Inspection on 25/11/08 for Tozer House

This inspection was carried out on 25th November 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tozer House 05/12/06

Tozer House 12/12/05

Tozer House 22/07/05

Tozer House 11/10/04

Tozer House 28/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tozer House Tozer House Tozer Way Chichester West Sussex PO19 7NX The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paul Stibbons Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 28 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Tozer House Tozer House Tozer Way Chichester West Sussex PO19 7NX 01243776703 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : tozer.house@westsussex.gov.uk West Sussex County Council care home 15 Number of places (if applicable): Under 65 Over 65 15 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD The maximum number of service users who can be accommodated is: 15 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home 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 two-storey 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. The scale of charges range from 408.59 pounds to 708.59 pounds following a financial assessment. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 28 How we did our inspection: This is what the inspector did when they were at the care home The last inspection on this service was completed on the 5th December 2006. This unannounced key inspection was conducted on the 25th November 2008. A completed AQAA (Annual Quality Assurance Assessment) was submitted to the commission prior to the site visit. The site visit was carried out over a period of 2.5 hours, a tour of the premises was conducted and a variety of records and documents were examined and members of staff and residents spoken with. What the care home does well Tozer House provides a safe and comfortable living environment where residents are involved as much as possible in planning service delivery. A person centred approach ensures the individual is the main focus and they are encouraged to exercise choice and make their own decisions wherever possible. Links with the local community are promoted and maintained. Care Homes for Adults (18-65 years) Page 7 of 28 What has got better from the last inspection What the care home could do better There are no requirements arising from this inspection and the service provides excellent outcomes for people using the service. Care Homes for Adults (18-65 years) Page 8 of 28 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Paul Stibbons 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective residents have sufficient information on which to base an informed decision as to whether the home can meet their needs. A comprehensive assessment of needs is carried out prior to admission to ensure the home can meet prospective residents needs. People living in the home have the security of an individual written contract of terms and conditions attached to the placement. Evidence: Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support and the AQAA states that a range of alternative residential options are put forward for their consideration. The home provides a statement of purpose that is specific to the service and the Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service users guide. When requested the service can provide a copy of the statement of purpose and guide in a format that will meet the capacity of the resident, for example, symbols, pictorial and written. Prospective residents are given the opportunity to spend time in the home and an individual member of staff is allocated to give them information and to help them understand how the home is organised and run and the facilities and services available. The allocated staff member will give them special attention, help them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. New residents are provided with a statement of terms and conditions and an accessible summary. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home benefit from having an individual plan of care that reflects their assessed and changing needs. People living in the home are consulted and supported in taking risks as part of an independent lifestyle. Evidence: The key principle of the home is that people using the service are in control of their lives and they direct the service. Staff members are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. Care plans viewed evidenced that people using the service make their own informed decisions and have the right to take risks in their daily lives. The care plan is developed with, and owned by the person using the service. It is based on a full and up to date holistic assessment. The plan is person centred and focuses on the individuals strengths and personal preferences. The support plans are written with the individual, or their representative, and includes a range of information that is Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: important to them. For example, information such as who and what is important to them, how they keep safe, their goals and aspirations, their skills and abilities, and how they make choices in their life. Plans are all different and highly individualised and they include evidence that the service values improving outcomes for people using the service. A variety of different and creative methods are used to help people who use the service to contribute to the development of their care plan and the ongoing review process. Key workers actively provide one to one support, keep the care plan up to date and make sure that other staff always know the persons current needs and wishes. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a can do attitude and risks are managed positively to help people using the service lead the life they want. The service recognises its own limitations and when to seek support from others to meet the individual needs of people, for example the involvement of speech and language specialists to develop more effective communication systems. Key staff members have attended training in the use of Makaton and it is planned to introduce visual communication boards for one particular person. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home have a range of opportunities that will meet their social, leisure and educational needs and their own personal development. People living in the home are supported in maintaining appropriate relationships with friends and family. People living in the home enjoy a healthy and varied diet that is of their choosing. Evidence: Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Routines are very flexible and residents can make choices in major areas of their life. The staff team actively seek information to enable people to access college and work placements. A range of leisure opportunities available includes, day centres, Gateway club, Allsports, Disco, gardening, reading, drawing, meals out, public houses and visits to places of interest. Residents are encouraged to be part of the local community by participating in local events, for example, Poppy day ceremony, Children in need, Macmillan coffee mornings and attending church. Annual holidays have included Devon, New Forest and Bournemouth. People who use the service have the opportunity to develop and maintain important personal and family relationships, and are able to access information and guidance about issues such as intimate relationships. The services policy on supporting relationships has recently been updated and is available in easy read format. The service employs two cooks who produce varied and nutritious meals that take into account the wishes of people using the service. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home receive personal support in the manner they prefer and require and their physical and emotional needs are met. People living in the home are protected by the homes policies and procedures for dealing with medication. Evidence: Individual health action plans clearly record peoples personal and health care needs and detail how they will be delivered. Staff members ensure that care is person led, personal support is flexible, consistent, and is able to meet the changing needs of the residents. Staff respect peoples preferences and these are recorded and shared to ensure a consistent approach. Care plans evidence that residents have access to all NHS health care facilities in the local community and regular appointments are seen as important and there are systems to ensure they are not missed. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: contain required entries, and are signed by appropriate staff. The local pharmacist conducts an annual audit and reports medication is managed to a good standard. Residents are given the support they need to manage their medication and where individuals prefer or they lack capacity, care staff manage medication on their behalf. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home can be confident that their views will be listened to and acted on and they are protected from abuse and neglect. Evidence: Policies and procedures regarding safeguarding adults are available to staff and give them clear guidance about what action should be taken. Staff training as a team has raised general awareness of issues and the AQAA reports an increased level of reporting and handling alerts since the training. Through group meetings people using the service or their representatives are made aware of what abuse is and have the complaints procedures explained to them. The service has Something happened forms to raise concerns. Access to external agencies or advocacy services is actively promoted. There is a clear system for staff to report concerns about colleagues and managers that ensures that concerns are investigated in line with local policies and procedures. Staff who blow the whistle on bad practice are supported.The home is clear when an incident needs to be referred to the Local Authority as part of the local safeguarding procedures. All staff working within the home are fully trained in safeguarding adults and know how to respond in the event of an alert. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents live in a homely, safe and comfortable environment with sufficient personal and communal space to meet their needs. Evidence: Residents are fully involved in decisions about the decor and any changes in their communal and personal accommodation. Residents rooms viewed during this visit had personal possessions on display and reflected the lifestyles and interests of the individual. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The home spends money on the environment in the best possible way so that outcomes are improved as much as possible for the people using the service. New furniture has been purchased and major refurbishments are taking place that will improve facilities for people living and working in the homes. All residents have a key to their own room unless a person centred risk assessment indicates otherwise. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Standards of hygiene and cleanliness throughout the homes are of a good standard. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home are supported by a competent and qualified staff team in sufficient numbers to meet their needs. People living in the home are protected by the services robust recruitment procedures for new employees. Residents individual and joint needs are met by an appropriately trained and supervised staff team. Evidence: Management prioritise training and facilitate staff members to undertake external qualifications beyond basic requirements. The AQAA confirms that over 50 of staff members have at least an NVQ level2 in care or higher. The home has internal developmental training, to complement formal training as part of an ongoing training plan. The staff team support each other and share skills and knowledge with colleagues. The service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for residents. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Local arrangements for temporary cover for vacancies and sickness has been replaced by a centralised system that is experiencing teething problems at present. Staffing levels reflect the needs of the people using the service, and rotas are flexible to fit around the lifestyles of individuals. Key workers have specific allocated time to spend with individuals. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. There is evidence that staff meetings and supervision sessions are regular. Staff members spoken with find them helpful in focusing on improving outcomes for people using the service, although some did comment that they felt their views were not always listened to. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents benefit from living in a home that is run by a competent and qualified manager and where their rights and best interests are safeguarded. Evidence: The registered manager has the required qualification and experience, is competent to run the home and meets its stated aims and objectives. The AQAA contains excellent information that is fully supported by appropriate evidence and includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to residents. The home demonstrates a high level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do this. The data section of the AQAA is accurately and fully completed and supports evidence in the self-assessment section. Record keeping is of a consistently high standard and records are kept securely. The home has a comprehensive range of policies and procedures to promote and Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: protect residents and employees health and safety. There is full and clearly written recording of all safety checks and accidents, including analysis, and there is no evidence of a failure to comply with statutory reporting requirements and other relevant legislation. There is evidence of organisational monitoring by corporate providers. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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