Care Home: 15 Cliffe Avenue

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What the care home does well The home was clean and hygienic in all areas at this time and continues to be improved through redecoration. Every day is started with the service user choosing what they wish to do. One service user was at home at this time undertaking a `house day` during which activities such as cleaning, personal shopping and cooking or eating out are undertaken. Other service users had gone swimming. Daily activities were clearly shown on individual daily planners that are shown in the conservatory area and also on a large wipe clean board. This identifies the activity and what support is required. Service users are supported to become as independent as possible and to develop daily living skills. Staff ensure this by encouraging and enabling service users to participate in the local community and enjoy local amenities. Three service users are currently working towards becoming independent and moving into supported living. What has improved since the last inspection? Care plans are now presented in an indexed folder and these are also being further developed to identify and collate clear healthcare information. Choices are given at all times with each day being spent as the individual wishes. Planned outings/activities are only undertaken if the service user chooses to participates, if refused, then alternatives are offered until a suitable activity is decided upon.Since the last inspection, staff recruitment has ensured there is now a permanent staff group that provide support for service users and ensure a stable environment in the home. The garden now has planting areas that some service users choose to help and assist with. A new dining table and chairs have been purchased, to provide more of a communal experience for service users and to enable joint activities to be enjoyed. What the care home could do better: While care plans have been reviewed, this has been undertaken on a two monthly basis and these need to be reviewed monthly to fully comply with national minimum standards. CARE HOME ADULTS 18-65 15 Cliffe Avenue Westbrook Margate Kent CT9 5DU Lead Inspector Brenda Pears Key Unannounced Inspection 7th July 2007 10:30 15 Cliffe Avenue DS0000023322.V340136.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 15 Cliffe Avenue DS0000023322.V340136.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. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 15 Cliffe Avenue Address Westbrook Margate Kent CT9 5DU 01843 232122 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 Royal National Institute for Deaf People Post Vacant Care Home 5 Category(ies) of Physical disability (5), Sensory impairment (5) registration, with number of places 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2007 Brief Description of the Service: 15 Cliffe Avenue is situated in a residential area with access to Margate and local amenities. The Home is registered for five people with a physical disability and this can be for the long term or as part of a programme for increased independent living. The home has appropriate alerts to fully support people with a hearing loss and there is currently one room vacant. The building is a large terraced house and is part of the Royal National Institute for Deaf People (RNID) organisation. The building is in keeping with others in the area and the style and ambience supports the Home’s purpose of providing a home for long term or as a stepping-stone towards independence. The fees for support from the home are set during the assessment period and are very individual to the needs of the service user, depending on the level of support required and the staffing numbers provided. A guide to average fee levels at this time range from a minimum of around £2,000 to a maximum of around £3/4,000 per week or more depending on the support needs as stated. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken with a focus on the well being, safety and quality of life for service users living in the home. The methods of inspecting the home included speaking to service users, the acting manager and members of staff. A tour of the building and observations of both staff and service users at this time are reflected in this report and outcomes. The acting manager explained that plans are being developed to extend the services being provided by 15 Cliffe Avenue. It is hoped that this provision will develop referrals to assisted living and extend the support currently being provided in the home. What the service does well: What has improved since the last inspection? Care plans are now presented in an indexed folder and these are also being further developed to identify and collate clear healthcare information. Choices are given at all times with each day being spent as the individual wishes. Planned outings/activities are only undertaken if the service user chooses to participates, if refused, then alternatives are offered until a suitable activity is decided upon. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 6 Since the last inspection, staff recruitment has ensured there is now a permanent staff group that provide support for service users and ensure a stable environment in the home. The garden now has planting areas that some service users choose to help and assist with. A new dining table and chairs have been purchased, to provide more of a communal experience for service users and to enable joint activities to be enjoyed. 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. 15 Cliffe Avenue DS0000023322.V340136.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 15 Cliffe Avenue DS0000023322.V340136.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): 2,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of any new service user are assessed before a move into the home and contracts are issued, ensuring full awareness of individual needs. EVIDENCE: The current service users have lived in the home for some years, there is currently one room vacant. A previous review of files has shown that pre admission assessments are undertaken. Assessments include information about behaviours and guidelines for staff and how to provide support with targets to work towards. Terms and conditions are issued for all new admissions and contracts are held by RNID head office. Visits to the home are encouraged prior to admission, short stays and visits for meals and participation in daily routines are also undertaken ensuring the placement is appropriate. