Inspection on 29/05/07 for Twyford House

This inspection was carried out on 29th May 2007.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Twyford House 26/09/06

Twyford House 19/12/05

Twyford House 25/07/05

Twyford House 17/02/05

Twyford House 10/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

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 Kim Rogers Key Unannounced Inspection 29th May 2007 11:15 Twyford House DS0000023595.V333283.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 Twyford House DS0000023595.V333283.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. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 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) The Robinia Care Group Ltd Mrs Jayne Anne May Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 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 a 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. The fee for living at this home is £ 83,115 to £106,280 per year For more information about this home and what he fee covers please contact the provider on twyford.house@robinia.co.uk Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and carried out by two inspectors. A total of about four and a half hours was spent on the site visit. Some pre inspection work was carried out including speaking to care managers and other professionals about the service. A pre inspection questionnaire supplied by the manager was looked at. The inspectors spent time with service users, spoke to and observed staff and interviewed the manager. A selection of records relating to service users and staff were sampled. The inspectors concentrated on assessing progress towards meeting requirements made at the last inspection. It is evident that the home has improved since the last inspection. Although some requirements are not fully met a good start has been made towards meeting them. The manager recognises the need to continue and develop this good start. What the service does well: What has improved since the last inspection? Care planning has been reviewed so plans are more person centred and detailed. These person centred approaches should now be fully implemented. The organisation has introduced a person centred assessment tool, which they plan to complete with each individual to review needs and identify aspirations and personal goals. A new behaviour support plan has been developed and should continue to be implemented. Service users must give consent to any physical intervention used. Incidents of staff using physical intervention have reduced. Health assessments and health action plans are in the process of being introduced. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 6 The range of training offered to staff has increased to include subjects relating to service users needs including person centred planning and active support. Some more community-based activities have been accessed for people. The manager and deputy have enrolled in a course at the University of Kent, Certificate in Person Centred Support. The Statement of Purpose and Service User Guide have been reviewed and updated since the last inspection. This ensures service users have the information they need to make an informed choice about this home What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Twyford House DS0000023595.V333283.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 Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Information about the home has been reviewed and updated. Service users know their needs and aspirations will be assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide have been reviewed and updated since the last inspection. This ensures service users have the information they need to make an informed choice about this home although this is only produced in a standard format. Prospective service users are able to make trial visits and stays all planned around their needs. The inspectors saw records of these trial stays. One person has moved in since the last inspection. The manager met the person and carried out an assessment of their needs and aspirations. This was seen in the person’s individual plan. The person and their representatives were involved in completing this assessment, which was detailed. The manager said the organisation have introduced a person centred assessment tool which they plan to complete with each individual to review needs and identify people’s aspirations and personal goals. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 9 Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Service users know their changing needs and personal goals will be identified and supported. Support has improved to aid communication and decisionmaking. Taking risks is not seen as an area for development and therefore risk management can still be restricting. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users plans were sampled and two people ‘case tracked’. The home has introduced a more person centred format to care planning, the previous format being quite clinical. People’s needs and personal goals are better recorded. Staff have had some training to support the implementation of person centred planning. There is some way to go until full implementation of person centred planning and the manager recognises this. Communication assessment and guidelines have been developed since the last inspection and some referrals made for support to speech and language Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 11 services. Some improvements have been made around the home to better support communication for example; pictorial activity planners have been produced for individuals. A functional communication intervention has been developed for one person. The manager said that risk assessment strategies are in the process of review and will form part of the new person centred plans. Currently risk is not evaluated as an area for development and some risk management strategies are restricting. Risk assessments are completed but these are basic and mainly focus on keeping people who use the service safe. Where limitations are in place, there is some evidence that decisions are agreed with the individual but this is not consistent and in some cases limitations are made for a minority but have a negative impact on the majority of service users. The manager said that reviews of new plans would be regular with the person and staff involved. Staff must ensure that this review is recorded against individual plans for effective evaluation. For example some records of monitoring and evaluation are recorded in detail in a general communication book but scant in the person’s plan. This is not complaint with the Data Protection Act and looses potential for good evaluation. Some staff have been working on a functional assessment and new format behaviour support plan. The manager said the plan is to develop, implement and evaluate the plan before developing support plans for everyone. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Some restrictions continue and need to be reviewed considering more effective staff deployment and shift planning. People have opportunities for in house and community based activities. Rights and responsibilities generally respected but some people could have more control. Food is good and balanced; some people could be more involved in the planning, preparing and serving of meals. Relationships are generally supported but more support is needed with sexuality issues. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally, staff are aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 13 People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. Where possible staff gathers information on community based events and try to make individual arrangements for people to attend. Some new community based activities have been introduced to some service users since the last inspection. Each person has an individual activity planner with pictures and symbols. This could be improved by including evenings and weekends. Educational, and where appropriate employment opportunities are explored and encouraged, people who use services are supported to lead a lifestyle that enables them to become part of the local community. Staff and resources could be used more effectively. For example some people are restricted from using the garden due to the needs of a minority. No one has a front door key and access to some bathrooms and toilets is restricted. There may be potential for some service users to increase their independence and control and this should be reviewed. More effective staff deployment and shift planning could reduce some limitations. Opportunities are available for residents to be involved in food shopping, the preparation of meals and menu planning, although the service might focus on the more able individuals and not always recognise the maximum potential of all people using the service. Access to the kitchen has been increased for some people although the kitchen remains locked most of the time. Some intimate relationship and sexuality issues need addressing. This was discussed with the manager. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users know their personal care and health care needs will be monitored and supported. Medication practice is adequate and some people are having support to control their own medication. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs are detailed in individual plans with an emphasis on independence. People who use services are supported and helped to be independent and can take responsibility for their personal care needs. People who use services have access to healthcare and remedial services, staff make sure that those residents who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. Referrals are made for specialist advice and support when necessary. The home has introduced health action plans for individuals and these are in the processes of being completed. The requirement made at the last inspection regarding a healthcare matter has been met. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 15 Some service users are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff manage medication. Clear guidelines are in place to enable service users to have the support they need to take more control of their medication. Staff should ensure that guidelines and support are relevant to the individual. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 A service user complaint system is in place, but is the domain of those who have vocal communication. Staff can recognise and respond to suspected abuse and challenging behaviours are better managed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure displayed in the office. People are given their own copy with the service user guide. The complaints procedure has some pictures and symbols but is not meaningful and understandable to everyone. The home keeps a record of complaints with action taken to address issues recorded. Some individuals know how to complain and do so, verbally. For others, their behaviours may be used to show they are not happy about something and therefore need more support to complain. For example one person who runs around a lot in open spaces when out may be saying they would like to live in a less restricting environment. Training of staff in the area of protection is regularly arranged by the home. Staff attend regular courses on safeguarding adults. Other training around dealing with physical and verbal aggression is also made available to staff as needed. This training has been reviewed recently. Previously staff had a limited understanding on how to support and manage challenging behaviours. This has improved with new types of assessment, behaviour support planning and training. Staff continue to use reactive Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 17 strategies in the main but the use pain complaint restraint and aversive techniques has ceased. The use of restrictive physical interventions has significantly reduced. Work has started to make behaviour support plans clearer for staff and to involve service users in their development. The incentive scheme to reinforce acceptable behaviours has been reviewed and individualised. Some people have some control over their money. Individual records and receipts are kept. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Environmental restrictions are still imposed and should be reviewed to give people more control. The home is clean and with a planned programme of maintenance. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Access to the garden is limited, as the doors remain locked. The manager said that this imposed restriction is made for one or two people although it affects everyone. The noise level within the home is high. The manager said some redecoration was planned and a development plan has been produced. Two bathrooms have been updated with a plan to update a third. One inspector had a look around. Bedrooms are personalised and people are generally happy with their rooms. One person would like a mirror replaced in Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 19 their room. One person now has a key to their bedroom giving them more control. Some toilets and bathrooms are kept locked. This restriction should be reviewed to ensure it is the least restrictive option. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Staff are trained however, deployment needs reviewing to be more effective for people who use the service. Recruitment procedure a are robust, which protects people. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using services are generally satisfied that the care they receive to meet their needs, but there are times when they may need to wait a short time for staff support and attention. There is a manager, deputy manager, assistant manager and senior staff. This leaves support workers delivering the hands on care and support that people need. A mix of staff with varying skills and abilities are on shift during the day. A dedicated day programme team work in the week to make sure activities take place. Rotas and shift plans could be more effective in supporting service users needs, reducing limitations and increasing opportunities. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 21 Staff files have been audited to ensure that the required documentation is in place for each member of staff. One file was sampled and this was the case. For a new member of staff, the required checks have been carried out and suitable induction completed. A service user was meeting with and asking questions of a new staff member during the inspection. Training is provided on a rolling programme facilitated by a training manager. Training now includes courses related to values and service users needs. Competency assessments have been introduced in some areas like medication administration. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The management of the home is adequate. The quality assurance system has been improved and takes service users views into account. Service users health and safety is generally protected Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered learning disability nurse and has managed the home for about three years. The manager has several years experience in working with people with a learning disability. The manager spoke with understanding and knowledge of service users needs. The manager plans to start a course in September 2007 ‘Certificate in Person Centred Support’ at the University of Kent at Canterbury. The manager said she is now receiving regular supervision sessions from her line manager. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 23 The homes policies and procedures have been reviewed recently although are not in formats that are meaningful to people who use the service. Audit and monitoring has improved with regular visits by an area manager although these have mainly focussed on maintenance issues and not outcomes for people. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home, although more work is needed in this area. Views of service users are sought yearly by surveys. These are also sent to relatives, GP’s, tutors and Care managers. This audit is analysed and an action plan to improve developed. Action has been taken to address some issues for example bathrooms have been improved. The manager said people also meet as a group chaired by a service user. Minutes are taken and any issues passed to the manager. The pre inspection questionnaire shows that the required health and safety checks are carried out. Accidents and incidents have been recorded and reported appropriately. Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 24 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 2 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 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 2 2 3 X Twyford House DS0000023595.V333283.R01.S.doc Version 5.2 Page 25 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 YA9 Regulation 13 Requirement Timescale for action 30/09/07 2. YA23 12,13 3. YA41 17 Risk management strategies must be reviewed to ensure more emphasis on enabling people rather than restricting them. Risk should be evaluated as an area for development as part of individual PCP’s. Imposed restrictions must be 31/07/07 reviewed to ensure they are the least restrictive option, especially access to the garden, toilets and bathrooms. Personal and sensitive 31/07/07 information must be recorded and stored in line with the Data Protection Act. 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 YA6 Good Practice Recommendations Individual service user plans must be developed from initial assessments using person centred approaches to DS0000023595.V333283.R01.S.doc Version 5.2 Page 26 Twyford House 2. 3. 4. YA16 YA35 YA40 support identified needs and personal goals. Work started should continue. Ensure staff deployment, by way of shift planning and other methods, is effective to meet service users needs and increase opportunities. The manager and staff should have ongoing training in person centred planning and support and Positive Behaviour Support. Ensure that policies and procedures are produced in formats that service users can understand. 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