Inspection on 20/09/06 for Treehaven Bungalows

This inspection was carried out on 20th September 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Treehaven Bungalows 05/09/07

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Treehaven Bungalows Sandy Lane West Runton Cromer Norfolk NR27 9LT Lead Inspector Mr Jerry Crehan Key Unannounced 20th September 2006 09:15 Treehaven Bungalows DS0000066873.V313067.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 Treehaven Bungalows DS0000066873.V313067.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. Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treehaven Bungalows Address Sandy Lane West Runton Cromer Norfolk NR27 9LT 01263 837538 01263 838414 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) Jeesal Residential Care Services Limited Application in Process Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection N/A Brief Description of the Service: Treehaven Bungalows are two linked bungalows situated on the site of the Treehaven service on the edge of the village of West Runton. The bungalows have separate secure garden areas. The Home provides a service for up to ten adults who have learning disabilities and autistic spectrum disorder. Accommodation is provided on the ground floor and in first floor flats. All tenants have a single bedroom, and there is a variety of communal space available. The Home is owned and managed by Jeesal Residential Care Services Ltd. Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 8 hours on 20th September, and was the first inspection of the service. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s tenants in addition to its staff (‘support workers’) and the manager. The inspection report reflects evidence from inspection of Key Standards and other National Minimum Standards. Ten comment cards were received prior to the inspection. Generally the comment cards received from relatives/visitors to the service reflected favourable comments, those received from tenants also provided positive comments, as did a comment card from a visiting social care professional. Treehaven Bungalows is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is from £950 to £1,900. What the service does well: What has improved since the last inspection? What they could do better: Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 6 A review of medication administration practice should be undertaken. Administration practice at the service has departed from its stated procedure and does not provide for clear accountability. A Requirement has been made that this practice is reviewed and safe procedures maintained. Two recommendations have been made in respect of the arrangements for the storage of medicines at the service. This includes a recommendation that medicine due to be returned to the pharmacy is stored separately to other medicines in current use. Garden areas are unkempt and provide a potential hazard to tenants. There was a lapse in ensuring evidence of the safe recruitment of a support worker, and in maintaining a regular programme for their supervision. 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. Treehaven Bungalows DS0000066873.V313067.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 Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 The overall quality outcome for this standard is good. The needs and aspirations of people thinking about moving into the home are assessed. EVIDENCE: There was evidence of good pre-admission assessment. A wide range of information had been collected prior to admission of tenants and was seen in files. This included evidence of liaison with tenants, their relatives and relevant professionals. The service provides prospective tenants with the opportunity to visit the service as often as necessary prior to admission, and tenants observed at the time if the visit appeared appropriately placed. The home has an assessment pro-forma and ‘application form’ used by the manager or other senior staff when collecting information. These documents are well designed to ascertain the level of support required by, and aspirations of, any prospective tenant. The service has a ‘Statement of Purpose’ that sets out information required by Regulation. It is recommended that the ‘Service User Guide’ for the home is made available to prospective tenants in the format most suited to their needs at the earliest opportunity, and that rules on smoking are clearly stated. (See recommendations). Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 The overall quality outcome for these standards is good. Tenants assessed needs and goals are reflected in their individual plan. Tenants make decisions about their lives with assistance as necessary and are supported to take risks as part of an independent lifestyle. EVIDENCE: A sample of individual care plans was reviewed. These set out care needs clearly, reflect goals or aspirations for tenants, and covering areas such as healthcare, autism, and independent living skills. Needs in each of these areas are summarised in ‘summary of needs and support’, and provide a clear guide for staff to follow when delivering care. Risk management guidelines are also clearly set out for staff to follow. Those seen provided a very clear analysis of risk and corresponding management guidelines. Evidence was seen of a monthly summary of risk management information, and of more comprehensive six monthly review of care plans and risk management information. These (and annual reviews) involve tenants, relatives and placing authorities where appropriate. Nightly meetings take place at the home, where tenants and staff consider issues of relevance, such as concerns, achievements, the home’s environment Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 10 and visitors to the home. Records were seen of a wider tenants forum involving tenants from other homes within the group owned by the proprietors. The manager stated that tenants and support workers are involved in ‘quality forums’ where aspects of the service provided are considered and improved. The manager stated that she intends to involve tenants in support worker ‘hand-overs’. Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 The overall quality outcome for these standards is good The home caters effectively for the lifestyle abilities and preferences of tenants. Links with the community are well maintained. EVIDENCE: Tenants care plans reviewed each provided evidence of a ‘daily living schedule’. These schedules set out the routines and activities the tenant prefers. There was evidence of excellent clarity for support workers as to how they may support tenants with the activities in their schedules, in the form of a detailed session plan. The manager stated that there are currently no vocational, or adult education classes attended by tenants, though tenants have accessed these recently through Sheringham Library. During the inspection visit activities on and off the home site were taking place, including shopping trips, walks and trips to the local café. This was confirmed in discussion with two tenants. The manager described the contact maintained with the local community. This includes access to the village hall, social club, café, hairdresser and church. Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 12 The home has access to two mini buses and a car. However, public transport is used in the form of buses locally and the train for trips to Norwich. The manager confirmed that tenants make a contribution toward the cost of the annual holiday outside the home if the trip if the price of the holiday is high. Otherwise the service meets the full cost. There were no visits to the home by relatives of tenants during the inspection visit. However, a service user spoken to stated that his father visits him regularly and that, at least for some of the time, they are able to spend time privately in the tenants room. The manager confirmed that relatives and other visitors visit tenants regularly and are made welcome by the home. Five out of the six comment cards from relatives received prior to the inspection indicate that they can visit their relative in private. All bedroom doors at the home are lockable. Support workers were observed talking to and interacting with tenants throughout the inspection visit. First names are used as the preferred form of address for support workers, and service users with verbal communication. Individual preferences and choices are supported by the home, and any restrictions agreed due to risk are set out clearly in the care plan. Support workers prepare all of the meals at the home, with the main meal taken in the evening. However, tenants participate in food preparation with assistance. Meals seen at the inspection visit appeared nutritious and were freshly prepared. Individual preferences and dietary need were evidently catered for. Meals for the next day are communicated to some tenants by means of symbols; alternative symbols are available if the suggested option is not preferred/desired. Tenants choose were they wish to take their meal, some preferring to eat on their own. Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The overall quality outcome for these standards is adequate. Service users receive support in the way they require. Their personal and healthcare needs are well attended to, with the exception of some medication practices. EVIDENCE: Personal care was provided to tenants so as to ensure their privacy and dignity. Support workers are supported by the clarity of information available within individual care plans. There is no evidence of specialist equipment at the home, which was confirmed by the manager. There is evidence of specialist support however, through the involvement of the speech and language therapist. Times for getting up or going to bed are evidently flexible. A tenant had remained in be throughout the morning, as they were possibly feeling unwell. When they arose in the afternoon their request for breakfast and their usual morning routine was addressed. The tenants GP undertake annual health checks, usually at the home. Records reviewed indicate that tenants health is carefully monitored and that access to community health professionals is supported where necessary. There are no tenants accommodated at the home who have responsibility for their own medication. Storage arrangements are secure but not ideal in a kitchen cabinet. The bulk of medication is available via the Monitored Dosage Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 14 System (MDS), though there is also packet and bottled medication. This is stored on a shelf, and tenants individual medication indicated by their name on the packet/bottle. It is recommended that medication provided in packets or bottles for tenants be stored individually (See recommendations). There is a practice of storing medication to be returned to the pharmacist in the medication cabinet with currently prescribed medications. This increases the risk of these medicines being wrongly administered. It is recommended that the practice of storing medication to be returned to the pharmacist with currently prescribed medications cease, and alternative arrangements made for its storage (See recommendations). Two support workers undertake medication administration and recording together. One support worker signs the MAR chart while the other administers the medication to the tenant. This is poor practice, does not provide clear accountability and is not in keeping with the home’s procedure which states ‘One member of staff should remove tablets from the bubble pack into a medicine pot and administer tablets to the tenant and then sign the MAR form to indicate that the tenant has received the drugs’. Medication administration practice at the home should be reviewed (See Requirements). Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The overall quality outcome for these standards is good. Arrangements for protecting and responding to the concerns and complaints of tenants and staff are good. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the service users guide, this is also made available in symbol format. Nightly meetings referred to above provide an opportunity for issues of concern to be discussed. Information in comment cards, and feedback from tenants provided evidence that tenants have an awareness of how they may make a concern or complaint known. Records of tenant’s monies were reviewed and were satisfactory. Records seen corresponded with monies held. The home has relevant policies and procedures, which relate to the protection of the tenants from any form of abuse. A procedure for responding to allegations of abuse is in place. Staff spoken to were aware of the procedure and its function, and had received appropriate training. Care plans outline clearly where tenants may harm themselves (or others), and outline strategies for reducing this. Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The overall quality outcome for these standards is adequate. A homely, comfortable and safe environment internal environment is provided for tenants. The external environment is not fully adequate. EVIDENCE: The premises are suitable for the homes stated purpose. The interior accommodation is in a good state of repair, with good quality furnishings and fittings. The bungalows are accessible to the solitary tenant who uses a wheelchair to mobilise. The garden environment to the front and rear of the home is secure though unkempt. Tenants evidently use the garden areas, which would present a risk in their current state (See Requirements). There are laundry areas in both bungalows. The home was clean and hygienic with no noticeable odours. Support workers have had infection control training and guidance. Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, 36 The overall quality outcome for these standards is adequate. A competent staff team who have access to good induction and ongoing training supports tenants. For this outcome area to achieve a good standard a programme of regular supervision meetings should be established, and proper recruitment procedures followed for all staff appointments. EVIDENCE: Staff rotas and staff seen at the time of the inspection visit indicate the deployment of sufficient support workers to meet tenants needs. There was a deployment of four support workers in each bungalow; the manager indicated that this is the usual deployment. There are two night waking support workers allocated for each night duty. From discussion with care staff and a review of staff files, it was evident that service users are generally protected by good recruitment practices, however, an exception was found in the file of a support worker who had worked for a period of months without the results of a POVA or CRB check, although a country of origin police check was in evidence (See Requirements). Records for staff training indicate access to full induction training for staff. This was confirmed in discussion with support workers who described working in a supernumerary capacity, being supervised by senior staff, having access to care plans, to policies, and having training sessions. Their progress was recorded individual induction booklets. Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 18 Feedback from staff and evidence from records support the undertaking of ongoing training for support workers that includes, food hygiene, first aid, moving and handling, abuse of adults with learning difficulties, Signalong, health and safety, and fire safety. Discussion with support workers and the manager provided evidence that regular recorded supervision is not taking place as specified in the Standard, however, there is ongoing support and supervision for staff throughout the day (See Requirements). Treehaven Bungalows DS0000066873.V313067.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The overall quality outcome for these standards is good. Tenants interests underpin monitoring review and development of the service. Tenants and staff benefit from the ethos and leadership of the home. EVIDENCE: The manager has three years learning disability management experience, and five years as deputy manager. She holds the City In Guilds Advanced Management in Care, and a Certificate of Disability Study. She is currently in the process of undertaking NVQ 4 in Care toward achieving the RMA. Support workers spoke favourably about the manager’s ability to provide support and to communicate clearly. The home has a quality assurance process in place that includes monthly reviews of care plans, team meetings, tenants meetings, and representation at the organisations Quality Forum meetings. A quarterly newsletter about the home is produced and provided to those associated with the home. The home produces an annual development plan made available to the Commission. Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 20 Staff are aware of risks associated with individual tenants, including those associated with behaviours which can be challenging. Relevant health and safety training for staff, including moving and handling, first aid, fire and food hygiene training, support safe practice. Treehaven Bungalows DS0000066873.V313067.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 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 22 N/A 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 YA20 Regulation 13(2) 13(4) Requirement Timescale for action 20/09/06 2 YA24 3 YA34 4 YA36 The registered person must undertake a review of medicine administration practice ensuring safe procedures are followed at all times. 13(4) The registered person must ensure all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. 19(1)(b)(1) The registered person must ensure that new staff are confirmed in post only following satisfactory checks set out in Schedule 2 of the Care Homes Regulations 2001. 18(2) The registered person must ensure that care staff at the home are appropriately supervised. 30/09/06 20/09/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 23 No. 1 Refer to Standard YA1 Good Practice Recommendations It is recommended that the ‘Service User Guide’ for the home is made available to prospective tenants in the format most suited to their needs at the earliest opportunity, and that rules on smoking are clearly stated. It is recommended that medication provided in packets or bottles for tenants be stored more distinctly from medication belonging to others. It is recommended that the practice of storing medication to be returned to the pharmacist with currently prescribed medications cease, and alternative arrangements made for its storage. 2 3 YA20 YA20 Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Treehaven Bungalows DS0000066873.V313067.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!