Care Home: 20 Towngate East

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What the care home does well Residents coming into this home receive a detailed assessment to ensure the home can meet their needs. They are supported and encouraged to make choices about what they wish to do and contribute to the running of the home. They are enabled to enjoy a positive lifestyle through varied activities, contact with the local community, contact with friends and family. They live in clean, safe and comfortable accommodation. Staff are correctly recruited and receive a comprehensive and varied training in order to support the people living in the home. The staff are skilled and committed to provide a person centred approach to care. What has improved since the last inspection? All requirements from the last key inspection had been addressed.The environment of the home had been improved by providing 3 specially adapted beds, adding new decoration to the lounge/dining room areas and they have provided new flooring in the kitchen and dining room and one bedroom. The garden had been tidied up and made more accessible. 3 bedrooms had been redecorated and a downstairs toilet installed. Work had been completed to make sure care plans were person centred through the use of easy to read symbols and pictures. Comprehensive health and safety audits had been introduced. What the care home could do better: There were no requirements or recommendations from this key inspection. Where improvements are required these were in the process of being addressed by the manager, staff and or the company. CARE HOME ADULTS 18-65 20 Towngate East Market Deeping Lincolnshire PE6 8DR Lead Inspector Tobias Payne Unannounced Inspection 9th April 2008 08:05 20 Towngate East DS0000002309.V362133.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 20 Towngate East DS0000002309.V362133.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. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 20 Towngate East Address Market Deeping Lincolnshire PE6 8DR 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) 01778 342091 towngateast@tiscali.co.uk Voyage.com Voyage Care Services Miss Joanne Lesley Dawson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories: Learning Disability (LD) - 7 places The maximum number of service users to be accommodated is 7. Date of last inspection 26th April 2007 Brief Description of the Service: 20 Towngate East is situated in the market town of Market Deeping in South Lincolnshire and within easy reach of local services and facilities. The home is within walking distance of local shops, pubs, library, health centre, post office, churches, and banks. It is registered to provide personal care for 7 adults having a learning disability. All bedrooms in the home are single and are situated on the ground and first floors. Accommodation on the first floor is served by a stair lift. One bedroom has an en-suite facility (shower and toilet). The home has one main lounge area and a separate dining room. To the rear of the property there is a large lawned garden with patio area, which is easily accessed by residents. The fees at the inspection on the 9/4/2008 ranged from £840 to £1,300 each week. Additional charges were made for hairdressing and Chiropody. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This key inspection was unannounced and started at 8.05 am. It was done using a review of all the information available to us about 20 Towngate East. It took place over 6 hours. We spoke with 4 staff and the manager. We also had a phone conversation with the operations manager for the company who was routinely phoning the home during the inspection. The main method of inspection was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with the care staff and observation of their care. We also examined the annual quality assurance assessment (AQAA) that was sent to us by the manager before this key inspection. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. It was very clear and detailed. We also received 7 comment cards from the residents in the home. The comments were obtained with the assistance of their key workers. All comments were very positive. We also examined records, spoke to staff and walked around the home. What the service does well: What has improved since the last inspection? All requirements from the last key inspection had been addressed. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 6 The environment of the home had been improved by providing 3 specially adapted beds, adding new decoration to the lounge/dining room areas and they have provided new flooring in the kitchen and dining room and one bedroom. The garden had been tidied up and made more accessible. 3 bedrooms had been redecorated and a downstairs toilet installed. Work had been completed to make sure care plans were person centred through the use of easy to read symbols and pictures. Comprehensive health and safety audits had been introduced. 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. 20 Towngate East DS0000002309.V362133.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 20 Towngate East DS0000002309.V362133.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): Standards 1, 2, 3, 4 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People receive a detailed assessment before coming to this home. There is also detailed information about the home to allow people to make an informed decision to come to this home. EVIDENCE: There was clear, up to date information about the home in the form of a statement of purpose and service user’s guide. The service user’s guide was in symbols and pictures in order to help people to understand them more easily. We examined records for a newly admitted resident. These showed that considerable time had spent to ensure that his admission went well. There were meetings with the resident and their family and they were invited to stay. Written confirmation was sent to confirm that the home was able to meet their needs. There was a structured and supported introduction to the home through the use of a named key worker. The placement was reviewed after 3 months and thereafter at least twice a year. From this information a detailed and person centred care plan was produced. Each person also had a contract signed by the home and advocate of the resident. 