Inspection on 18/07/06 for Zion House

This inspection was carried out on 18th July 2006.

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

Zion House 16/01/06

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Zion House Zion House Trevellas St Agnes Cornwall TR5 0XS Lead Inspector Ian Wright Key Unannounced Inspection 18th and 20th July 2006 16:30 Zion House DS0000064502.V300776.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 Zion House DS0000064502.V300776.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. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Zion House Address Zion House Trevellas St Agnes Cornwall TR5 0XS 01872 552650 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) Mrs Paula Elizabeth Stevens Mr Malcolm Stevens Care Home 8 Category(ies) of Learning disability (7), Physical disability (1) registration, with number of places Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 8 adults with a learning disability (LD) Service users to include up to 1 adult with a physical disability (PD) One bedroom can be used to accommodate 2 service users until 30.06.06 Total number of service users not to exceed a maximum of 8 Date of last inspection 16th January 2006 Brief Description of the Service: Zion House provides residential care for eight adults with a learning disability, one of whom also has a physical disability. Mr and Mrs Stevens are the registered providers, and also live on the premises. The home is situated in the hamlet of Trevellas, which is between St Agnes and Perranporth on the north coast of Cornwall. Accommodation is provided on the ground floor with 8 single bedrooms. Service users have access to a lounge, dining area, kitchen, and bathroom / toilet facilities. Three of the bedrooms are within a recently built extension, and provide en suite facilities. There is a garden with a sitting area, which service users can use. The home is accessible for people with a physical disability. A copy of the inspection report is available in the lounge, and it is suggested a copy is requested from management or CSCI if required. The range of fees at the time of the inspection is £324-£1113 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection took place in seven and a quarter hours over two days. All of the Key Standards were inspected. The methodology used for this inspection was: • To case track four service users. This included, where possible, meeting and discussing with the service users their experiences, and inspecting their records. • Discussing with staff their experiences working in the home. • Discussion with other service users and their representatives. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? The registered providers have made considerable effort to upgrade the premises-even though they have historically been to a good standard. Changes include providing three new en suite bedrooms. This has not increased the number of service users accommodated. It has however ensured no service user now has to share a bedroom, and there are improved facilities for a service user who has a physical disability. These changes, completed at considerable expense, are commended. The work has been carried out to a high standard although there are some minor works, which need to be addressed. Suitable action has been taken to action the previous statutory requirements. The medication, and adult protection policies have been updated to assist staff to follow the correct procedures and regulations. There is a paper towel Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 6 dispenser in the communal toilet, and the floor covering in the shower room has been replaced. 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. Zion House DS0000064502.V300776.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 Zion House DS0000064502.V300776.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Service users funded by Cornwall County Council receive a social service contract at the time of admission. This enables service users to be aware of their rights and responsibilities. The pre admission assessment procedure is good, and, if used, will enable the registered persons to ascertain they can meet the needs of service users, before admission is arranged. However there have not been any new admissions for a considerable period of time. EVIDENCE: Copies of social services contracts of care are available for inspection. The home has not had any recent admissions, but the registered providers have developed a suitable assessment policy and procedure. Some service users have been reassessed while living at the home, and copies of health service assessments were available on service user files. Zion House DS0000064502.V300776.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. All service users have a care plan and these are reviewed. This ensures staff have suitable information to provide care, and care plans are amended when changes in service users’ needs occur. Service users are encouraged to make decisions about their lives with suitable assistance as required. The registered providers approach to handling service users monies is satisfactory, so service users can be assured their financial interests are safeguarded, where the registered providers are involved in this area of their lives. The registered providers have a suitable approach to risk, so service users can be assured they will be supported to take risks as part of an independent lifestyle. EVIDENCE: There is a copy of a care plan in each service user file. Staff said care plans were accessible to them. The care plan format is comprehensive and gives clear guidance to staff regarding service user needs. Service users said they were aware of their care plans and are involved in drawing up them. There is suitable evidence that care plans are reviewed on a monthly basis. Service users and staff said service users are encouraged to make decisions regarding their lives. Suitable risk assessments are in place to assess any risks Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 10 or actions to promote independence. The registered providers look after some service user monies, for which suitable records are maintained. The registered provider acts as agent for some service users’ benefits for which suitable records are kept. The registered provider has a satisfactory policy regarding diversity and equality. There are currently no service users from ethnic minorities, although the registered providers stated they would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Zion House DS0000064502.V300776.