Inspection on 19/12/05 for Twyford House

This inspection was carried out on 19th December 2005.

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

Twyford House 29/05/07

Twyford House 26/09/06

Twyford House 25/07/05

Twyford House 17/02/05

Twyford House 10/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

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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 Twyford House Whitfield Avenue Dover Kent CT16 2AG Lead Inspector Mrs Penny McMullan Announced Inspection 19th December 2005 09:30 Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Twyford House Address Whitfield Avenue Dover Kent CT16 2AG 01304 241804 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) Robinia Care South East Ltd Mrs Jayne Anne May Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: Twyford House is part of the larger Company of Robinia Care, and is registered to provide accommodation and personal care for 13 younger adults with learning disability and at times may present challenging behaviour. The premises are a purpose built detached property. All service users have their own bedroom. Two of the service users also have a small private kitchenette area. It is situated on the outskirts of Dover in a residential area near to local shops with easy access to the main bus route to the town. The local church and pub are within walking distance from the home. The home also has its own transport. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 19 January 2005 over a period of 6.50 hour. Mrs Jayne May, Registered Manager and Mrs Karen Graham, Deputy Manager were in attendance. Feedback from the postal survey was as follows: six comment cards from relatives indicate that overall all are happy with the care services being provided. There were two GP comment cards and five Care Manager/Placing Officer comment cards, all indicating their satisfaction with the overall services being provided. Some of the current residents have limited communication skills, therefore are unable to provide substantial feedback with regard to the services being provided. There were three relatives visiting the home at the time of the inspection and although none wished to speak with the Inspector one comment was ‘my son has settled very well in this home’. During the inspection six members of staff were spoken to, and observation was carried out at lunchtime with service users and staff. The home applied for a variation to their registration to admit a resident who is under the age of 18 years. After careful consideration the variation was agreed and the home has demonstrated that the residents needs are being met. What the service does well: One comment from a relative survey was ‘ I have found the staff to be extremely caring and considerate of my relative’s needs and can not fault them in any way’. There are no requirements in this report as the home is working well to achieve the national minimum standards and consistently providing high quality care to the residents. The Registered Manager and Deputy Manager ensure that staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. During lunch time staff were observed interacting with residents in a positive respectful manner, handling situations in a calm professional manner. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 6 The home is an assessment unit and works well with residents to ensure they are able to move to smaller units to further promote their independence and enhance their daily lives. The home involves residents in their personal care plan in all aspects of daily living and provides stimulating varied activities by qualified professionals. The home was well decorated for Christmas and the residents have made the decorations themselves as part of their activity programme. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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 Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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): 2 The home has robust policies and procedures in place for the admission of new resident’s into the home. EVIDENCE: The General Regional Manager/Operations Manager takes the initial referrals of prospective residents. A joint assessment is then carried out with the Registered Manager. Prospective residents and relatives are encouraged to visit the home with their current carers and stay as long as they wish, have a meal or stay overnight. A detailed care plan is completed, monitored and reviewed in order that the home can meet the resident’s needs. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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 care planning system is clear and consistent to provide staff with the information they need to meet the resident’s needs. The home promotes resident’s rights and choices. Residents are supported to take responsible risks within the homes risk assessment management strategy. EVIDENCE: Care plans are detailed and thorough, covering all aspects of personal and social care. Daily logs are completed and accidents/incidents are recorded appropriately, tracked through to the service user plan and actioned accordingly. The plans and risk assessments are updated and reviewed on a regular basis. Any restrictions on choice are clearly recorded in the care plan and risk assessed. Advocacy services are involved in the home and individual choices are also recorded in the care plan. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 10 The care plans contain risk assessments for self-harm, absconding, aggression, self-neglect, non-compliance with medication, confusion/disorientation, exploitation from others and sexual promiscuity. Risk assessments are reviewed on a regular basis and carried out for all activities and outings. Environmental risk assessments are also in place. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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): 14,17 Residents are supported to attend and enjoy the local amenities and access college courses of their choice. Dietary needs of residents are well catered for with a selection of food available to meet their tastes and choices. EVIDENCE: Staff members support residents to peruse their chosen activity. Likes and dislikes are recorded in the care plans and residents are able to go out in the evening, weekends to the local pub, theatre, and cinema. Christmas shopping trips have taken place and residents have been taken out to view the many Christmas lights in local areas. The home had its own transport and some residents are also able to use public transport for shopping or trips. Lunch time was calm and relaxed in the home with residents taking their time to enjoy their meal. Residents were able to choose sandwiches or soup and the dessert of various fruit or yoghourt. Some residents arrived back from an outing during lunch and this caused some distraction to other residents. The Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 12 Registered Manager and staff reacted in a positive way and managed the situation in a calm assured manner. Some residents are supported to assist with clearing the tables and minor chores. Each resident can have a cooking care plan, which details his or her choice of meal, shopping for the food, assisting with the preparation and cooking. The four weekly menus were varied and residents said they enjoyed their lunch. The residents were looking forward to a ‘take away’ of their main meal in the evening. This information was displayed on the wall by the kitchen. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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): 20 The systems for medication administration are good with clear and comprehensive arrangements being in place to ensure residents medication needs are met. EVIDENCE: The home uses the Monitored Dosage System (MDS) to administer medication and Medication Administration Record (MAR) sheets were in good order. The administration of homely remedies is also recorded on the sheets. The receipt and return of medication is in place and all senior staff has received medication training. Hand written entries on the MAR sheets are countersigned to minimise the risk of error. The home has a medication policy and records instances of medication errors and action taken. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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 the following standard(s): The complaints system is in place to enable residents to voice their concerns and know the home will take action if required. EVIDENCE: A complaints book is used to record and action resident concerns no matter how minor. There have been no formal complaints to the home since the last inspection. The home has a clear Complaints Procedure, which is in large print with signs and symbols. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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 the following standard(s): 24,30 The standard of the environment within the home is well maintained providing residents with a comfortable and homely place to live. Laundry facilities are satisfactory and policies and procedures are in place to control the risk of infection. EVIDENCE: Since the last inspection the toilets have been refurbished, the installation of an additional shower room is in process and some service users bedrooms have been redecorated. There are areas in the home that require redecoration and the Company has a maintenance team to address these issues. There was a homely atmosphere with service users relaxing in the lounge or in their own bedroom. The laundry is satisfactory with washbasin facilities and easily cleaned. There are policies and procedures in place for infection control and there the home was free from offensive odours. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34.35 The staff is well trained, competent and experienced ensuring good quality care and support is provided to the residents. Recruitment polices are consistently followed resulting in residents receiving care from staff that have not been appropriately vetted. The arrangements for the induction and foundation training are in place with the staff demonstrating a clear understanding of their roles. EVIDENCE: There are ten members of staff who have ΝVQ2 or above and 5 staff completing the award. The Registered Manager has completed the A1 Assessor award and will be supporting the candidates to achieve their award. The staff say the Company is committed to training to ensure they have the skills to meet the service user needs. Staff demonstrated their communication and listening skills whilst interacting with the residents. The head office carries out the recruitment process and all necessary documentation was in place including CRB/POVA checks. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 17 Staff says they are supported with training to do their jobs well. The Deputy Manager ensures that the training courses are booked and all staff has received mandatory training. New recruits have a six-month period of induction, which is linked to CWLD, and are booked to complete the mandatory training. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 18 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 Registered Manager provides clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The systems for resident, relative, staff and other stakeholders consultation are good, however the lack of evidence of specific information with regard to the individual home does not take the their views and choices into consideration for the development of the home. There is robust Health and Safety Management in the home promoting and protecting the health, safety and welfare of residents. EVIDENCE: The Registered Manager, Mrs Jayne May has been in a senior/manager position since 1998 and has over 24 years of experience working in the care sector. Mrs May has completed her Registered Manager Award and AI assessor award. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 19 She is a qualified Learning Disability Nurse and demonstrated her skills, experience and knowledge of the service user group. Residents, relatives, staff and other stakeholders have completed a detailed quality assurance questionnaire. The Company has collated and summarised this information on a national basis and the information is broken down into regions. There is no specific data with regard to Twyford House and it is recommended that specific information be provided to evidence that residents/relatives views underpin all self-monitoring, review and development of the individual home. This is a recommendation in this report. Updates of mandatory training are provided and new staff attend all mandatory training. Fire Safety Records were inspected and in good order. The home has now fitted a fire door magnectic device for the Team Leader Office in the lounge/dining room. The Accident Book was completed in a satisfacotry manner and incidents were tracked through to the care plans and monitored appropraitely. There are robust records with regard to Helath and Safety and Coshh requirements, all data sheets were in place and risk assessments are in place. Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Twyford House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x DS0000023595.V263129.R01.S.doc Version 5.0 Page 21 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. 1 Refer to Standard YA39 Good Practice Recommendations To provide specific quality assurance information rgarding Twyford House this was a recommnedation from the last inspection and the current system applies to all homes in the Robinia Group Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Twyford House DS0000023595.V263129.R01.S.doc Version 5.0 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. 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