Inspection on 12/06/05 for Tudor Rose

This inspection was carried out on 12th June 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 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

Tudor Rose 07/11/06

Tudor Rose 20/09/05

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Tudor Rose 23 Borovere Lane Alton Hampshire GU34 1PB Lead Inspector Craig Willis Unannounced 12.04.2005 09:50 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 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 Stationary 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. Tudor Rose Version 1.10 Page 3 SERVICE INFORMATION Name of service Tudor Rose Address 23 Borovere Lane Alton Hampshire GU34 1PB 01420 544118 01420 544140 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ILIACE LTD No manager registeredl CRH 4 Category(ies) of LD Learning Disability, 4 registration, with number of places Tudor Rose Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration Date of last inspection N/A Brief Description of the Service: Tudor Rose is registered to provide care and accommodation for four adults with learning disabilities between the ages of 18 and 65. The accommodation is provided in a large detached house, approximately half a mile from Alton town centre. The home has a large lounge, a dining room and kitchen and each service user has a single bedroom. There is an enclosed garden to the rear of the home which service users are able to access. Service users are supported to take part in the running of the home and to take part in employment and educational opportunities. The home is managed by ILIACE, who have a number of similar services in Hampshire.. Tudor Rose Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours and was the first statutory inspection of the year April 2005 to March 2006. A tour of the building took place. Three of the four service users and two of the staff were spoken with during the inspection. The inspector also met with the Head of Care for Iliace during the inspection. Iliace have recently appointed a new manager to the home and the CSCI have been informed that an application for registration will be made. What the service does well: What has improved since the last inspection? What they could do better: The individual care plans need to be improved so that they include the personal goals of service users and guidelines need to be developed for staff to take action to reduce the dangers that service users face. Changes need to be made to the way staff support service users to withdraw money from the bank so that their money is kept safe. Staff need to be provided with comfortable sleeping facilities so they don’t feel they need to sleep in the lounge. The home needs to make sure that enough staff are employed so that consistent care can be provided for service users. Tudor Rose Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tudor Rose Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Tudor Rose Version 1.10 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 standard(s) 2 The system for assessing potential service users is good, leading to a clear understanding of the needs of people moving into the home. EVIDENCE: The Head of Care at Iliace had completed a comprehensive needs assessment of all four service users at their previous home. These assessments were available in the service users’ files in the home and covered personal care, education and training, contact with family and friends, culture and religion, physical health and communication. The assessments were completed with the input of the service users and their supporters. Tudor Rose Version 1.10 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 standard(s) 6,7,8 and 9. The home has developed some good initial care plans with service users, although work is needed to ensure personal goals are reflected in the plans. The systems for consultation with service users are good and service users are supported to make decisions about their lives. The system for assessing risks to service users is poor resulting in a lack of guidance for staff on action to take to minimise identified risks. EVIDENCE: All service users had level one care plans in place, which set out how the needs identified in their initial assessment should be met and contained detailed instructions to staff. Level two care plans, which detail personal development goals were not in place for all service users and those that were in place had limited information on the support that was required to meet the goal. It was noted that the plan for one service user having a bath instructed staff to stay in ‘close proximity’ in case the person had a seizure in the water, without any definition of what close proximity meant. Service users spoken with said that they held regular house meetings with the staff and felt confident in raising issues of concern. Minutes of these meetings were made and available in a symbol format to aid understanding. One Tudor Rose Version 1.10 Page 10 service user reported that they had been involved in the recruitment interviews for the new manager and support staff. Some risk assessments were in place for each service user, although none of them had been reviewed by the date listed on the document. Assessments were not in place for areas of identified risk in incident reports and the needs assessment, including aggression towards staff and throwing objects, which could injure people in the vicinity. Tudor Rose Version 1.10 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 standard(s) 12,15, 16 and 17 Leisure activities and personal relationships are good, providing choice and interest to service users and opportunities for personal development. Dietary needs of service users are well catered for with a balanced and varied selection of food available. EVIDENCE: Service users said that they took part in a range of activities, including work in a local charity shop, horticulture, textiles and courses at a local college including cooking, craft and computer use. One of the service users said they were hoping to go on to work in a garden centre after getting some experience of shop work. Placement reviews included evidence of the involvement of service users’ families and support was provided for service users to contact family and friends by e-mail and phone. Details of the support required with this contact were included in the individual plans. Tudor Rose Version 1.10 Page 12 Service users spoken with said