Inspection on 03/09/07 for Victoria Court (Community Therapeutic Services Limited)

This inspection was carried out on 3rd September 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 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

Victoria Court (Community... 28/03/07

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The Vicarage

St George`s

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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 Victoria Court (Community Therapeutic Services Limited) 1 Victoria Park Weston-Super-Mare North Somerset BS23 2HZ Lead Inspector Nicola Hill Unannounced Inspection 3rd September 2007 09:30 DS0000068448.V344280.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 DS0000068448.V344280.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. DS0000068448.V344280.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Court (Community Therapeutic Services Limited) 1 Victoria Park Weston-Super-Mare North Somerset BS23 2HZ 0845 0943233 Address 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) www.cts-homes.co.uk Community Therapeutic Services Ltd Dr David Wing Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places DS0000068448.V344280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia (Code MD) Learning Disability (Code LD) The maximum number of service users who can be accommodated is 6. 2. Date of last inspection 28th March 2007 Brief Description of the Service: Victoria Court is a two-storey Victorian property that is set above the town of Weston-Super-Mare offering views across the seafront and bay. It offers homely accommodation for up to six residents. In addition to provided therapeutic space, it is in easy walking distance of all local amenities. The home is registered with the Commission for Social Care Inspection for people between the ages of 18 to 65 years old and registration category is for people with learning disabilities who may also have mental health difficulties. The service is available to both male and female resident; all rooms are single and have ensuite facilities. Service users needs are met through therapeutic interactions, which respect service users dignity, individuality and privacy and support their rights as individual citizens. There is an experienced staff team on duty over the 24-hour period and access to expert clinical support from consultant psychiatrists. The aim of the home is to support service users through a therapeutic programme toward integrated social living and greater independence. Fees are negotiated on an individual basis according to presenting need. DS0000068448.V344280.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of the home was undertaken with the directors of Community Therapeutic Services Ltd, Dr David Wing and Dr Emily Bladon. We also spoke with one of the people living at the home, and the staff who were on duty. We looked at the records held at the home and used resident surveys to gather information about Victoria Court. An AQAA had been completed and sent to the Commission, this was discussed with the directors as part of the inspection process. The home has been assessed as having some excellent areas of practice, which have been highlighted in this report. The overall assessment is that Victoria Court provides a good level of service to the people who live there. What the service does well: What has improved since the last inspection? Since the last inspection there have been changes made to the systems, which promote the well being of both the people who use the service and the staff. The providers have invested in alarm systems so that people can call for support quickly; there is a safe system of work in place so both residents and staff understand the use of the alarms. The use of Change Picturebank has been embedded in the care planning to aid residents in their understanding of documentation. DS0000068448.V344280.R01.S.doc Version 5.2 Page 6 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. DS0000068448.V344280.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 DS0000068448.V344280.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): 2,3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent making admission to the home personal and well managed. The home has developed a comprehensive Statement of Purpose and Service User Guide, which is very specific to the resident group and considers the different styles of accommodation, support, treatment, philosophies and specialist services required to meet the needs of people who use services. All new residents receive a full comprehensive needs assessment before admission this is carried out by staff with skill and sensitivity. EVIDENCE: Since the last inspection there has been three admissions to the home. One of these was an emergency admission of a person known to the service; the other two admissions were planned that so as to limit any disruption to the established residents and following a process, which was suitable to the person’s, needs. DS0000068448.V344280.R01.S.doc Version 5.2 Page 9 The management of the home have developed individual plans, which include risk assessments and therapeutic support where necessary. There was evidence that the person who uses the service, their family and other professionals worked together to facilitate a comprehensive preadmission assessment and to identify the agreed outcomes of the admission. The process for admission to Victoria Court is individualised and trial periods have agreed and planned review dates. The home uses specialised assessment tools based on best clinical practice. The staff at the home are sufficiently trained and skilled to meet specialist needs, and the assessment processes ensures that potential needs and skill amongst the team are matched. The management at the home have taken into consideration the overall service provision and needs of the current resident community before proceeding with admissions. It is planned that a further two admissions take place over the next six weeks and these will include introductory visits to the home. DS0000068448.V344280.