Inspection on 21/01/09 for Underwood

This inspection was carried out on 21st January 2009.

CSCI found this care home to be providing an Good service.

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

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Underwood Sponden Lane Sandhurst Cranbrook Kent TN18 5NR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joseph Harris     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Underwood Sponden Lane Sandhurst Cranbrook Kent TN18 5NR 01580850167 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joan Penelope Gradwell Type of registration: Number of places registered: Mrs Joan Penelope Gradwell care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Underwood is a new service that provides accommodation for up to 3 people who have mental health problems. The home relocated to new premises near Cranbrook in August 2008. The premises are located in a rural area approximately 3 miles from the nearest town, but close to the village of Sandhurst. The house is arranged over 2 floors and has been completely refurbished and redesigned to a high standard offering 3 single bedrooms with en-suite facilities. The current fees are 320.63 pounds per week. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 3 Brief description of the care home Information about the service and the facilities are summarised within the statement of purpose. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection process culminated in a site visit to the service on the 21st January 2009. This was the first key inspection process conducted under the Care Standards Act 2000. The home returned its Annual Quality Assurance Assessment (AQAA) providing details of the service, facilities, changes and developments. This document was used to inform the inspection process. During the course of the site visit discussions were held with the two current service users and the manager. A tour of the premises was undertaken and a range of documentation was examined including service user files, health and safety documentation, medication records and other information relating to the running of the service. Care Homes for Adults (18-65 years) Page 6 of 27 Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of prospective service users are assessed prior to admission. Evidence: There have been no new admissions to the home since 2003, but the manager stated that she is currently considering new referrals. The home has recently relocated to a new area and the new premises have 3 registered rooms with 2 service users in residence at the present time. A discussion was held with the manager about the homes referral process and she was able to demonstrate that the needs of the current service users and the limitations of the service would inform any future decisions in this regard. The service user file for one resident was examined and this contained full and detailed pre-admission assessment information, which included Care Programme Approach (CPA) documentation, care management care plans, risk assessments and information from the individuals previous place of residence. The file also included a detailed resume of the admission process from initial meetings through to trial visits providing information about needs and observations. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and risks of service users are planned for. Residents are supported to make decisions affecting their day to day lives. Evidence: The home has developed a plan of care and support for both service users in conjunction with CPA documentation. The plans of care address the personal care and support needs of service users in good detail providing sufficient information to enable staff to consistently meet individual needs. A review of care is completed monthly covering changing needs, activities and other issues of note. Both residents spoken to stated that they are free to make decisions affecting their day-to-day lives and that the home supports them in this. The manager does not act as a financial appointee for either of the residents, but does provide a safekeeping facility for residents should they wish to use it. Records are kept of all incoming and outgoing transactions. One service user has been supported to start attending a selfhelp group in the local area for people with similar mental health needs. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: There is a positive risk management process in place that encourages responsible risk taking and personal responsibility appropriately. The risk assessments provide suitable detail to enable staff to minimise perceived risks. These assessments are reviewed and updated on a regular basis. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have a lifestyle that suits their needs. Evidence: The home has recently been relocated to a new area. In discussion with the manager it was stated that opportunities and resources in the local area are still being explored. One of the service users goes out on a daily basis to the local shop and regular takes trips to nearby towns, although he did state that the home, set in a rural location, is somewhat isolated. The manager acknowledged this, but said that she provides transport when required and that the bus route provides a fairly regular service. One of the residents has been supported to attend a local group for people with mental health problems. Both of the service users stated that they like to spend time in their rooms and expressed satisfaction at the facilities available in the home. One of the service users is supported to take at least an annual holiday. Another resident has Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: limited mobility and finds it difficult to go out. However in discussion he said that he is happy and enjoys spending time in his room watching television and reading. The manager has recently planted a rose garden visible from his room as this is a particular wish. Visitors are welcome to visit the home at all reasonable times, however, it was reported that neither of the service users have significant family contacts. The home provides a healthy, balanced diet. There is a main cooked meal provided daily. One service user prepares his own breakfast and lunch and is provided with food specifically for this purpose. Residents are able to have drinks and snacks throughout the day whenever they choose. Menu records are maintained and the kitchen was well stocked with good quality produce. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and healthcare needs of the service users are met. Evidence: Service users are supported to retain their independence with regard to personal care needs and one individual is fully self-caring. Another resident requires a higher level of support and stated that the staff are aware of his needs and preferences and support him with dignity and respect. Individual plans provide suitable information to enable staff to meet needs consistently. The home maintains records of healthcare appointments and the outcomes of any consultations. All service users are registered with a local GP and it was reported that the home receives good support from care management and local mental health services. Service users are encouraged to be as independent as possible with regard to their healthcare needs and one service user attends appointments independently. Complimentary healthcare services such as chiropody, dentistry and opticians are available. The home uses a NOMAD system of medication administration from a local pharmacy. One resident is self-medicating and supplied with his medication weekly. The home has Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: recently introduced an improved system of recording medication administration. Staff in the home have attended training courses relating to medication administration and storage facilities are suitable for the needs of the home. Policies and procedures are in place. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of service users are listened to and acted upon and they are protected from forms of abuse. Evidence: The home has a clear and effective complaints process in place. One complaint has been received since the last inspection, which was dealt with and resolved by the manager promptly and to the satisfaction of the complainant. in discussion with service users they stated that they feel comfortable raising concerns with the manager and are confident that any issues will be dealt with appropriately. The home has policies and procedures relating to adult protection and abuse awareness and the manager was conversant with her role and responsibilities for recording and reporting any possible issues of abuse. It was advised that the staff in the home attend refresher courses covering the topic of Adult Protection. Refer to recommendation 1. No adult protection alerts have been raised in connection with the service. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for the needs of the service users. Evidence: The service was relocated to the current accommodation in August 2008 having moved from Birchington near Margate to a rural location near Cranbrook. The house is situated on a country road and has parking available at the front of the building. There are large, attractive gardens situated at the rear of the house. The nearest town is approximately 3 miles away and there is a shop in a nearby village that one resident walks to on a daily basis. One resident said that he feels the home is somewhat isolated, having previously been so close to Birchington. However, positively, he has begun to use public transport in the area and stated that the staff are available to provide transport when he requires. A tour of the premises was undertaken. The manager stated that the building was completely refurbished throughout to her specifications. There are three single bedrooms all with en-suite facilities. Both of the service users stated that they like their rooms very much and have sufficient space throughout the home. There are communal rooms available and the home has been decorated and furnished to a high standard. There are two kitchens that are well equipped one of which is used regularly by the service users. The laundry facilities are suitable for the needs of the home. The Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: manager stated that she also has plans to develop another building into a games/activities room. It was reported that the home meets the requirements of the fire safety and Environmental Health Departments. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an experienced and stable staff team that have received necessary training, although some updates are advised. Recruitment procedures are followed. Evidence: The home operates with a small, experienced staff team consisting of the manager, who lives on site and a support worker who has been employed by the service for over 6 years. It was reported that there are bank staff available to cover sickness and annual leave who know the service users well. The support worker has not achieved a National Vocational Qualification (NVQ) in Care at level 2 or above and it is advised that he works towards this qualification. Refer to recommendation 2. Both staff members have attended training covering all mandatory topics, but it was noted that there are areas of training needs that are due to be renewed. These also include Adult Protection and Medication training. The manager stated that she is in the process of booking appropriate courses in these respects. Refer to recommendation 3. There have been no new staff employed in the home for many years. Recruitment records show that appropriate processes have been followed and CRB, references, proof of identity and other key information is retained on file. Care Homes for Adults (18-65 years) Page 21 of 27 Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interests of service users. Health and safety issues are monitored and addressed. Evidence: The manager has owned and run the service since 1984. She has achieved the Registered Managers Award/NVQ level 4 and has consistently continued to update her own knowledge having become a qualified counsellor and completed other courses relating to mental health issues. In discussion she demonstrated a good awareness of the needs of the service users and in promoting independence. One service user said, We get on very well, i have a nice life, i like it here. The manager lives on site and ensures that service users have the opportunity to air their feelings, concerns and needs on a daily and periodic basis. There is evidence that issues in the home and the development of the service are monitored on an on going basis. The home has recently been completely refurbished and all service checks and certification is in place relating to health and safety issues. The home has installed a Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: modern fire alarm system that is linked to the local fire brigade and a fire risk assessment has been completed. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 23 32 35 Staff to attend updated training in Adult Protection issues. Care staff should achieve an NVQ level 2 or above in care. The staff training needs are due to be updated and refreshed. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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