that staff respected their rights and treated them well, although service users had reminded some staff that they need to use English and Makaton signs when in the home. Staff were observed interacting with service users in a friendly and respectful manner. Service users took part in household jobs, details of which were included in the individual plans. The home had a planned menu that took into account the likes and dislikes of service users and provided a balanced and nutritious diet. Support was provided for service users to be involved in the preparation of meals and alternative meals, snacks and drinks were available at all times. Tudor Rose Version 1.10 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 standard(s) 20 The systems for the administration of medication are good with clear arrangements in place to ensure the needs of service users are met. EVIDENCE: The home had a monitored dosage system for the one service user who took regular prescribed medication. Records were seen of medication received and disposed of and the medication administration record had been fully completed. Medication was stored in a locked cabinet in the office and staff administering medication had received assessed training. Tudor Rose Version 1.10 Page 14 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 standard(s) 23 Arrangements for protecting service users’ money are not satisfactory, placing them at risk of financial abuse. EVIDENCE: The home currently holds the bankcards and PINs for service users and support is provided to draw money from the bank. One member of staff reported that on occasions the card and PIN are taken together in the house purse to the bank machine to withdraw money with service users, meaning that the card and PIN would be together if the purse was lost or stolen. Withdrawals are entered in a record book along with a receipt. It was not possible to find the receipt for the most recent withdrawal recorded in the book. The home had suitable adult protection procedures and the member of staff spoken with demonstrated a good understanding of action that should be taken in the event of an allegation of abuse. Tudor Rose Version 1.10 Page 15 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 standard(s) 24 and 30 The standard of the environment within the home is generally good providing service users with an attractive, safe and homely place to live. The use of the lounge for staff to sleep-in is not good and could compromise privacy and dignity and restrict service users’ choice. EVIDENCE: The home was clean and domestically furnished which service users reported met their needs. The home is approximately half a mile from the centre of Alton and service users are able to use the house car, although there is currently only one member of staff who can drive. Information on infection control was available and measures agreed with the environmental health officer to prevent laundry being taken through the kitchen whilst food was being prepared were implemented. Staff said that the sofa bed in the lounge was not comfortable and that the oncall staff frequently slept in the lounge of the home on one of the sofas. Action needs to be taken to ensure that staff have suitable facilities to sleep and do not use the lounge as staff sleep-in accommodation. Tudor Rose Version 1.10 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The use of temporary staff to cover the high level of staff shortages does not offer consistency of care to service users. EVIDENCE: The home had three permanent staff members, leaving four full time vacancies, although it was reported that two additional members of staff were due to start in the next month. Service users spoken with said that the number of staff changes unsettled them. The current deployment of staff is two staff between 7.30am and 3pm, two staff between 2.30pm and 10pm and one member of staff on-call and sleepingin between 10pm and 7.30am. One staff member spoken with said that there were times when it was not possible for the sleep-in staff to go to bed at 10pm as service users were still up and needing some support. The member of staff spoken with did not cover the sleep-ins. The shift system should be reviewed to ensure that it is best organised to meet the needs of service users. This will be followed up at the next inspection. Tudor Rose Version 1.10 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The system for maintaining the health, safety and welfare of service users is satisfactory. EVIDENCE: The home’s fire alarm system and extinguishers were checked regularly by the maintenance team of Iliace and records were made of the checks. The home had health and safety information and action had been taken to store hazardous chemicals in locked cupboards. Food was suitably stored and daily checks of the fridge and freezer were recorded. The member of staff on duty was not able to locate the safety certificates for the gas or electrical systems and this will be followed up at the next inspection. Tudor Rose Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 Tudor Rose x 3 x x 3 Standard No 31 32 33 34 35 36 Score x x 2 x x x Version 1.10 Page 19 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x Tudor Rose Version 1.10 Page 20 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 6 Regulation 15 (1) Requirement The registered person must ensure that individual plans are expanded to include service users personal goals. The registered person must ensure all areas of identified risk are assessed and action taken to minimise these risks. The registered person must ensure that the system of support for service users to withdraw money from the cash machine and the method of recording withdrawals is revised to minimise the risk of financial abuse. The registered person must ensure that staff are provided with suitable sleeping accommodation and do not use the lounge to sleep in when oncall. Timescale for action 31/7/05 2. 9 13 (4) (c) 31/5/05 3. 23 13 (6) 31/5/05 4. 24 23 (3) 31/5/05 5. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Tudor Rose Version 1.10 Page 21 No. 1. Refer to Standard 33 Good Practice Recommendations The registered person should review the deployment of staff to ensure that it is best suited to meet the needs of service users. Tudor Rose Version 1.10 Page 22 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Tudor Rose Version 1.10 Page 23 - 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!