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 9 15 Cliffe Avenue DS0000023322.V340136.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 adequate. This judgement has been made using available evidence including a visit to this service. Individual plans have been redesigned and goals and individual needs continue to be developed, but these must be regularly reviewed on a monthly basis to fully support the well being of service users. EVIDENCE: Each day is started with the service user choosing what they wish to do and one person was enjoying a ‘house day’ during which activities such as cleaning, personal shopping and cooking or eating out are undertaken. Staff were seen to be ensuring service users had choices and that choice was then respected. Each person has their own routine and their unique way of communicating and at this inspection service users were given time and 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 11 appropriate consideration by staff. Service users are treated appropriately with due consideration for privacy and respect. Staff explained that one service user had agreed to be taken to the hairdressers recently. On arrival, the person pulled their hood over their head and this was taken as a clear indication that hair was not going to be cut on this occasion. Care plans have been reviewed every two months but this must be undertaken on a monthly basis to fully comply with the national minimum standards. Reviews are carried out with care managers and families wherever possible, but the acting manager explained this has become increasingly difficult with some local authorities. Care managers are changing roles or leaving their positions and this causes problems with continuity and with the provision of care. The home continues to arrange these reviews and will endeavour to secure appropriate funding to fully meet the changing needs of service users. The storage of care plans was discussed and the acting manager stated that following this inspection, they would be moved into the secure office area. 15 Cliffe Avenue DS0000023322.V340136.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. Service users enjoy their chosen activities, many of which are undertaken in the community, providing both choice and control. EVIDENCE: Events in the home are undertaken with the full involvement of service users. Choices are supported and encouraged, with daily routines being developed to ensure the wishes of the individual are met. The review of care plans are also undertaken with participation of family/care manager and /or any person who is important to the service user, after obtaining their permission. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 13 Likes and dislikes are recorded on care plans and activities chosen by any person are supported with appropriate staffing levels. Daily routines in the home are chosen by each service user at the start of the day and these choices are displayed on a board in the conservatory area. One person continues to carry out a newspaper round and other activities include bowling, trips to the pub and swimming. Discussions at this time and previous sampling of records confirm that activities and outings are regularly undertaken in the community. Service users make their own choices regarding where and when these trips are undertaken. Three service users are being supported towards becoming independent and moving into supported living. This has been accomplished with previous service users and staff continue to work hard to achieve independent outcomes. Advocates support service users where possible and others enjoy regular contact with families. One service user has recently been to the Caribbean for a holiday having undergone a major operation. This operation has been worked towards and various forms of communication have been used to ensure the person fully understood what was to be undertaken at hospital and the reasons why. This August, some service users are going on holiday to France. One person will be taking individual days out and special outings as a long journey is not suitable for this person, all holidays have been fully risk assessed. 15 Cliffe Avenue DS0000023322.V340136.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. Medication is appropriately stored and administered by staff who do ensure the well being of service users. EVIDENCE: Health professionals provide support that enables staff to meet care needs for each service user. All service users have access to appropriate healthcare professionals and visits are recorded on care plans. Staff do consider the physical and emotional needs of service users. Medication is appropriately stored in the home. The acting manager explained that storage is currently being risk assessed to move individual medication into the service user’s room. This will support independence and give additional control to service users. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 15 All appointments are clearly written on a yearly appointment planner that supports a document known as ‘Healthcare plan’ that has been developed in the home. This has been produced to provide full information about each service user to ensure any decisions are made with the appropriate information at hand. This document includes medical history, current medical information, all healthcare appointments and their outcomes, any ongoing medical issues and regular appointments such as dentist. There are also clear instructions on how to support the individual at any of these appointments. Current medication being taken is fully listed, not just a referral to ‘see medicine charts’. This file will include all healthcare needs and information that will support medical appointments. 15 Cliffe Avenue DS0000023322.V340136.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged and supported to share any problems they may have and are protected from abuse. EVIDENCE: The home has organisational policies and procedures in place to protect service users. The manager stated that no complaints have been received since the last inspection was undertaken. There are laminated indicators in every service user room that asks how the person is feeling and if they have anything that they need help with or want to discuss. These questions are also supported by symbols (Widget) to assist communication. Records show what responses are given and also clearly state when the person has refused to answer, or refuses to participate. Discussions with staff showed that attention is given to the moods and actions of each service user to ensure their choices and wishes are at the centre of the routines in the home. At the beginning of every shift, a form is completed that is signed by the senior taking over the shift. The balance of all money that is held for each service user is counted and balances agreed, the diary is read and medication is also signed over. This provides a clear audit trail that ensures any discrepancies are quickly identified and can be checked at any time, or if an error is found. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 17 Protection of vulnerable adults (POVA) training is booked for September 12th and information is available in the home regarding actions to be taken in any case of suspected abuse. 15 Cliffe Avenue DS0000023322.V340136.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users rooms are personalised and individual and communal areas continue to be improved through the ongoing improvement programme. EVIDENCE: The home continues to be improved with an ongoing redecoration and refurbishment programme. The lounge area provides a bright and comfortable communal room that is soon to be redecorated. The dining room flooring is to be replaced as the previous covering was not suitable. The kitchen is to be totally replaced and the home is awaiting the third quote for this work. The shower room is currently locked as this is not in a suitable condition for use, service users currently use the bathroom on the first floor. There is a small garden area to the rear of the home and this now has two planting areas that are tended by staff and the service users who choose to help with this. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 19 Service user rooms are very individual and comfortable and have been regularly decorated. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are appropriately trained and the numbers of staff provide support for the current service users. EVIDENCE: All staffing levels are set after an assessment of daily needs is undertaken. Depending on the daily activities, the rota then reflects the staffing levels that are required. Staffing at the time of this inspection consisted of the acting manager and three care staff, with an additional member of staff due on duty at 1.30pm. There is an on call system and one person undertakes sleep in duties during the night. The manager explained that all service users usually sleep through the night. Training and service user needs are at the centre of all plans and service delivery in the home. All CRB checks are in place prior to any new person starting work in the home, which ensures the full safety of service users at all times. All core training is currently up to date and refresher courses are now being booked where needed. All staff have undertaken training for the 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 21 management of potential aggression (MAPA) and the home continues to work closely with BILD to develop independent care plans. The home has previously sent any reported incidents to the appropriate agencies and it is noted that these incidents have decreased over the last few months. During this time, the staff group has stabilised and routines in the home have settled. All these occurrences have helped to produce a calmer and more stable environment in the home. Staff have also experienced less sickness as when days off are due, staffing allows these to be taken regularly. The permanent staff group now cover any gaps in the rota and this has also cut out the use of agency staffing levels in the home. The staff at 15 Cliffe Avenue have recently received an award for being the most improved service within the RNID. The office area is now more organised and provides an improved working space. The bed used for sleep in duties remains in the office. There is now more room available and some additional filing cabinets are to be obtained to further support staff and the suitable storage of paperwork. The organisational head office obtains all paperwork for new staff and copies are issue to the home to keep on files for evidence. The inspector was shown files that have been reviewed and now contain the required paperwork. Appraisals have recently been undertaken and regular supervision is also undertaken. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is an appropriate person to be managing the home and the safety and welfare of service users is maintained through practices being undertaken in the home. EVIDENCE: 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 23 The acting manager has 25 years care experience and has also worked with a psychiatric unit in Nottingham. After moving to Eastbourne he worked with a community mental health team and later managed a residential unit for people with learning disabilities and mental health problems. He has worked for RNID since May 2006. The health and well being of service users is considered at all times and staff expressed a thorough knowledge of service user needs. Any change in the personal or physical needs of service users is clearly recorded and procedures drawn up to ensure appropriate and full support at all times. A quality assurance questionnaire has been developed to obtain the opinions and comments of family members and friends. This information will assist the home to identify any areas that need attention or how the home can improve services. The acting manager explained that this questionnaire will be sent out at this time and then again next year to assist with any further developments in the home. An up to date insurance certificate is required, as this comes directly from the organisation, the acting manager stated that a copy certificate will be obtained. The manager stated that a test of electrical items has been booked as this is now due, other services are up to date, fire exits are clearly signed and no COSHH items were in evidence at this time. 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 24 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 3 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 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation YA 15, 17 Requirement A full review of service user files to be completed and evidenced on a monthly basis. (Brought forward from last inspection, partly met at this time) Timescale for action 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 15 Cliffe Avenue DS0000023322.V340136.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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