lead Inspector Judy Cooper Unannounced Inspection 6th July 2007 10:15 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.V338168.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 DS0000032607.V338168.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower House Address 34 Higher Brimley Road Teignmouth Devon TQ14 8JU 01626 776515 01626 779474 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) Craegmore.co.uk Park Care Homes (No 2) Ltd Nigel Ian Herring Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2006 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, and lounge. The lower ground floor is used by one specific person who has their own lounge and dining area as well as bedroom. The laundry is also located on this level. The weekly fee at Tower House currently ranges from £1041 02 - £4297.98. with fees dependent on the type of facility or care package and needs of the individual person. The fee does not include hairdressing, chiropody, homeopathy, outings, some day services, college courses, some meals out, personal items, public transport, own birthday, Christmas presents and those for friends and family. The home’s inspection report is made available on request, with a notice to this effect on the notice board in the entrance hallway whilst copies of the report are forwarded to all relatives/carers of the people who live at the home. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a Friday between 10.15 a.m. and 5.00 p.m. During the visit the opportunity was taken to tour the home, examine appropriate records and policies and talk with the manager, deputy manager and several staff members whilst observing the people that use the service noting such things as staff communication and interaction with the people at the home and opportunities made available to them. Other information about the home, including the receipt of questionnaires from four relatives and three visiting professionals has provided further feedback as to how the home performs and all of this collated information has been used in the writing of this report. (Staff questionnaires were also forwarded but none these were not returned, however several staff members were spoken with in a group setting during the inspection to obtain their views). Additionally the care of two people, living at the home, was inspected in detail to ensure that they were receiving appropriate care. All required core standards were inspected during the course of this inspection as well as a few others that were in relation to issues being discussed during the inspection. What the service does well: Tower House is specialist trained Autism unit that meets the needs of the people that use the service by providing a specialist trained staff team and an individual activities programme to assist the people that use the service to lead a fulfilled life. Staff at Tower House try hard to enable the people living there to lead interesting and active lives. Staff are also trying to develop varying means of communication to allow the people to be better able to express themselves in differing ways that they can participate in. This will then allow staff to better understand the needs of the people and therefore ensure that individual feelings on different matters are known and can be acted upon. The well established staff training programme, including working towards nationally recognised qualifications as well as providing statutory and relevant in-house and external training courses, continues to be made freely available to all staff. This ensures that the staff are appropriately trained and experienced and are able to care for the people at the home correctly. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 6 The home has a thorough assessment and care planning system in place to ensure that the needs of the people are understood and met, including personal and healthcare needs. The organisation is now working towards introducing a more person centred approach to care planning to ensure that their views are always taken into account in any such planning. The views of the relatives/carers of the people have been sought out and used to enable the management of the home to ensure that the services provided in the home are those which would be of most benefit to the people living at the home. The newly registered manager is performing his duties to a high standard and has/is addressing any identified shortfalls within the home in an efficient and professional manner. The required annual quality assurance assessment returned to the Commission was of a particularly good standard. This evidenced the clear understanding the manager has regarding the need to ensure that the care provision available to the people in the home is the best it can be. What has improved since the last inspection? What they could do better: Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 7 All of the people that use the service should be provided with an up to date contract between the registered provider and themselves so that the terms of residency are both agreed and known by the either the person using the service and/or their carer. The communication methods used within the home need to be further increased so that the people who use the service are empowered, as far as able, to express their own views and choices in how they wish to receive care and live their lives generally. The registered manager and staff should explore ways of ensuring that any individual religious needs are understood and met so that the people at the home and/or their relatives/carers can be assured that these needs will be met appropriatly. Staff should also receive training on equality and diversity issues to ensure that they are fully aware and confident of how to promote and maintain these within the home. The registered manager should ensure that any ageed reccommended professional input is made avaialble to the individual peron who needs this imput.This will ensure that the