20 Towngate East DS0000002309.V362133.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There was exceptional detailed person centred care planning which included risk assessments. People are encouraged to make decisions for themselves with the support of staff. EVIDENCE: Each person had a care plan, which included health action plans and risk assessments. We examined in detail 2 resident’s care plans. Each person had a care plan file, which was very detailed and well maintained. The information contained, a resident contract, aims and objectives, personal plan, accommodation “your room”, a pictorial guide to 20 Towngate East, individual risk assessment, detailed complaints procedure with the address of the commission, details of the person’s background, interests, details of how to vote, fire escape plan and details of keys to their bedroom. From this the care plan was divided into sections with pictures and symbols concerning aspirations and interests. In addition there were sections in symbols and pictures about “things I like”, “foods I like”, “people I care about”, “It is my right to”, “when anxious”, “help me”, “things I need”, 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 10 domestic skills, communication, personal care, social skills, eating and drinking, mobility and room safety. Information was very clear and detailed with evidence of involvement of residents, their family and advocate where appropriate. 20 Towngate East DS0000002309.V362133.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were involved in meaningful, appropriate activities, which included educational and recreational activities. Staff respected the resident’s rights and choices. EVIDENCE: The inspection took place before most of the residents were about to go out for the day to various day centres accompanied by staff. The majority of residents attend day centres and college during the week where this is appropriate. The home has a vehicle to give residents access to the community and public transport is also used. Residents are able to attend a variety of clubs and leisure facilities and holidays are also available. Pictorial records of events and activities are maintained along with a monthly chart of activities undertaken. Residents are encouraged and supported to live a full and meaningful life. Residents were supported to maintain and develop any skills or interests, which were included within their care plans. Any specific goals were included 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 12 and communications with relevant supporting agencies were noted. Comment cards included: “I make simple day to day decisions about what I like to do i.e. activities etc. I do this verbally and I also use pictures/symbols”. There was clear information to inform residents about their rights in picture and symbols and care records gave clear instructions to staff as to how individual rights and choices were to be promoted and met. Information relating to sexuality and relationships was also included and policies and procedures were in place regarding this subject matter providing guidance to staff. The home received 4 stars from South Kesteven District Council in March 2008 in recognition of their catering standards. Residents’ dietary needs were catered for and residents were involved in choosing the foods provided. Again this was done with the aid of the pictures of the food. Records showed they received a varied and nutritious diet. Information regarding residents’ food preferences and any dietary requirements were clearly documented in individual care plans. The menu was available and records of food temperatures, fridge temperatures were examined. The kitchen was clean and tidy. 20 Towngate East DS0000002309.V362133.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s health, medication and emotional needs are met safely and in a supportive way by a staff team who know how to meet individual needs well. EVIDENCE: Staff were trained to support the independence of residents in the home. There were a variety of hoists available, which had been tested and were safe to use. Staff had received training in order to safely use the equipment. In addition 3 specialised beds had been purchased to make caring and support easier and safer. All the people that live at the home needed support in order to take their medicines safely. There were clear and very detailed medication records. There was a photograph of each resident and very clear and specific information about the medication, its purpose and how it should be given to the resident. This was all written in the first person and again person centred. There was also a comprehensive medication policy and a weekly audit carried at by the manager. Records were well maintained and all entries signed. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 14 Staff were trained and skilled to understand and react to any changes in residents behaviour and to respond in an appropriate manner. Residents’ health and medical needs were clearly identified within the care plans and staff showed they had the skills to care and support peoples individual needs. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 15 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): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Any complaints received are taken seriously and residents are protected from abuse by the training of staff. EVIDENCE: We have received no complaints or safe guarding adult’s issues since the last key inspection. There was a detailed complaints procedure, which was in each resident’s file with the address and phone number of the commission. There was also an easy to read complaints procedure “your views on your services” which gave clear details about how a resident could make a complaint. This used pictures and symbols. Advocacy information was also available. Comprehensive risk assessments were also available. All staff were recruited correctly with a check by the criminal records bureau and 3 staff confirmed they had received protection of vulnerable adults training during their comprehensive 6-week induction. Staff knew what abuse was and what they should do if abuse was suspected. The home had adult protection procedures and an up to date copy of Lincolnshire County Council’s adult protection procedures. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 16 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): Standards 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean, well-decorated and comfortable home. EVIDENCE: The home was clean and comfortable throughout. Residents’ bedrooms were personal and reflected their personalities and had locks available to promote the peoples privacy. Since the last inspection 3 specially adapted beds had been purchased, decoration had been completed in the lounge/dining room. The kitchen, dining room and one bedroom had been fitted with new flooring. The garden had been tidied up and made more accessible. 3 bedrooms had also been redecorated and a downstairs toilet installed. There was a detailed health and safety policy available, which staff said they applied to their day-to-day work at the home. 20 Towngate East DS0000002309.V362133.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are safe levels of staff and staff are trained and skilled to meet the resident’s needs. EVIDENCE: There was a well supported team of staff. Staff spoke of the support they received and of the supervision and appraisal systems in place. All staff were responsible for care, catering, domestic and laundry duties. They are therefore responsible for all services in the home. From 9.30 pm to 7 am there was now one wakeful member of staff. Previously there was a sleep in cover but this was reviewed and improvements made as required from the last inspection report. The staff felt they could meet the needs of the residents and felt they had sufficient time. This was observed during the inspection by staff taking particular time to communicate residents in a calm, kind and sensitive manner. Staff also spoke of the support provided and how they all worked as one team. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 18 Specific comments were “I love coming here”, “staff welcomed me when I came here”, “I quickly became a member of the team”, “everyone is very supportive”, “The Manager is very approachable and supportive” and “I received a comprehensive and supported induction programme”. Each new member of staff received a comprehensive induction over a 6-week period. Computer-aided learning also supported them. This had modules on protection of vulnerable adults, health and safety and food hygiene. There were individual records of the type of training staff had received. The manager provides formal training in care and support and 50 of the staff team had been successful in passing nationally recognised qualifications. The company had a foundation training framework outlining what training each person must have received including moving and handling, first aid, fire safety, risk assessment and equal opportunities. There was also specialist training available. The home also had member of staff who was responsible for communication and had specialised skills in developing staff knowledge. Staff had knowledge of MAKATON and other methods in order to understand and communicate with residents. Staff clearly knew and understood the needs of the residents. Throughout this inspection this was seen and people indicated clearly that they felt well supported. 20 Towngate East DS0000002309.V362133.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 40, 41, 42 and 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well led by a competent and committed manager. This in turn has given rise to a confident, supported and trained staff team. EVIDENCE: The manager had care and managerial experience. She had been the manager for 4 years and continued to study for a management qualification. Staff we spoke with were very complimentary about the way the home was managed. They spoke of the support offered and how approachable the manager was. They received regular supervision every 6 weeks. There were regular staff and resident meetings and staff said they work hard to ensure they obtain the views of the residents. 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 20 There were detailed and up to date policies and procedures in the home. These included quality assurance procedures. This comprised an annual quality service review and development plan. This also included obtaining the views of each resident “residents point of view” in a picture format in order to get their views about the catering, personal support and care, “your home and the management of your support service”. People who live at the home were supported to communicate their views by their key worker. The last annual survey in 2007 showed 91.24 satisfaction with the service. The company made monthly-unannounced monitoring visits and detailed reports had been sent to the Commission. There was a policy on equality and diversity. All of the staff had good communication skills and understood the needs of the residents. There were no equality and diversity issues and staff were trained and skilled to understand the complex needs of the residents. Records examined on the day of the inspection were available, well maintained and up to date. The home had a comprehensive and detailed health and safety policy together with detailed risk assessments covering all aspects of daily living activities for each resident. A detailed fire risk assessment had also been carried out. There were regular tests of the fire system as well as regular fire drills. 20 Towngate East DS0000002309.V362133.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 4 2 3 3 3 4 3 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 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 x 3 3 x 3 3 3 3 20 Towngate East DS0000002309.V362133.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. 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. Refer to Standard Good Practice Recommendations 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 20 Towngate East DS0000002309.V362133.R01.S.doc Version 5.2 Page 24 - 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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