Inspection on 05/12/06 for Tozer House

This inspection was carried out on 5th December 2006.

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 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 25/11/08

Tozer House 12/12/05

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 V Gay Unannounced Inspection 5th December 2006 12; 45 Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 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.V322374.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. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 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.V322374.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users under 65 years may be admitted. Date of last inspection 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. The scale of charges range from £408.59 to £708.59 following a financial assessment. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Key Inspection, which took place on 5 December 2006 between 12-45pm and 5-45pm. Prior to the Inspection, the previous inspection report and pre-inspection questionnaire was reviewed, along with any correspondence received since the last inspection. During the inspection the Inspector spoke with residents, and staff. In addition a number of records were seen. What the service does well: What has improved since the last inspection? Since the previous inspection five bedrooms and communal areas have been re-decorated. Rosemead unit has been fitted with double glazed windows. The garden has been further developed and additional outside lighting installed. A staff development-training plan has been implemented and a business plan has been formulated. New residents admitted to the home have a written contract, which they have signed. Risk assessments have been carried out and are up to date. Medication procedures have been reviewed to ensure resident’s safety. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to entering the home to ensure their needs and personal preferences can be met. EVIDENCE: The files of three new residents admitted since the previous inspection were examined. These included a comprehensive assessment carried out by a social worker involved in the placement. From this information, during a period of time staff develop a care plan with the resident, to ensure their personal needs are met. Special needs are identified and extra staffing hours are being provided to ensure one to one working between the resident and his/her key worker. The key worker is responsible for supporting the resident with their daily living tasks and provides social and recreational support. Several residents made reference to their key workers saying, “ they are so friendly…I really like her…he helps me with my shopping”. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager develops a care plan with each resident based upon the initial assessment of need. Staff provide residents with information and assistance with communication to enable them to make decisions about their own lives. Residents are supported to take risks as part of an independent lifestyle and risk assessments are now being routinely carried out and are up to date. EVIDENCE: The care plan is developed with the resident as far as is practically possible depending on their physical and mental capability. The care plans examined gave evidence to support this. On one occasion an interpreter had been involved to help with the specific needs of a resident. The care plan is reviewed with the resident and any key persons whom he or she wishes to be present. During the inspection staff were observed working with the residents on an individual basis. The residents were encouraged to make decisions and were confident to make their opinions known. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 10 Symbols and makaton signing is used to help residents to communicate. Since the previous inspection risk assessments have been reviewed and any situation that could compromise the safety of a resident have been recorded. The Registered Manager showed the inspector examples of how various situations regarding residents going out unescorted, or using public transport were being risk managed by the staff. This was seen as a positive way of balancing the duty of care against the level of risk involved. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home seeks ways to reflect the cultural diversity of residents as appropriate. Residents have the opportunity to attend college and develop social skills. Residents are encouraged to pursue their own interests and hobbies in and out of the home and maintain personal relationships. Residents make use of all local resources and integrate within the community. They are offered a healthy diet and enjoy their meals. Resident’s rights are respected. EVIDENCE: The specific needs of a resident was discussed and it was evident that the home ensures as far as is practically possible, to meet her cultural needs and preferences within the home. Residents pursue their own interests and hobbies. These include reading the newspaper, drawing, shopping and gardening. They have an annual holiday. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 12 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. 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 do prepare their lunchtime sandwiches or snacks. The meal served on the day of inspection offered three choices which were appetising and included a vegetarian option. Fresh vegetables are always used and fruit offered particularly as part of their packed lunch when they attend day care centres. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents choose their own clothes and their appearance reflects their personality. The health care needs of residents are met by them visiting community resources. The arrangements for the safe guarding, recording, storage and disposal of prescribed medication was found to be satisfactory. EVIDENCE: Residents told the inspector about their shopping trips to Chichester to purchase clothes of their choosing. One resident showed the inspector his new trousers and shirt he was going to wear at a party arranged for the following night. It was evident that residents are afforded choice and encouraged to be as independent as possible. One resident said a member of staff had escorted her to the dentist that day. Another said he had a hospital appointment and that his Mother was going to take him. Records showed that residents have access to a range of community health related services. Following a previous requirement the arrangements for safeguarding prescribed medication has been reviewed. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 14 A Pharmacist, with whom the home has a contract, visited March 2006 to inspect the arrangements in place for the safe storage, handling, administering and disposal of prescribed medication. A report of her finding was satisfactory and there were no recommendations made at that time. An medication sheet has been implemented which is signed by the duty officer at time of handover to confirm residents have received their prescribed dose of medication on that shift. This is to ensure that the medication record has been signed and that the correct dose given. Residents who choose to manage their own medication are supported to do so following a risk assessment. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 15 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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents able to engage in meaningful conversation said their opinions are sought. Systems are in place to protect residents. EVIDENCE: The home has a clear complaints procedure which resident are helped to understand by using symbols and pictures. Residents told the inspector that they knew who to complain to and that they would tell their key worker if they had any concerns. Staff have received training in Adult protection and know what action to take if they suspect bad practice. There are no allegations in respect of safe guarding adults and no complaints have been made to the commission. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 16 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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tozer House provides a comfortable safe environment for the residents to live in. Cleanliness and hygiene standards throughout the home were considered to be of a good standard. EVIDENCE: The inspector visited both houses on the complex and visited residents in the privacy of their rooms. The home offers comfortable accommodation and is furnished and decorated to a good standard. Residents are encouraged to personalise their rooms with their own belongings, which reflected their likes and personality. Residents told the inspector that they found their rooms comfortable and were able to lock their bedroom doors should they choose following a risk assessment. Standards of hygiene and cleanliness throughout the home were of a very good standard. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 17 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): 32,34, & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent staff, who are deployed in adequate numbers to meet the varying needs of the residents. Robust recruitment procedures are followed to ensure vulnerable people are protected. 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. A social worker /psychiatric nurse was visiting a resident on the day of the inspection. The Registered Manager informed the inspector that 50 of the care staff have obtained, or are working towards National Vocational Training level 2 or 3. The number of staff is adequate for the residents needs. Three people have identified special care needs and additional staff are employed for these residents. One new person has been appointed to the staff team as well as a relief member of staff. This means that there is less reliance on agency staff but Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 18 when they are used the home is able to engage those who have been there before and therefore know the residents. 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 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 and a training and development plan has been formulated for 2006/2007. The Registered provider operates a thorough recruitment procedure to ensure suitable people are employed to work with vulnerable persons. Files for two new appointed staff were examined. They contained the relevant information required by Schedule 2 of the Care Homes Regulations. All staff have satisfactory police checks carried out (CRB) before commencing work to ensure they are suitable to work with vulnerable people. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 19 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): 37,39, & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well run home. Since the previous inspection, reviews and development of the home has been strengthened. Since the previous inspection risk assessments have been reviewed to ensure the safety and welfare of staff and residents. EVIDENCE: There is a 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. This is being developed to include feedback from other people involved in the home such as health professionals and social workers. Residents were encouraged to become involved in the inspection and were happy to discuss the daily happenings of the home with the inspector. Some Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 20 residents have an advocate or attend an advocacy group. Statutory records required were being confidentially stored. A residents meeting was arranged to explain to them their right to access information held in respect of them. The agenda was clear and contained details regarding costs, room they would occupy and any extra costs involved from personal requisites. A Service Users Guide also contains information in picture and symbols to help residents understand more fully. Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 21 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 X 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 3 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 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 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 Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Recommendations Tozer House DS0000037456.V322374.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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