CARE HOME ADULTS 18-65
Victoria House 1 Victoria Terrace Plymouth Devon PL4 6BL Lead Inspector
Brendan Hannon Unannounced Inspection 10:30 12th January 2005 Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 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 Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 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. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Victoria House Address 1 Victoria Terrace Plymouth Devon PL4 6BL 01752 661171 01752 661171 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 Regard Partnership Limited Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: Victoria House is made up of two individual terraced houses. Each house/unit has its own communal facilities, kitchen and staffing rota. No.1 Victoria Terrace has accomodation and communal facilities for six residents and No.2 Victoria Terrace, next door to No.1 within a terraced street, has accomodation and communal facilities for four residents. The home is situated within walking distance of local shops and amenities and the City Centre of Plymouth. Neither house is suitable for people who have significant mobility difficulties. The home is owned by the Regard Partnership Limited. Both houses are registered for people aged between 18-65 years who have a moderate learning disability and may have behaviours that challenge services. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. Preparation for the inspection included analysis of the annual pre inspection questionnaire and the previous inspection report. An inspection plan was developed from this information. The inspector was in the home for 3.0 hours from 10.30am to 1.30pm. The inspector looked into the care of the existing residents and spent time with the three residents who were present at times during the inspection. The whole of the building was inspected. The manager and three staff were spoken with during the inspection. The manager was spoken with at length. Care planning files, care delivery records, medication records and general records were inspected. What the service does well:
The home has a reasonably stable staff team. The management and staff aim to provide a homely and comfortable place for the residents to live. Within the Statement Of Purpose the service describes clearly the needs that it can meet. The service has assessed the needs of prospective residents to ensure that both their needs can be met at the home and that existing residents needs will continue to be met. All the residents enjoy enough leisure and valued life activity. The residents are supported to maximise their independence both inside and outside the home. The service has enabled the residents to develop an individualised lifestyle based on their individual interests and needs. Residents receive enough varied good food. The home was previously commended for the involvement of the residents in the choice, purchase and preparation of their food. Residents’ personal care, health and medication administration needs are met by support from an effective staff team. The residents benefit from a homely, comfortable, clean and well maintained building. The organisation has invested considerably in the facilities and decoration of the home. This redevelopment work in particularly No.2 has been completed to a high standard. Resident’s needs are met by enough, competent staff. The manager maintains an open resident focussed style of management. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 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 Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Prospective service users are able visit the home. Pre admission assessments ensure that Victoria House will be able to meet service users care needs. Service users guides are not yet available to prospective residents. EVIDENCE: The Statement Of Purpose has been updated, but a Service Users Guide (SUG) is still not available. A SUG that complies with the Care Homes Regulations must be available for existing and future residents and their representatives to tell them about the service they can expect to receive. The service should also redevelop the SUG in formats to meet the different communication needs of the residents. The home has an admissions procedure and a pre admission assessment document was available on a new residents file. This document gave a full and comprehensive assessment of the residents needs. This allowed the service to judge that not only was the home appropriate to meet the new resident’s needs but also that they would be appropriate to the existing residents in the home. The organisation carries out an assessment of any prospective service user, and they are offered trial visits and stays at the home if they wish. All residents have a contract in place. Statements of terms and conditions have been distributed to the home by the organisation for those residents who are funded by a local authority. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 Service users can be assured that staff will enable them to be as independent as possible and be encouraged to safely participate in all aspects of life in the home. EVIDENCE: For each resident there was a care plan in place covering identified areas of need. This care plan is broken down into a pen picture, strengths and needs, action plans, behaviour management plans where necessary, and individual risk assessments. Though some issues were identified in general the care plans are detailed and comprehensive. The Regard Partnership service policies define the frequency of reviews for individual plans. The National Minimum Standard for the frequency of reviews is met. Routines of daily living, community participation and social/leisure activities were all present in these plans. All agreed restrictions of choice or facilities should be documented within all residents plans or risk assessments. Service users plans showed clearly residents activity throughout a normal week. Activities outside the home should be risk assessed and these assessments documented. The participation of each resident in the home depends on the level of his or her abilities. Residents are encouraged to participate in all aspects of life in the home. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15,16,17 Residents have appropriate activities to ensure a good quality of life. Residents receive enough, varied, good food. EVIDENCE: From discussion with residents, discussion with the manager, and information from care plans it was evident that staff support residents to participate in activities in the community. Service users are encouraged to use various forms of public transport such as buses and taxis. They also access ordinary community facilities such as further education colleges and shops. Service users confirmed that they enjoyed a holiday in 2005, and some service users have enjoyed visits to their families with the assistance of staff. The atmosphere in the houses was relaxed. Residents commented that they enjoyed the meals. Residents help to plan the menus, shop, prepare, and cook the food. All service users have made a list of their food likes and dislikes. A food record is kept in the daily planner. There is a four week menu plan to use as a guide. The service was previously commended for the quality of the food provision and the involvement of the residents in this area of daily life. This commendation is continued in this report. