Inspection on 12/12/05 for Tozer House

This inspection was carried out on 12th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tozer House 25/11/08

Tozer House 05/12/06

Tozer House 22/07/05

Tozer House 11/10/04

Tozer House 28/06/04

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Thorndene

Insight - Eastchurch

Southfields

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33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Tozer House Tozer House Tozer Way Chichester West Sussex PO19 7NX Lead Inspector Mrs K Allen Unannounced Inspection 12th December 2005 02:00 Tozer House DS0000037456.V272379.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 Tozer House DS0000037456.V272379.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. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tozer House Address Tozer House Tozer Way Chichester West Sussex PO19 7NX 01243 776703 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) www.westsussex.gov.uk West Sussex County Council Mr Paul Buckwell Care Home 15 Category(ies) of Learning disability (15), Learning disability over registration, with number 65 years of age (15) of places Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users under 65 years may be admitted. Date of last inspection 22nd July 2005 Brief Description of the Service: Tozer House is a care home providing personal care and accommodation for fifteen people with a learning disability over the age of eighteen. It is within walking distance of the town of Chichester, West Sussex with all of its amenities and serviced by public transport. The premises consist of two houses within a complex of three, all of which are similar in design. They are twostorey and purpose built around a well-maintained courtyard. All of the bedrooms are single although none have en-suite facilities. In addition, there is a separate building with an office, kitchen and communal lounge. There is no passenger lift. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspection a review was made of the contact between the home and the Commission for Social Care Inspection (CSCI) since the last inspection. This included an analysis of incident reports and those of other statutory bodies such as the fire service. The inspection took place from 2pm over four and a half hours. During the inspection six residents were spoken to in communal areas. A discussion was held with two deputy managers, the cook and two care staff on duty. In addition a number of records were seen. What the service does well: 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 6 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 Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 7 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): 5 Residents do not have an individual contract with the home. EVIDENCE: A new person had moved into the home since the last inspection and no written contract had been drawn up with him. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 8 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): 9 Residents are supported to take risks as part of an independent lifestyle however, risk assessments are not routinely carried out or kept up to date. EVIDENCE: Some risk assessments had been carried out, for example for one person who was at risk of falls and another who smokes. In one case a resident could not weight bear and staff were lifting him. No risk assessment had been conducted. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 9 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 & 17 Residents engage in appropriate leisure activities and maintain personal and family relationships. Resident’s rights are respected. They are offered a healthy diet and enjoy their meals. EVIDENCE: Residents pursue their own interests and hobbies. These include reading the newspaper, drawing, shopping and gardening. They have an annual holiday. Staff are committed to residents maintaining family relationships even when this is difficult. There are obvious friendships between residents and they are supported by staff. There are regular events which residents go to such as social clubs and they have recently held a Christmas party to which family and friends were invited. Staff are courteous to residents and use their preferred form of address. They understand them well and listen to them. Residents have a key to their room if it is safe for them to do so. They open their own mail although most need assistance to understand their post. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 10 They have unrestricted access to the house and grounds and can spend time alone if they wish. Rules on smoking and alcohol are clear to residents. They are offered a choice of menu and two part-time cooks are employed to provide the majority of the meals. Residents are not involved in the preparation of the main meal although they door prepare their lunchtime sandwiches or snacks. Fresh vegetables are always used and fruit offered particularly as part of their packed lunch when they attend day care centres. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 11 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): 19 & 20 Resident’s health needs are met however they are not protected by the homes procedures for dealing with medication. EVIDENCE: Residents have access to information about general health care such as routine screening. They are supported in attending appointments with doctors, dentists etc and regular check ups are scheduled. There are close links with the Community Team for People with a Learning Disability which offers specialist advice and services. Medication is stored safely and administered by senior staff. A record is kept of resident’s current medication and this is up to date. A local pharmacist provides a service to the home where advice can be obtained. The record of medication administered was not complete. One person had apparently not been given his medication on two occasions. The medicine was in liquid form so it was difficult to ascertain if this had actually been given. On another occasion someone else had only received one of four prescribed medications. Again it was not possible to check if these had been given however the person in charge said she was confident that they had been administered. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 12 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): 23 Residents are protected from abuse. EVIDENCE: There are written policies and procedures for staff to follow should there be any suspicion of abuse. This includes the requirement to record and report any concerns. Guidelines are in place for staff when dealing with physical or verbal aggression from residents. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 13 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): None EVIDENCE: Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 & 35 Residents are supported by competent staff who are deployed in adequate numbers for the needs of residents. Staff are appropriately trained. EVIDENCE: Staff are accessible and approachable and residents are relaxed in their company. They communicate well with residents and are well motivated. Professional relationships exist between staff at the home and others such as doctors, social workers and psychiatrists. Three staff have National Vocational Qualifications (NVQ) and five are working towards them. The number of staff is adequate for the residents needs. Two people have identified special care needs and additional staff are employed for these people. One new person has been appointed to the staff team as well as three relief staff. This means that there is less reliance on agency staff but when they are used the home is able to engage those who have been there before and therefore know the residents. There is an on-going training programme for staff although currently the emphasis is on people obtaining an NVQ. Induction training is carried out under the guidance of senior staff. Anyone who has not had any experience of working with people with a learning Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 15 disability will undertake the Learning Disability Award Framework (LDAF) training within the first six months of coming to the home. Staff have their own training and development programme although the home does not have a plan for training and development. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 16 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 & 41 Self-monitoring, review and development of the home should be strengthened. Residents best interests are protected by the homes record keeping although their rights could be compromised if they are unaware that they can see their records. EVIDENCE: There is no annual development plan for the home based on systematic reviewing which reflects the aims and outcomes for residents. Their views are obtained through discussion, individual care plans and reviews. In addition, the home does a bulletin to families which asks them to complete a questionnaire about the service. They are also consulted at individual residents reviews. Formal feedback is not sought from other people involved in the home such as health professionals and social workers. Residents know when a planned inspection is going to take place. Some residents have an advocate or attend an advocacy group. Records required to be kept are in place and safely stored. It was not possible to ascertain if residents know of their right of access to their records. Tozer House DS0000037456.V272379.R01.S.doc Version 5.0 Page 17 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 X X X X 3 Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score X 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 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tozer House Score X 3 1 x Standard No 37 38 39 40 41 42 43 Score X X 2 X 3 X x DS0000037456.V272379.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes 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 YA20 YA9 Regulation 13 13 Requirement Medication must be recorded when it is administered. Unnecessary risks to health and safety must be identified and eliminated as far as possible Timescale for action 12/12/05 12/12/05 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. 33. Refer to Standard YA41 YA35 YA5 Good Practice Recommendations Reference to residents right of access to their records should be made in the Service Users Guide. The home should have a training and development plan. Residents should have a written contract with the home. 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