person benefits from additional expertise and staff are made more aware of how to provide the necessary specialist care. The registered provider must ensure that the garden area at the rear of the home is made safe as soon as possible so that the people that use the service are, once again, able to enjoy being outside of the home in a safe environment. The registered manager should arrange for the redecoration of those areas of the home that are looking a little “tired”, for example, the entrance hall and downstairs corridor as well as addressing any maintenance issues that need attention for example, the toilet in the lower ground floor needs to checked to ensure it is functioning properly and the rear wall behind it repainted. Additionally the registered manager should arrange for the renewal of any furnishings and fittings that are now past their best, for example the settees in the lounge area of the home were noted as being worn and staff reported that they were hard to keep clean due to the fabric they were made of. 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 DS0000032607.V338168.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 DS0000032607.V338168.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): Standard 2,5 Quality in this outcome area is adequate. Information about the home is presented in an easy to understand yet informative manner, which will allow all interested parties an awareness of what services the home can offer. A thorough admission process is in place in the event of any prospective person who may use the service, which would ensure their needs are known prior to admission. However there were no contracts in place for any of the people who live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to Tower House since 2002. However the manager is working towards having a suitable new admission policy and procedure available to ensure that any prospective person who may choose to use the service and/or their families/carers will be certain, following the admission processes undertaken, that the service can meet the prospective person’s needs. Also since the last inspection, undertaken in November last year, the newly registered manager has amended the home’s service user guide and statement of purpose. This is now presented in an informal and user friendly format, which would also allow the documents to be more easily understood by those people that may use the service who could understand symbols. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 10 All the relatives/carers of the current people at the home have been sent a copy of this new documentation to ensure that they are all aware of what services and care the home is offering. Although there have not been any new admissions since 2002 it was pleasing to note that the on-going care planning for the people who currently use the service was in depth and ensured that any newly presenting needs were noted and appropriate care made available to meet them. It was pleasing to note that a point contained in the home’s terms and conditions of residency which is freely available within the home’s documentation states one condition as: “Not to commit or allow invited visitors to commit any form of racial harrassment on the grounds of race, colour, religion, sexual orientation or diasability that may interfersw with the peace and comfort of, or cause offence to any other service user, visitor, neighbour or employees or contractors”. This evidences that the organisiation have considered the need to promote and protect the individual rights of the people that use the service and of the staff and others that have regular contact with the home, to individuality and respect regardless of any individual diversity they may have. However there was no evidence of individual contracts being in place for each peson living at the home. Tower House DS0000032607.V338168.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): Standards 6,7,8 and 9. Quality in this outcome area is adequate. The manager and staff are skilled in planning for all aspects of the overall needs and personal goals of the for people that use the service, at the home, showing both sensitivity and awareness of each person’s current and changing needs. However communication is limited between the people and the staff at the home due to a lack of varying and meaningful communication methods being in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When care plans are put together there is input from the person using the service (as far as is able), relatives/carers, care management, key-workers and any other appropriate outside professional. All care plans are reviewed on a monthly basis by the person’s key-worker and in an annual review with input from the person’s relative/carer, care management and key-worker. This ensures that the a broader view of the person’s needs is considered and not all the decisions are made by one person. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 12 All perple at the home have an identified key worker who will specifically work with them and take overall repsonsibility for providing the correct care and undertaking individual identified activites etc. The manager is intending to further increase the key worker’s role to involve them in the creation and updating of the new person centred care planning processes. A “key worker day” has just been introduced within the home. This is a specific day that key workers spend on a regular basis on a one to one with the person they are linked to. This means that key workers can focus entirly on this person for this designated day and ensure records, clothes, personal needs etc are in order. Two care plans were inspected in detail, during the inspection, and these related to the two people whose care had been looked at in detail. It was pleasing to note that some recent work undertaken with care management, involving both individuals, had been fully noted and the care