Inspection on 16/05/07 for Twynhams

This inspection was carried out on 16th 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Twynhams 21/05/08

Twynhams 19/01/07

Twynhams 08/12/05

Twynhams 04/07/05

Twynhams 12/01/05

Twynhams 06/07/04

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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 Twynhams Old Christchurch Road New Milton Hampshire BH25 6QB Lead Inspector Craig Willis Key Unannounced Inspection 16th May 2007 09:30 Twynhams DS0000055837.V336179.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 Twynhams DS0000055837.V336179.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. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Twynhams Address Old Christchurch Road New Milton Hampshire BH25 6QB 01425 618950 01425 618950 twynham@truecare.co.uk 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) Truecare Group Limited ** Post Vacant *** Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category of LD must be at least 18 years of age. Date of last inspection 19th January 2007 Brief Description of the Service: Twynhams is owned and managed by Truecare and is registered to provide personal care and accommodation for up to 7 residents who have a learning disability. The home is located close to local amenities in New Milton. The house is a two storey detached property with car parking for several vehicles and a garden to the rear. Residents are provided with single bedroom accommodation with five rooms having en-suite facilities. The manager reported during the visit that the weekly fees for living at Twynhams range from £1096.76 to £3013.08 Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to the Commission for Social Care Inspection (CSCI) since the last visit. This information included incident reports sent to CSCI, an annual quality assurance assessment and comment cards from three people who live in the home. A site visit to the home was made on 16 May 2007. During the site visit the inspector spoke with three of the residents and observed the interactions between residents and staff. The inspector also spoke with the manager and two members of staff on duty. A tour of the building was made and documents relating to the running of the home were inspected during the visit. What the service does well: What has improved since the last inspection? What they could do better: Care plans are generally good, although they need to be reviewed to ensure they contain information on how to meet all of people’s identified needs. The medication records need to be accurately completed, which will help to make sure people receive the medication they need. The manager needs to make sure the complaints system is accessible for all people living in the home. The provider needs to make sure their management systems identify shortfalls in the service and ensure the service continues to improve. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 6 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. Twynhams DS0000055837.V336179.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 Twynhams DS0000055837.V336179.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): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems to assess the needs of people before they move into the home, which helps to assure people their needs can be met. EVIDENCE: The records of three residents were inspected during the visit. For each person an assessment of their needs had been completed prior to them moving into the home. Copies of the care management assessments were also available on file. The manager reported that Truecare has a referrals director who completes assessments for any potential residents with the manager. Once an assessment has been completed and a person identified as suitable for the home a transitional plan is developed and the person is invited to visit the home several times, including an overnight stay. The potential resident is consulted throughout the process and the assessment is updated following the visits. Nobody has moved into the service since the last inspection. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning and risk assessment systems are generally good and provide clear information to enable staff to meet most needs, however, they do not cover all of the identified needs for individuals. EVIDENCE: The personal files of three residents were inspected during the visit. All of these files contained a set of care plans and risk assessments that had been developed from the person’s needs assessment. These plans were reviewed monthly with the resident and their keyworker. Since the last inspection guidelines, a functional analysis and risk assessments have been developed for one resident in respect of challenging behaviour and physical interventions. These documents clearly set out how staff should support the person to manage their behaviour, including at what stage and how staff should physically intervene. All three plans seen promoted the use of distraction and re-direction in managing challenging behaviour and physical interventions are Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 10 used as a last resort. There have been no incidents of physical restraint since the last inspection. One person has recently had two falls due to their mobility needs. Evidence was available that the service has consulted with the occupational therapist about how they should be supported, although there were no care plans or risk assessments for this person relating to their mobility. This resident was spoken with and indicated that staff know what his needs are and how to meet them. The manager agreed to review the plans to develop information about mobility. The care plans and risk assessments for one person did not contain any information about a recent assault by another resident and action that was required to keep them safe. This information was available in other documents held in the home and staff spoken with demonstrated a good understanding of the action they should take to keep the person safe. The manager agreed to ensure the information was placed in the person’s care plans and risk assessments. Three people completed a service users’ survey for CSCI, one said the home always meets their needs and two said they usually meet their needs. One resident spoken with said he took part in regular reviews of his plans and was supported to develop his independent living skills. Evidence was seen that people had signed their care plans and other documents to indicate their agreement with the contents. Both members of staff spoken with demonstrated a good understanding of the needs of people and how they should meet them. The manager reported that she plans to review all of the care planning documents to provide better information about how to meet people’s needs. The manager also said she plans to develop the use of person centred planning models and increase the use of advocates where appropriate. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good support for people to take part in activities they enjoy and meet their lifestyle choices. EVIDENCE: Residents are supported to develop an activity plan and people spoken with said they enjoy the activities they take part in. Activities include using local amenities such as swimming, pubs, cinema and a local college. One person said he was going to go to a local snooker club on the afternoon of the visit. The manager reported that she planned to work with residents to develop the activities that were available and the support and motivation that was needed. Residents spoken with said they maintained regular contact with their family and friends, who were made to feel welcome when they visited the home. One the day of the visit one person went to a health appointment with a family member for support. The care planning system has identified specific needs in Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 12 relation to spirituality and sexuality and support is provided to meet these needs. One resident spoken with said he received good support to follow a specific diet and that the food available was good. One person said he was supported to plan, shop for and prepare their own meals, which helped him to develop independent living skills. A monthly menu is developed with residents as part of a meeting, using pictures to help some people plan what they wanted. The menus provide a varied and balanced diet and residents confirmed alternatives were available if they wanted. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical and emotional needs of people are well met, however, errors in the medication records do not demonstrate safe practice. EVIDENCE: Details of residents’ health, emotional and personal care needs are set out in the care plans and people spoken with said staff know what their needs are and treat them well. Records are maintained of appointments with a range of health professionals and include any advice given by the practitioner. People spoken with said they were able to see their doctor when they needed to. None of the people living at Twynhams currently administer their own medication, although the manager said she thought this might be possible for some people following an assessment of the support they need. Medication is stored in a locked cabinet in the office and most tablets are received in a monitored dosage system. A record of medication administered to people is kept and had been fully completed. All staff administering medication have completed training in safe administration of medication. Some tablets are not included in the monitored dosage system and a record is kept of the number of Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 14 tablets held. These records did not match the tablets held for one person. One person’s tablets needed to be cut in half to administer the dose prescribed by their doctor. Staff spoken with said that they broke the tablet in half by hand as they did not have a tablet cutter. In response to the medication issues highlighted during the visit, the manager said she was going seek advice from the pharmacist to ensure tablets are cut correctly or supplied in a strength that does not require them to be cut. The manager also said she was going to introduce a weekly medication audit to ensure accurate records are maintained of medication held in the home. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are good systems to keep people safe from abuse, although the complaints procedure is not accessible to all residents. EVIDENCE: The home has a complaints procedure, which is supplied to people in the Service Users’ Guide. This procedure is only available in written format and the manager reported that it would not be accessible to all of the people living in the home due to their disability. The manager said the procedure was due for review and she would consider what alternative formats would be suitable for people. There is a complaints record and one complaint has been made by a resident since the last inspection. The record did not contain any details of follow up action and the manager reported that she had followed the matter up verbally with the person but not recorded it. The record was updated during the visit and the manager said she would ensure a full record of follow up action is made for any future complaints. The person who made the complaint was spoken with during the visit and said he was happy with the response from the manager. Of the three people who returned CSCI service users survey forms, two said they know how to make a complaint if they need to and one did not answer the question. People spoken with said they know how to complain and were confident any complaint would be taken seriously and investigated. Since the last inspection the senior management of Truecare have conducted an investigation into how the home responded to allegations of abuse and the Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 16 implementation of the safeguarding adults procedures. Following this investigation, additional training has been provided to staff and further training is planned. Since the last inspection there has been an allegation of abuse between residents and action was taken to report the allegation under the safeguarding adults procedures. Action has been taken to keep people safe and staff spoken with said they feel the action taken is appropriate. Both staff members spoken with demonstrated a good understanding of abuse and action to take if abuse is witnessed, reported or suspected. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 17 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): Standards 24, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a comfortable, clean and safe environment for residents. EVIDENCE: A tour of the communal areas of the home was made during the visit. Since the last inspection the bathroom on the ground floor has been refurbished to ensure the shower meets the mobility needs of everybody living in the home. Residents have decided that they will not smoke anywhere in the main house and there is a designated smoking shed in the garden. The garden is accessible for all residents and provides grassed and planted areas for their use. Since the last inspection the new conservatory has been furnished with items chosen by residents. The manager reported that following consultation with residents a computer was going to be fitted in the small lounge for their use. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 18 All areas of the home were clean and people spoken with said this was always the case. The home has a separate laundry room and laundry is not taken through food preparation or storage areas. The manager reported that there was a contract in place for the disposal of clinical waste. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 19 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): Standards 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good staffing arrangements, which helps to ensure people are protected and their needs are met. EVIDENCE: The manager reported that ten of the fourteen staff have achieved the National Vocational Qualification (NVQ) in care at level 2 or above and the remaining four staff are working towards the award. The manager reported in the annual quality assurance assessment for CSCI that they obtain Criminal Records Bureau (CRB) checks and references for all staff before they start working in the home. Records sampled during the visit confirmed this. The home has a training programme and staff spoken with said they felt the training provided was good and helped them to meet people’s needs. Courses staff have completed include fire safety, management of violence and aggression, moving and handling, control and restraint, risk assessment, adult protection, first aid and breakaway techniques. The manager reported in the annual quality assurance assessment that she planned to make the training Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 20 more individually targeted for staff, to ensure any individual training needs are met and staff are aware of the development objectives for the service. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 21 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): Standards 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are systems in place for managing the home, although these have not identified all of the shortfalls in relation to meeting people’s individual needs. EVIDENCE: Since the last inspection a new manager has been employed at the home and started work in April 2007. The manager reported that she has previously been registered with CSCI as a manager, has completed the registered managers award and is currently completing the NVQ level 4 in care. The manager reported that she is in the process of gathering the information required for her to submit an application for registration to CSCI. Following the last inspection in January 2007, CSCI required Truecare to produce a formal improvement plan to demonstrate how the quality of service Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 22 provided would be improved. This was not sent to CSCI by the required date, which a representative from Truecare reported was due to changes in the office base and administrative errors. The improvement plan was submitted after this visit. All of the requirements made following the last inspection have been complied with. The operations manager visits the home each month to assess the quality of the service provided. Reports are made of these visits and include any actions that are required. The manager reported that a survey of residents and their relatives was being conducted in June 2007 and the results would be incorporated into the annual development plan to ensure that the service continues to improve. The quality assurance systems have not identified the shortfalls described in this report in relation to care planning and medication practices. The manager reported in the annual quality assurance assessment for CSCI that equipment in the home, such as fire detection and fighting equipment and the heating system were regularly serviced and maintained to ensure they were safe. A sample of these records was checked during the visit and confirmed that maintenance was up to date. Assessments are completed for chemicals used in the home and hazardous substances are securely stored when not in use. Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 23 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 X 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 3 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 15 Requirement The registered person must ensure that care plans include information about how all the identified needs of service users should be met. The registered person must ensure that accurate records are maintained of medication held in the home. Timescale for action 30/06/07 2. YA20 13 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Twynhams DS0000055837.V336179.R01.S.doc Version 5.2 Page 26 - 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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