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Residents’ wellbeing is maintained by meeting the residents’ personal care needs and through the effective administration of their medication. EVIDENCE: Some service users have behaviours that challenge services, and although empowerment is difficult, it is being promoted, along with valued lifestyles within the necessary behaviour boundaries. Behaviour management plans are in place where necessary and all staff receive specific training in this area of care. Most service users need only verbal prompts to maintain personal care tasks. Personal care needs and the directions to staff to meet these needs are clearly documented within care plans. There is a medication policy and procedure in place. A monitored dosage system of medication administration is in use. All members of staff who administer medication have received accredited training. Appropriate controlled drug storage is in place. Medication administration recording was accurate and well kept. Residents and their representatives can be assured that residents prescribed medication is being appropriately managed and administered. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not inspected on this occasion. EVIDENCE: This section was not inspected on this occasion as both these core standards were inspected at the last inspection in May 2005, at which time both standards were met. There have been no complaints reported to the CSCI during 2005. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,30 The residents benefit from a homely, comfortable, clean and well maintained building that has been appropriately adapted to meet their needs. EVIDENCE: A great deal of refurbishment and interior building alteration has been completed in both houses during the last 12 months. At No.1, the lounge has been redecorated to a high standard. At No.2 a fourth bedroom with ensuite toilet and shower has been built as well as a new bathroom on the first floor, a new soak away shower in the old bathroom on the ground floor and a new office also on the ground floor. New carpets have been laid throughout No.2 and only one vacant room has not been completely redecorated. The conservatory roof has also been completely replaced making this room into a safe and comfortable all year round seating area. The low banister railing at the head of the stairs has not yet been dealt with as identified at the last two inspections and by the environmental health officer. The manager has agreed to risk assess this issue. Toilet and bathroom door locks have now been replaced by locks that can be overridden from the outside. All windows are fitted with window restrictors. However these restrictors are routinely overridden to open these windows fully. Therefore wherever this type of restrictor is fitted these window openings
Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 14 should be risk assessed. The manager stated that none of the existing residents are at risk from these window openings. In both houses, bedroom doors are lockable, residents have been offered keys and some residents are using either bedroom door or front door keys to provide security for their belongings and increase their independence. All the bedrooms were personalised, and residents said that they liked their rooms. A sink is being fitted in the vacant bedroom in No.2. Both houses provide adequate numbers of toilets and bathrooms. Both homes have a no smoking policy, and any residents who wish to smoke do so outside. The office in both houses is available to provide a staff sleeping in facility as well as space for administration. Staff are only ‘sleeping in’ at night in No.1 Victoria Terrace. The laundry was moved into an internal room in No.1 approximately 18 months ago. It was previously recommended that the washer and dryer be vertically stacked to promote residents’ use of the laundry. This has been done and the laundry room is now much more accessible. On the day of the inspection both houses were clean and hygienic. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 Resident’s needs are met by enough competent and trained staff. EVIDENCE: All staff have a job description and are aware of their roles and responsibilities. The staff team are trained in a number of key areas, such as First Aid, challenging behaviour, medication administration, the Learning Disability Award Framework and NVQ qualification. There are two different staffing regimes in the two houses due to the differing needs of the client groups in the two houses. The staffing rotas evidenced appropriate numbers of staff on duty at all times meeting both resident need and contracted staffing levels agreed with some local authorities. In No. 1 there is a minimum of 2 staff on duty at all times during the day, and at night there is one ‘sleeping in’ staff. In No. 2 there are three staff during the daytime and a ‘waking staff’ at night. The staff have been appropriately trained to work with service users whose behaviour challenges services. This training is given to all staff and is renewed annually. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The management of the home is effective, ensuring that residents needs continue to be met. The organisation has not made application for the registration of a manager within a reasonable timescale. EVIDENCE: The position of registered manager is formally vacant at present. An application for registration of the existing manager, Mr Keith Morgan, has been requested for some time. An immediate requirement for application to be made to register a manager was issued at this inspection. Mr Morgan has 13 years experience as a support worker, senior support worker and deputy manager before taking over the manager’s post for this service. He is currently pursuing the Registered Managers Award. It was observed during the inspection that there was an open and direct style of management being used in the home. It was evident from communication between staff and residents that there are good relationships between the staff and residents. The organisation has begun to develop a resident focussed quality assurance system. However this is at an early stage and no quality assurance process is expected in the near future.
Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 17 The following section covers health and safety. All the radiators in both houses are covered, and all hot water outlets have temperature regulators fitted. These physical adaptations, if working effectively, will eliminate the risk of burns and scalds to the residents from hot surfaces and hot water. The accident book was reviewed and there have been no reported accidents since the last inspection. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 X 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 X 3 X X X CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Victoria House Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score 1 X 2 X 3 X X DS0000044465.V258026.R01.S.doc Version 5.0 Page 19 Yes 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 YA1 Regulation 5 Requirement A Service Users Guide that complies with regulation 5 of the Care Homes Regulations and standard 1.2 of the National Minimum Standards must be available in the home. Original timescale for action 30/09/05 – extended. The manager in charge must apply for registration. Timescale for action 01/04/06 2 YA37 8 28/01/06 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 YA1 YA6 Good Practice Recommendations The service users guide should be made available in a format that is accessible to the residents. Individual risk assessments should be in place for each resident’s external activities. All agreed restrictions in place to protect the welfare of the residents should be documented in care planning. A resident focused quality assurance system should be developed and implemented. 3 YA39 Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 20 4 YA42 Risk assessments should be in place for all window openings where the window restrictor can be easily overridden. Victoria House DS0000044465.V258026.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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