plans updated accordingly in accordance with the recommendations of the care manager. Agreements reached following on from this outside professional input was also noted as being put in place. However in one instance the reccomendation to obtain additional specialist support for one of the people had yet to take place. The staff at the home work within the framework of a recognised care programme called the: “five accompishments”. This is a goal based programme which provides some way of measuring the quality of services that people with a learning disability/autisim use and then allows the service to both test its aims and objectives as well as their success and acheivements. These five accomplishments that are measured and worked towards include: Choice Respect New Skills Integration in the Community Relationships The staff at the home were clearly seen to be working hard towards ensuring that these areas are promoted for the people that currently use the service. Although there has been some work undertaken to ensure that communication is better improved for people in the home that have severe communication problems, such as staff attending total communication workshops and the introduction of indivdual communication programmes including the use of photos and simple signs etc, the manager and staff are still aware that there is a need to further build on this to provide an increased variety of addditinal communication methods. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 13 There has also been some input from the community speech and language therapist team to assist the staff team to start building a communication pack to assist the people at the home to communicate their needs, choices and views. When this greater communication is achieved it will allow and facilitate a more person centred approach to the care provided by ensuring the people’s contribution towards how their care should be given is both known and taken into account. Care plans are currently reviewed on a monthly basis by the person’s keyworker so that changes can be noted and care made available to meet these. All care plans includes risk assessments which detail risk and the means to minimise them as far as possible whilst still allowing risks to be taken safely which leads to more fulfilled life. For example one person was noted as being facilitated to make their own coffeee in the home’s kitchen, under supervision but essentially by themself, something the person took great pride in. Additionally an annual care plan review is carried out for each person at home with input from the persons’ relatives/carers, care manager and key-worker from which the care plans are further updated. This allows any changes or improvements that people have made to be noted and built on. At this inspection two peoples’ care planning, including their risk assessments were examined and staff were talked with about the care the given to these two people. During the inspection observation of the care given was also noted and it was noted that it met the needs of the people. The manager is about to implement anew person centred care planning system for each person and is currently working towards this. However the information contained within the existing care plans was very thorough and in-depth and reflected all needs and progress or changes concerning the individual people but it is currently not presented in a user friendly manner. This should be alleviated with the introduction of the new care planning systems. Two people have their finances managed by the registered provider and the manager was able to show evidence that a new financial management system has recently been introduced by the registered provider, which now incorporates these two for people that use the service. Others are managed by family involvement. Appropriate systems were noted as in place for handling of these peoples’ monies. Full financial details were available with receipts of monies spent and of monies held which fully protected all the people living at the home. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 14 Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15,16 & 17 The quality in this outcome area is adequate. Life at the home is, on the whole, varied with visitors encouraged and welcomed, however the home’s activity programme is not fully meeting the needs of the current group of people living there. Staff respect personal choices and the home provides nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is as individual activities programme for each person using local facilites as well as in house activites. For example on the afternnon of inspection one person attended a trampoing session which also involved using local transport. Previously the same person had been supported by staff in the cleaning of their room, of which the person was jusifiably proud. This particular person was also noted as holding and using a key to open and lock their room. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 16 All other people are offered the same facility but have chosen or are unable to manage to use the lock that is in place on each bedroom door. However this evidences that the home promotes the privacy rights of all who live there. All of the people at the home have an individual activities programme, which includes day-to-day living skills, using local community facilities etc. Currently the range of activities vary from trips out, meals out, holidays, walks, shopping, going to clubs for people with learning disabilities and having regular contact with family and friends. The home also has an activities co-ordinator working two days a week. However due to the current identified need to improve communication methods with the people thaat the home, it is not always possible to evidence that the activites provided are those that would be personally chosen by them, themselves. There was also some feeback from other outside professionals and families