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. The individual understands the information in the care plan. The plan will usually include photos, pictures and is written in plain language. EVIDENCE: The inspector was able to read and confirm with the people who use the service that they have individual care planning and an individual programme of support. The evidence from the written documentation was that the text of plans are in plain English and easy to read avoiding professional jargon. DS0000068448.V344280.R01.S.doc Version 5.2 Page 11 There is a significant amount of information relating to the support of the individual residents at Victoria Court. This is an indicator of the depth of knowledge and professional expertise employed at the home to identify the best type of support and way of working with individuals to enhance their quality of life. The key elements of the support plans are produced as individual care plans and made accessible by use of the Change Picture Bank. The documentation clearly indicated where any restrictions on choice of freedom had been agreed with the person using the service. Also included were agreed techniques for interventions should they be necessary, whilst retaining a focus on positive behaviour and the reinforcement of agreed boundaries. There was evidence that the care plans are reviewed at regular intervals. The care plans contained good quality information with supporting assessments and evidence of evaluation of the support to residents. There was evidence that residents are involved in planning a chosen lifestyle and to work toward agreed outcomes. It was clear from the documentation that the home is successful with planning and working with residents towards independence. The ethos at Victoria Court promotes residents taking decisions by supporting them with information to make an informed choice. Evidence of this was seen in the care plan for one resident who is supported with making decisions about how to spend their money. The risk assessment identified the potential negative outcomes for the resident if control measures are not used, and indicated the agreement of the resident to being supported with financial decisions. This plan of action had been evaluated for success and the control measures renegotiated to allow the resident to take more control. It is acknowledged that the residents may not always make an informed choice in their best interest, and the home use the support of other professional people involved with the resident i.e. consultant psychiatrist, to promote safe decisions. Risk management is central to the function of the home and supporting residents take responsible risks whilst implementing agreed actions to minimise risk is reflected in all of the care planning processes. DS0000068448.V344280.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling people who use services to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. EVIDENCE: At the time of the inspection there were three people in residence at the home. They were made aware of the inspection and had the option to speak with the inspector. One person was happy to talk with the inspector and discussed aspects of their daily life at Victoria Court. The resident was positive about the changes that had happened following their admission. DS0000068448.V344280.R01.S.doc Version 5.2 Page 13 In the time immediately after moving to the home, the resident stated that it was a period of adjustment and getting used to a new place with new people and a lot of different things to do. After a little while a routine was established which allowed them to do the things they wanted as well as to go to college and to make contact with the local Job Centre for opportunities to work. The resident had a full timetable with varied daytime and evening activities as well as being able to use their room which had home entertainment equipment. We discussed the good things about living at Victoria Court, the resident stated that they liked the staff team although some people were new, ‘they were all nice people’. The relationship between the resident and the management was stated to be good, and something that the resident valued. The variety of activities was discussed and the resident stated that they enjoyed exercise through cycling and going to the gym. We also discussed how friends and relations were allowed to visit or phone. The resident was very positive about what they had achieved since moving into the home in April, and the future plans for developing relationships with people outside the home, and possibly living independently. The other people who use the services did not appear to offer any companionship at the moment, but the resident was aware that this might change in the future. The residents are supported to access the kitchen and prepare individual meals; a variety of food is made available to them. DS0000068448.V344280.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services and particularly younger adults are encouraged to manage their own healthcare. Regular appointments are seen as important and systems are in place to ensure they are not missed. The home has developed efficient medication policy, procedure and practice guidance. EVIDENCE: The personal care support at the home is gender specific and the management are working to ensure that the staff gender mix always reflects the personal preferences of the residents. Generally the residents are self-caring and require prompts rather than direct care. If someone is unwell then there is staff support available to them. Since the last inspection there has been no change in the way the home accesses primary health care services on behalf of residents. The home continues to benefit from the support of the local mental health and learning disabilities teams as well as the consultant psychiatrists who are accessed for expert advice. DS0000068448.V344280.R01.S.doc Version 5.2 Page 15 We discussed the implementation of health action plans which may or may not be appropriate to the residents at the home; the necessity for a HAP will need to be linked to the residents’ personal preferences and skills. There is a unit dosage medication system in use at the home; the records and stock levels of medication were checked and found to be correct. DS0000068448.V344280.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supplied with a complaints procedure that they can understand. Complaints from individuals are always recorded, however the records are incomplete with outcomes and actions not being properly logged. All staff understands what restraint is and alternatives to its use in any form are always looked for. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. EVIDENCE: There is an accessible complaints form for residents to use and the home has dealt with three complaints/concerns from residents since the last inspection. When reviewing the record complaints we discussed the necessity of following through the procedures so that the home can demonstrate that the complainant was satisfied with the outcome of the complaint. It was recommended that all elements of complaints are kept in one place i.e. complaints file, with copies on individual resident’s files, this then allows for easier auditing of the system for trends. The home should record concerns if they are raised and the inspector suggested that these are recorded on a specific comment form. By recording concerns from residents it acknowledges that they have been listened to and gives the management the opportunity to respond before a concern becomes a complaint. DS0000068448.V344280.R01.S.doc Version 5.2 Page 17 The home also records any untoward incidents that occur in the home. This again ensures that remedial action can be taken at an early stage to prevent incidents recurring as well as sharing information. The management team will review incidents on a weekly basis. Safeguarding adults training has been provided for all the staff at the home. The recruitment process ensures the protection of the vulnerable adults at the home. There have been incidents that have occurred outside the home where it has been necessary to contact external agencies; these incidents are fully documented on resident’s files. The care plans for the residents may identify that physical intervention may be needed in certain circumstances. The staff team have attended positive response training and are aware of the de-escalation techniques on resident’s files. The Commission are notified via regulation 37 notices of incidents where physical interventions have been used. DS0000068448.V344280.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a very pleasant, safe place to live the bedrooms and communal rooms are larger than the national minimum standard, all bedrooms have ensuite facilities. EVIDENCE: Victoria Court has been refurbished to a good standard and has the facilities that provide a comfortable home for residents. The areas visited by the inspector were clean and tidy. One resident pointed out that the windows in their room were drafty, however, they were also aware that the window was going to be replaced in the near future. The residents have large rooms, which they are encouraged to personalise and use as their own personal space. DS0000068448.V344280.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): 32,34,35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service is proactive in its staffing, recruitment and training. The recruitment of good quality carers is seen as integral to the delivery of an excellent service, the recruitment of the right person for the job being more important to the filling of a vacancy. The service has staff available at all times to support the needs, activities and aspirations of the people using the service. EVIDENCE: The home has a recruitment procedure for all new staff, which ensures that the interests of residents are safeguarded. There has been a significant turnover of staff since the last visit; we were able to have access to and read the personal staff files for six new staff. The records for the other staff had been examined at the last inspection in March 2007. There were no documents missing from the files and the home was able to demonstrate a clear pathway of staff recruitment, induction and training. DS0000068448.V344280.R01.S.doc Version 5.2 Page 20 For some staff there was evidence of individual supervision but this obviously was dependent on the length of time staff had been employed. The staff rota showed that there were a minimum of 5 support staff and one manager on duty each day; in addition to this there is part time administrative staff. We spoke with three members of staff; one who had been employed at the home since March 2007, and two newer members of staff. During the discussions, staff confirmed that there is a structure in the home that allows for team meetings, and day to day support through shift handover sessions. When there are incidents at the home the staff are given one to one debriefing sessions. Staff stated that the felt the strengths of the home were that the team worked closely together and were supportive of each other. The quality and quantity of training that was provided was recognised as being integral to providing a quality service for the people who live at Victoria Court. The number of residents in comparison to staff is low at the moment, but staff stated that they used these opportunities to practise what they had learnt through training. DS0000068448.V344280.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): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a strong ethos of being open and transparent in all areas of running of the home. The manager is person centred in their approach, and leads and supports a strong staff team who have been recruited and trained to a high standard. EVIDENCE: We discussed how the day to day running of the home was achieved, and the management structures in place. Since the last inspection a deputy manager has been appointed who is currently being fully inducted and who will have tasks delegated to them. The administrative systems in place when the home opened are being tested and adjusted where needed. The focus has been on health and safety systems with a personal alarm system for staff now in place. DS0000068448.V344280.R01.S.doc Version 5.2 Page 22 We discussed the number of incidents and accidents recorded; currently these are being audited for any trends. Incidents will be reviewed on a weekly basis at the management meeting to allow for any remedial action to be taken. Overall the management of Victoria Court since it opened in March 2007 has been successful, the home has been very busy despite the low resident numbers. Both the people living there and the staff team were happy with the open style of management and that they can personally approach the proprietors. The regulation 37 notifications received by the Commission and follow up action to prevent any reoccurrence demonstrate that the wellbeing of the people using the service is the priority for the service. DS0000068448.V344280.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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 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 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 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 3 X 3 X 3 X X 3 X DS0000068448.V344280.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA22 YA24 Good Practice Recommendations All records relating to complaints are held in one place to allow easy monitoring of procedure. The business planning incorporates the replacement of the windows to ensure resident comfort and safety. 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