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this area is generally good. The judgement has been made using available evidence including a visit to the service. Service users can participate in a suitable range of activities, and are able to mix with the wider community. Service users are encouraged to maintain relationships with friends and relatives. Service users rights are respected, and service users are enabled to take a suitable amount of responsibility in their daily lives. Suitable arrangements are in place so service users enjoy a healthy and varied diet. EVIDENCE: Service users said they attended the day centre in Redruth during the week. All said they enjoyed going there. Some service users said they also went to college, although this had currently broken up for the summer holidays. Service users and staff said other activities were also arranged in the evenings and at weekends. For example service users go for walks and go out in for trips in one of the registered provider’s vehicles. Service users also go swimming, and visit shops and markets. Activities are also arranged in the house for example the practice of literacy skills are encouraged. Service users said they visit friends and relatives regularly, and they are encouraged to maintain contact via the telephone or post. Visiting Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 12 arrangements are flexible, and there is suitable space for service users to receive visitors privately. Service users said they could get up and go to bed when they wish, although some may need reminding to get up on the days they attend the day centre. Service users said staff worked with them in a way, which respected their privacy and dignity. For example staff knock on doors, and mail is not opened without service users’ agreement. Locks are fitted to bedroom doors, and service users each have a lockable cash box to store money and valuables. Service users and staff said service users have some involvement in household tasks for example doing laundry, some cleaning tasks etc. The inspector shared a meal with service users, which was to a high standard. The meal consisted of home made quiche, and salad. Fruit fool, and fresh fruit was provided as a sweet. Service users all said they enjoyed the food provided, and said it was provided in sufficient quantities. Suitable records are maintained regarding food provided. Zion House DS0000064502.V300776.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Personal care is delivered to a good standard, and there are suitable links with medical professionals. Service users medicines are managed appropriately. Service users can therefore be assured there personal and health care needs are met appropriately. EVIDENCE: Service users said they received suitable care and support from staff. Any personal care needs are clearly documented in care plans, and staff seemed clear regarding what assistance service users need. Care plans document appropriate links with GP’s, dentists, chiropodists and other professionals. Service users said they regularly saw medical professionals when required. The registered provider and other staff reported no problems with links with medical professionals. Medication is stored securely, and dispensed via a ‘monitored dosage system’. Medication records kept are appropriate although one dosage appeared not to be signed for on one occasion. There is a suitable medication returns system. Staff have received suitable training regarding the handling of medication. However at least two staff have not received a certificate from the college for the training they had received. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 14 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): 22, 23 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered providers have suitable procedures regarding complaints and adult protection. Subsequently service users can be assured there are appropriate procedures to deal with any concerns or bad practice. EVIDENCE: The registered provider has satisfactory procedures regarding complaints and adult protection. Staff and service users showed some awareness of the procedures, and were able to say whom they would approach if they had a complaint or were concerned about abuse. Staff and service users all said they had not witnessed any bad or abusive practices. All staff have Criminal Record Bureau check, and a Protection of Vulnerable Adults check (where applicable). Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 15 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, 30 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Zion House provides a pleasant, homely, clean and well-maintained environment for service users to live and feel at home in. Some minor works need to be completed regarding the new extension. EVIDENCE: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and homely. There is a pleasant garden which service users can use. Garden furniture is provided so service users can sit outside. All communal rooms are homely and comfortable. There is a lounge, and a dining room. Bedrooms are individualised and comfortable. All decorations are maintained to a good standard. The registered provider has recently built an extension, which contains three en suite bedrooms. Although this does not increase the numbers of service users accommodated, each service user now has their own bedroom in cases where two people used to share. The new bedrooms are to a very high standard, and provide an en suite toilet, and shower. One bedroom is for a wheel chair user. The three service users are currently in the process of moving in to their new bedrooms. All eight bedrooms are suitably individualised. There are suitable shared bathroom and Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 16 toilet bathrooms, which are lockable. Suitable kitchen and laundry facilities are provided. The home was clean and hygienic at the time of inspection. There are still some minor works regarding the new extension which need completed. An inspection was completed to register the new rooms on 3rd July 2006. As outlined in the visit’s inspection report, Mr Stevens said he would blank off the door handle furniture in the bedroom for a person with physical disabilities, as this door is not going to be used. This has been agreed as satisfactory by the fire authority. Secondly, Mr Stevens said Room 3 will not be used, until a window has been knocked through the wall. These works still need to be completed. The service user from this bedroom is moving into one of the new bedrooms. Any outstanding works regarding the building work need to be completed. The Commission for Social Care Inspection also still needs confirmation from Building Control that the work complies their standards. Some landscaping work also needs completion preferably by the end of 2006. Mr Stevens said he will be redecorating the service users’ lounge and Room 3 shortly. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 17 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): 32, 34, 35 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Staffing levels appear satisfactory so service users can be assured they will get suitable levels of staff support. Recruitment records are good so service users can be assured there are suitable recruitment procedures and checks in place. Staff training provision is good so staff receive appropriate training as required by regulation. This should assure service users that staff have suitable skills and knowledge to cater for their needs. It is recommended staff receive some additional training in dementia, autism and epilepsy. Equal opportunities issues regarding recruitment and work practices seem satisfactory. EVIDENCE: The registered providers live on the premises with their family and provide the ‘sleep in’ cover. Rotas show at least two members of staff are on duty in the evening and at weekends. There are sometimes three staff on duty during the daytime at the weekend. A cook is also employed Monday to Friday who prepares the evening meal. The registered providers also work in the home, and assist staff with providing care. The registered providers have a suitable approach to providing National Vocational Qualifications for care staff. Some staff are due to enrol to complete an NVQ 2 qualification from September 2006. Staff training required by regulation is appropriate. Staff training includes most staff having a first aid certificate (at appointed persons level), training in manual handling, fire Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 18 training, and food handling. Staff have also attended a health and safety course. The registered provider has had difficulty obtaining infection control training, although the registered provider said this issue was covered on the health and safety course staff completed. The registered provider was given the telephone number of the infection control nurse who may be able to provide some additional training. It is recommended the registered provider obtains training for staff in dementia, autism and epilepsy. Although service users who have these diagnoses have been accommodated at the home for many years, and care is appropriate, this training would assist in providing staff with a deeper understanding of these conditions. Recruitment records were inspected. Most staff have been employed for some time. Suitable records are maintained for all staff such as an application form, two references and a record of staff induction. All staff have a Criminal Records Bureau check (and Protection of Vulnerable Adults check-as applicable). The registered provider’s approach to equal opportunities and anti discrimination is satisfactory. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 19 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): 37, 39, 42 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered providers appear to be suitably experienced, skilled and qualified to manage the home. There is a suitable quality assurance system in place. The management of health and safety issues is good so service users can be assured they live in a safe environment. EVIDENCE: The registered providers appear caring, approachable and competent. The staff the inspector spoke to say the providers were good to work for, and provided sufficient guidance and support to help them to do their jobs. The providers work day to day in the home and have a good knowledge of service users. Mrs Stevens has an NVQ 4 in care and a Registered Managers Award. Service users were positive about the registered providers approach. The registered providers have a suitable approach to quality assurance. A survey has been completed of stakeholder views and these are positive. A summary report of the findings was produced. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 20 The registered provider has a suitable health and safety policy. Regular health and safety checks are completed. Other records kept of checks required by regulation are satisfactory. For example there are suitable records of the testing of fire equipment, the central heating system, portable electrical appliances and the electrical hardwire circuit. Accident records are suitably maintained. Health and safety risk assessments are satisfactory. Although checks to prevent Legionella are satisfactory, a risk assessment needs to document the checks, which are completed. This needs to be available for inspection. The Environmental Health Department can provide a leaflet outlining what this should include. Although the registered provider’s said an electrical hardwire test had been completed the documentation was not available for inspection. A copy of this needs to be obtained and available for inspection. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 21 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 3 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 2 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 3 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 3 X 3 X 3 X X 2 X Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA26 Regulation 16, 23 Requirement Timescale for action 30/09/06 2. YA42 13, 23 The registered provider must: • Complete any outstanding works regarding the new extension as outlined in the report. • Forward Building Control approval for the building works as soon as possible. 30/09/06 The registered provider must ensure there is: • A risk assessment outlining suitable steps regarding the prevention of Legionella. • A certificate for the electrical hardwire test. available for inspection. Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA35 Good Practice Recommendations Staff should receive training to increase their awareness of people with: • Dementia • Autism • Epilepsy Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 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 Zion House DS0000064502.V300776.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!