which indicate that they would like to see a wider and more adhered to activity programme for the people at the home generally. For example one comment recived in relation to this stated: “Planned activities do not get always off the ground” and: “the use of symbols/photos is still not off the ground”. One person has a specific religious need, which was not being fully met as there was no specific information available to allow staff to understand this person’s religious beliefs There is open visiting in the home with a visitors book in place and families and friends regularly visit and are welcomed into the home. The weekend following the inspection the home was hosting a birthday party for twins that live at Tower House, involving their family, other people at the home, staff etc and there were plans in place to ensure that this will be a very enjoyable day. A seven seater minibus is available and is used very regularly. One person also owns their own car, and other public transport is also used regularly. Feedback received from relatives/carers indicated that they were made welcome at Tower House that they were able to visit at any time and were kept informed of important matters relating to their relative. On the day of the inspection a light lunch was shared with the people and staff on duty. The main meal of the day is provided at night time. All eat together to promote a sense of unity within the home. For people that need prompting or support to eat are fiven this in a friendly and sensitive manner, which does not drawer ant unnecessary attention to anyone’s specific need. The menus were inspected and these reflected the meals staff knew people liked. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 17 However again choices could not be fully made by the people themselves, as the information about meals was written and not available in a more accessible format for the people. A new cook has just been appointed and is to work with the manager and staff in photographing meals so that the people can make choices more easily. Fresh fruit, snacks and drinks are also available throughout the day as required. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 18 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): Standards 18,19 and 20. Quality in this outcome area is good. Staff provide sensitive, flexible personal support and care to maximise the privacy, dignity, independence and freedom of choice rights of the people who live at the home. Staff also have a good awareness regarding of the health and emotional needs of the people that use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All care plans are collated from varoius sources of information including from relatives, key-workers and on occasions the person’s care manager. Peoples’ personal and healthcare needs were clearly documented in the care plans examined. There were records of regular medical and specialist check ups and appropriate specialist input requested. Peoples’ personal care needs were observed to be supported in respectful and dignified ways by staff, and staff spoken with were able to demonstrate clearly how they respect the privacy and dignity of the people that use the service. For example an awake night staff member is on duty so that all can go to bed in their own time. Another example was noting a person’s breakfast being taken to them at 10.30 a.m. which is the time they wished to have it. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 19 All the people have their own GP who will visit them at home if required. There is as individual healthcare section in the care plans so that staff can record all healthcare issues, which means they can better monitor the health care needs of people that use the service more easily. The manager also intends to make sure that all the people that use the service receive an annual medication and health review. Everyone has a self medication risk assessment regardles of whther or not they do self adminster medication. This ensures that even if they are able to underake a very small degree of self medication it can be faciitaited and managed correctly. For example one person collects their medication at 7.00 a.m from a staff member, and then takes it independently at 8.00a.m. This small act provides this person with a sense of responsibilty but to ensure the person’s safety full details are docuemeted and all staff are aware of this agreed procedure. A recognised monitored dosage system for the administration of medication is in place within the home, which is overseen by the local pharmacy. The manager has ensured that all staff responsible for medication administration have attended recent medication training. A medication administration error occurred a little while ago, however all necessary steps were taken to ensure the peron was not at risk from this error (i.e the G.P was called and the Commission was also informed). Following this the manager ensured that staff were very aware of their responsibilities to record medication administration as required, and to fully minimise any further error occuring one staff member undertakes the administration f the medication whilst another does a routine back-up check shortly afterwards. additionally the manager continues to monitor their practice reguarly. There were full details of medications received into the home and the medication records included an individual photopgraph of each person and all records inspected were up to date. Medication was stored correctly in a locked fixed cuboard. The home is not holding any controlled medications at preent, but is aware of the procedures necessary should this change. The last medication inspection was carried out in May this year where few minor recommendations had been made which had now been acted upon. The aditional monitoring of the medication administration by the management of the home has ensured the on going safety of the people at the home and has evidenced that the newly registerd maanger is aware of the staffs’ responsibilites and of his to ensure the staff are trained and then undertake their duties as required. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 20 Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 21 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): Standards 22 and 23. Quality in this outcome area is good. There is a satisfactory complaints procedure and arrangements for protecting the people who use the service from abuse are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints procedure, which is included in the service users’ guide and has been developed using pictures/symbols. A copy of this complaint procedure is also available within the home as is the staffs’ whistle blowing policy. This informs staff and others of how to report any concern they may have regarding care given to the people at the home. A visitors’ questionnaire has been sent out to involved parties so that the home can receive suggesions or act upon complaints so that ultimatley the service can be improved in the best interests of the people who use the service. The home’s complaints procedure has also been distributed to all interested parties so that they are aware of how to complain if they need to. This procedure has also been adapted into a format that the people that use the service may better understand. The Commission for Social Care Inspection has not received any complaint about the home since the last inspection. The home has policies and procedures regarding adult protection, in line with the local multi-agency code of practice and staff receive thorough training in this area. There was a full investigation, in line with the adult protection procedures, in November last year when there was a disclosure regarding a member of staff’s approach towards the people that use the service. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 22 The organisation took immediate action to protect the people and undertook a full investigation, which resulted in the organisation activating their disciplinary procedures appropriately, and the member of staff involved now no longer works at this home. This evidences that the home will always ensure that protection for people that use the service is paramount. All staff have received training in adult protection, which was noted as documented in their training records. Any incident of an untoward nature are also fully documented and records were seen in respect of some incidents, which had been a result of some behavioural problems involving the people that live at the home. Utilising these measures protects all involved in living or working at the home. The manager is also working toward ensuring the people at the home are better able to communicate any concerns they may have by an increased and enlarged communication system as already discussed and it is to the manager’s credit that he has identified this as an area to work on. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 23 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): Standards 24 and 30. Quality in this outcome area is adequate. Tower House is comfortable, homely, clean and hygienic and does not have an institutional appearance. However some areas of the home look a little shabby and the people that use the service cannot currently access the garden due to health and safety reasons associated with a crumbling exterior garden wall. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of all the communal rooms and bedrooms was made at the visit. The environment was noted as clean, homely and although in fairly good repair some areas of the home needed redecoration to improve the appearance, for example the entrance hall, the hallway and lower ground floor toilet. The sensory room has been redesigned and redecorated since the last inspection and now provides a pleasant relaxing environment. Tower House had a dedicated maintenance person to carry out day-to-day repairs and redecoration and on the day of the inspection he was noted repairing the front door to the home. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 24 The bedrooms reflected the personalities of the people with some having many personal items whilst others had chosen to have none or very little personal items displayed. Some rooms have floor covering rather than carpet to help maintain a pleasant odour free environment. All were noted as clean and free from odour. The home’s communal first floor bathroom is very small accommodating only a bath with no toilet or washbasin, although there is a communal toilet further down the upstairs hallway. This room can, at times, prove a challenge for staff to work in when helping with bathing or providing personal hygiene in respect of those who need this at the home. It was noted that the manager and staff are maintaining the home’s fire precautions as required. On the day of the inspection there was a planned full fire evacuation procedure and it was pleasing to note the professionalism with which this was undertaken, taking into account that some of the people that use the service do find this kind of disruption difficult to deal with. The home’s fire log book was inspected and seen to be in order with fire precautions and fire training undertaken as required. Door guards are also in place as required and it was pleasing to note one had been put in place to allow a person living at the home to be able to keep his door open, something he wishes to do. Laundry facilities were clean and hygienic and there were sufficient procedures and training to ensure the control of infection with staff receiving regular infection control training. The home has a pleasant garden area which is normally well used and enjoyed by the people at the home, however currently this are cannot be used as a retaining wall in the garden has been designated as a health and safety risk. The result of this is that people cannot go outside safely in the good weather. Immediate action should be taken to rectify this problem and therore restore this area for the peoples’ use and enjoyment. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 25 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): Standards 32,34 and 35. Quality in this outcome area is good. The people who use the service are well supported by an appropriately experienced and trained staff group. The staff recruitment programme is robust and protects the people that use the home and there are adequate numbers of staff on duty to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has increased the staffing levels to help ensure that the individual needs of the people are met by having additional staff onduty when activites take place. The staffing rotas have also been ajusted for the same reason and to create more uniform shifts so that staff and the for people living at the home can be aware of who will be on duty at what time. Staff spoken to felt that there were usually enough staff to provide for the needs of the people, however they stated that they sometimes felt extra staff on duty would further allow them to go out more with for the for people that use the service. This was also mentioned in a feedback form from relative who stated: Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 26 “staffing can be an issue preventing people that use the service from participating in meaningful activities at times”. However the staffing rota does ensure that the service has the correct number of trainind staff on at all times and there are an eqaul proportion of mixed gender staff group with eleven females and ten males. Currenly there is only one female living at the home with all others being male. However following discussion it was clear that thought is given to ensuring that there is always a female member of statf on duty to provide for the personal care needs for this one female and that she is accompanied to activites etc whenever possible by a female member of staff. There is a core group of staff that have worked at the home for a number of yars and as such are very familiar with the peoples’ needs and all spoken with had a genuine desire for the for peoples’ best interests to be met. Staff commnets stated such things as: “We work well together as a team” “We all care very much about the people here”. The manager, deputy manager, maintenance man are all extra to the care staff numbers each day as will the new cook be on commencement of her duties in a couple of weeks time. The rotas inspected evidenced that care staffing numbers are worked around there being: 2 carers from 7.00 a.m. until 8.00a.m. 5 carers from 8.00 a.m. and 10.00 a.m. 9 carers from 10.00 a.m. until midday. 10 carers from midday until 4.00/5.00 p.m. 8 carers from this time until 6.00pm 4/5 carers from 6.00 p.m. until 8.00 p.m. and then two until 10.p.m. Between 10.p.m and 7.00 a.m. there is one 1 awake and 1 asleep staff. The numbers of staff on duty are on a sliding scale to ensure that there is a greater number of staff on duty at times when people that use the service may need extra support to do activities etc. The staff rota also ensures that there is a senior member of staff on duty at all times. Sometimes, as happened on the day of the inspection, staffing numbers can be lower due to sickness etc. On the morning of the inspection there were seven carers on duty rather than the preferred nine. Neither the manager nor the deputy manager work at weekends. Designated team leaders take responsibility for the home during this time. Team leaders are experienced members of staff and so the people at the home remained cared for by well trained and experienced staff. There is a staff board within the entrance hall which clearly identifies what duty staff are designated to do throughout each shift which then ensures that all necessary tasks are completed. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 27 Staff were observed during the inspection to be interacting at all times with respect for people at the home, and when spoken with all showed a genuine affection, regard and understanding of those they cared for. The home’s recruitment process is in order and protects the people at the home as does the staff supervision support programme, and the level of staff training made available. The staff files for the last three staff members were inspected and two of the staff members spoken with during this inspection. Staff files demonstrated that correct staff recruitment processes were carried out including obtaining criminal record bureau checks (apart from one where a POVA check had been completed and the home was now awaiting the return of the CRB check). In the meantime this staff member was working in a supervised capacity to ensure the people that use the service are protected at all times. The two staff members spoken with were able to verify that their recruitment had been carried out as the files had stated and both said they had received a good range of training and support to allow them to feel confident in their role. All new staff work within a six month probation period which includes an in depth introducation training programme. The manager has recognised the need to ensure that the staff remain well trained and consequently aware of the needs of the people that use the service. For example further in depth training in safe handling has been planned (during the inspection the actual dates were confirmed with the manager)to make sure that the staff are remain fully aware of how to help people move to another place safely when they are showing inappropriate behaviours in the original setting. This will help staff to work confidently in what can be a tense and difficult situation and the people at the home will be able to feel more confident at the same time, knowing they are being supported by confident well trained staff. Additonally more training for staff is being planned in communication methods and specialist training in working with autisim to again allow staff to be able to better communicate with and understand the peoples’ needs. The manager is also creating a training package to cover equality and diversity issues that staff need to be aware of. However it should be noted, that although this training will enhance their knowledge, staff displayed a commitment to providing care for each person at the home in a fair and non discrininatory manner which took into account the many diverse needs of the current group of people living at the home. Currently there is a very high ratio of staff trained to a recognised national level in care trained staff (84 ) and all statutory training is reguarly provided. Indepth induction traning is also provided whilst each staff has an annual trianing plan in place. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 28 The home also has a corporate training development plan as well. All these measures mean that the for people that use the service are cared for by an experienced, aware and confident staff group. The manager holds staff meetings and the deputy manager provides regular supervision sessions with records kept. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 29 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): Standards 37,39,41 and 42. Quality in this outcome area is good. The home is managed efficiently and well. The management and staff endeavour to ensure that the home is run in the best interests of the people living there. The home provides a safe, secure environment where peoples’ safety and well being is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tower House has had a newly registered manager in post from February 2007, although he was working at the home for a few months before this. He transferred from another home within the organisation and is very experienced and appropriately trained holding both the Registered Manager’s Award and the nationally recognised qualification at level four in care. An experienced and suitably qualified deputy manager supports him in the management of the home. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 30 Staff spoken to felt that the manager was approachable and supportive and understood their roles. However they also stated that they currently do not feel supported by the current Responsible Person from the organisation who visits monthly as they felt they do not have much communication with this person and as a consequence do not feel valued by the senior management of the organisation. The manager confirmed that there were up to date policies and procedures in place to cover all areas of health & safety including fire, manual handling, first aid, COSHH, infection control etc. The registered provider carries out a range of quality monitoring checks and audits including regular themed self-audits (the latest being on care provision at the home undertaken in May this year), and visits are regularly undertaken by professionals employed by the registered provider to audit care practices, financial systems and health & safety systems. The organisation notes areas that can be improved upon as well as areas that are good. Having this level of monitoring in place ensures that the home is always testing itself to ensure that the care provided is the best it can be. All staff receive training in health & safety issues which are updated annually. Questionnaires are sent out to relatives/carers so that the management and staff are able to obtain their views on how the home is run. An action plan is then put together incorporating any changes that may have resulted from ths feedback. The most recent was seen at the inspection. The management intend to work towards also including the views of the people that use the service by improving the communication methods. The pre-inspection paperwork returned to the Commission by the manager stated that that checks on the home’s electrics, central heating, water and gas installations were carried out regularly. The home’s accident recording was in order as were any written records of incidents happening within the home. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 31 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 32 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23 (2) (o) Requirement The registered provider must ensure that the external grounds are suitable and safe to be used by the people that use the service. This means that the garden area at the rear of the home can again be used for recreational and personal enjoyment by the people that use the service. Timescale for action 06/08/07 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 2 Refer to Standard YA5 YA8 Good Practice Recommendations All people that use the service should be provided with an up to date contract between the registered provider and themselves. The communication methods used within the home between staff and the people at the home need to be further increased/improved upon. Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 33 3 YA19 The registered manager should ensure that any ageed reccommended professional imput is made avaialble to the individual peron who needs this imput. The registered manager and staff should explore ways of ensuring that any individual religious needs are understood and met by the staff at the home. The registered manager should ensure that those areas of the home that are looking a little “tired” are redecorated and that maintenance work is undertaken as required to ensure that the facilites within the home remain in good working order at all times. Additionally any worn furnishings and fittings should be renewed as required. Staff should recive training on equality and diversity issues. 4 YA13 5 YA24 6 YA33 Tower House DS0000032607.V338168.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 - 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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