Inspection on 25/07/05 for Twyford House

This inspection was carried out on 25th July 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

Twyford House 29/05/07

Twyford House 26/09/06

Twyford House 19/12/05

Twyford House 17/02/05

Twyford House 10/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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33 St John`s Church Road

Dovedale Court

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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 Penny McMullan Unannounced 25/07/05 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. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Twyford House Address Whitfield Avenue, Dover, Kent CT16 2AG 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) 01304 241804 Robinia Care South East Limited Mrs Jayne Anne May Registered Care Home 13 Category(ies) of Learning Disability registration, with number of places Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 February 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 who 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 H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 25 July 2005 over a period of 5.75 hour. Mrs Jayne May, Registered Manager and Mrs Karen Graham, Deputy Manager were in attendance. There were no relatives or professionals visiting the home at the time of the inspection. 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 no relatives or professionals visiting the home at the time of the inspection. An announced inspection will be held during the year to ensure that all people involved in the provision of care at Twyford House are consulted as to the homes ability to meet the needs of the residents. During the inspection three members of staff were spoken to and five service users. What the service does well: Good interaction was seen between staff and service users. The home works well with residents to promote their rights, choices and independence and three residents are now ready to move on to less dependent units. The home involves residents in their personal care plan in all aspects of daily living and provides stimulating varied activities. Staff said that the Company were very good at providing on going training to ensure resident’s needs are met. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 6 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 H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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 Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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 home has robust policies and procedures in place for the admission of new residents into the home. EVIDENCE: The General Regional Manager takes the initial referrals of prospective residents. A joint assessment is then carried out with the Registered Manager. Prospective residents and relatives 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 H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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) 6,7,9 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 residents 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 were recorded appropriately and tracked through to the service user plan and actioned accordingly. The plans and risk assessments are 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. The care plans contain risk assessments for self-harm, absconding, aggression, self-neglect, non-compliance with medication, confusion/disorientation, Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 10 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 H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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) 12,13,14, 15,16,17 Residents are supported to attend and enjoy the local amenities and access college courses of their choice. A planned fulfilling activity programme is in place for each resident provided by qualified professional staff. Family contact is promoted in the home with systems in place to ensure residents have the choice to go out with their family or stay in the home. Residents are encouraged to take an active part in the daily chores in the home whilst promoting resident’s rights and choices. The meals in this home are good offering both choice and variety. EVIDENCE: Due to the dependency of the current residents they are unable to participate in employment opportunities. The Day Care Co-Ordinator is a qualified teacher who provides daily activities and literacy and numeracy sessions are provided. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 12 Residents also attend college courses such as IT, woodwork, cooking and pottery. Sessions in sewing and model making are also provided. Staff members support residents to go out in the evening and weekends to the local pub, theatre, and cinema. The home has its own transport and service users also use public transport for shopping or trips. All of the residents are registered to vote but none are politically active. The home provides in house activities by professional well trained staff. Residents said the activities were good and music entertainment is also provided. Each resident has a detailed activity programme which is reviewed on a regular basis. Relatives are able to visit, and all telephone calls and contact is recorded in the residents’ care plan. Residents confirmed that they are able to visit their relatives and the home provides transport and staff to take them home. Staff also go out with relatives and residents if they wish to do so on their visits to the home. Relative information is detailed in residents care plan including birthdays and special events. Residents were seen unlocking their bedroom doors and entering independently. Staff support residents with their mail and residents are able to access all parts of the home. Staff interaction with residents is supportive and respectful. Residents are encouraged to assist with household chores and this information is recorded in the care plan. Lunch time was calm and relaxed in the home with residents taking their time to enjoy their meal. Residents were able to choose the dessert of various fruit or yoghourt. Residents each have a cooking care plan and enjoy choosing the meal, shopping for the food, assisting with the preparation and cooking. The four weekly menus were varied and residents said they enjoyed the food. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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) 18,19,20 Personal support in the home is offered in such a way as to promote and protect Service Users privacy, dignity and independence. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Overall the system for medication administration is satisfactory however the home is required to review the homely remedy system and storage of additional medication. EVIDENCE: Support and personal care are detailed in the resident care plan. Residents said that the staff took them to the hairdresser and shopping to choose their own clothes. Each service user has a key worker and specialist services are accessed via the GP as and when required. Health care needs are monitored and recorded in the care plan, including hospital appointments. Staff accompanies service users to out patients or to the GP surgery. Staff goes with residents to visit the local health centre for dental treatment and the Chiropodist carries out home visits if required. Massage sessions are also held in the home on a regular basis. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 14 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 required to be reviewed together with the administration of over the counter pain relief. A requirement has been issued to address this issue. All senior staff has received medication training. The home is also required to review the security of the storage of additional medication. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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 standard(s) 22,23 The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted on. Staff have knowledge, training and understanding of Adult protection issues which protects residents from abuse. EVIDENCE: A complaints book is used to record residents concerns no matter how minor and each entry is actioned appropriately. There have been no formal complaints to the home since the last inspection. The home has a clear Complaints Procedure, which is included in the Service User Guide. The format is in large print with signs and symbols. A four day training course is provided for all staff which includes conflict management, the use of breakaway techniques and safely managing challenging behaviour. Protection of Vulnerable Adult training is also being provided. The home has a policy for Dealing with Suspected Abuse and a policy for Raising Concerns at Work. Residents have their own bank account and personal property lists are included in the care plan. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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 standard(s) 24,30 The standard of the environment within the home is good 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: The home is bright and airy and there were no offensive odours. Some flooring has been replaced in the home and further decoration of some service users rooms. A new shower room is being installed and one table and chairs have been replaced in the lounge/dining room. There are areas in the home that require redecoration and the Company has a maintenance team to address these issues. The Registered Manager has also requested new furniture for the lounge. There are no outstanding issues from the last fire officer or Environmental Health Officer visit. The laundry room has washbasin facilities and the floors and walls can be easily cleaned. There are policies and procedures in place for infection control and there the home was free from offensive odours. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The arrangements for the induction and foundation training are in place with the staff demonstrating a clear understanding of their roles. EVIDENCE: The Company provides a rolling programme of training and staff said the training was very good and any specific training requested is considered to meet the resident’s needs. The induction and foundation training is linked to CWPLD and mandatory training is updated on a regular basis. There is a dedicated training budget and all staff have an individual training record. Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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 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) 39,42 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. Overall the home is providing a safe environment for residents, however the lack of a magnetic fire device on the Team Leader Office door potentially puts residents, staff and visitors at risk. EVIDENCE: Service users, 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 Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 19 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 is required to provide a fire door magnectic device for the Team Leader Office in the lounge/dining room. This is currently being wedged opened by residents and staff. A requirement has been made in this report to fit this device. The Accident Book was completed in a satisfactory manner and incidents were tracked through to the care plans and monitored appropriately. Certificates of servicing confirm that all appliances have been checked. 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 H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 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 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Twyford House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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. 1. Standard 20 Regulation 13 Requirement The home needs to review homely remedies system and storage of additional medication To provide a magnetic fire alarm device to the team leader office door Timescale for action 31/8/05 2. 3. 42 13 31/8/05 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 33 Good Practice Recommendations To provide specific quality assurance information regarding Twyford House Twyford House H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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 H56-H05 S23595 Twyford House V236712 250705 Stage 4.doc Version 1.40 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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