Care Home: 94 Whitstable Road

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What the care home does well This home is being properly maintained, and is tidy, clean and odour free. There are homely touches throughout. The service users have been living together at this home for several years, and are supported by very dedicated and caring staff. The rapport between the staff and residents is relaxed and respectful. The service users have lots of things to do and are supported to make good use of the community (staffing levels permitting). There are good outcomes for them. MCCH shows an awareness of the home`s strengths and development, and has the ability to make further improvements. areas for What has improved since the last inspection? The Manager has completed the application process and is now the Registered Manager of the home. What the care home could do better: Review the staffing levels at the home. CARE HOME ADULTS 18-65 94 Whitstable Road Canterbury Kent CT2 8ED Lead Inspector Sandra Crosby Key Unannounced Inspection 26th October 2007 10:00 94 Whitstable Road DS0000032234.V346902.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 94 Whitstable Road DS0000032234.V346902.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. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 94 Whitstable Road Address Canterbury Kent CT2 8ED 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) 01227 471980 whitstable@mcch.org.uk MCCH Society Ltd Karen Loughrill Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2006 Brief Description of the Service: 94 Whitstable Road is registered to provide accommodation and personal care for up to seven adults who experience a learning disability (residents). In practice, the Home accommodates a maximum of six people because the one double room is used as a single. The Home is operated by Maidstone Community Care Housing, which is a private company, with charitable aims. The Registered Manager is responsible for the supervision of its day-to-day operation. This is an older property, which has been adapted for its present purpose. The accommodation is provided on the ground and the first floors. All of the residents have their own bedroom. There is dedicated parking for one vehicle, and the home has a large walled garden to the rear. The home is situated within easy walking distance of local shops, pubs and a train station; it is also on a main public bus route. The City of Canterbury, with extensive shops and amenities is approximately 15 minutes walk away. The home has access to one dedicated vehicle to support residents to get out and about. The current fees for the service at the time of the visit are £262 - 315.13 per week. Information on the home’s services and the CSCI reports for prospective residents should be detailed in the Statement of Purpose and Resident Guide. The e-mail address for this home is: whitstable@mcch.org.uk 94 Whitstable Road DS0000032234.V346902.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 site visit, which was intended to inform this year’s key inspection process. The inspection visit took place on the 26 October 2007, between 10.30 and 14.30, and involved discussion with the Registered Manager, staff and service users. The inspection also involved a tour of the premises and the examination of a range of records. Two service user’s files were selected for care tracking. Conversations with the service users were very limited because of their level of disability, but interactions between staff and the service users were observed during the visit. The information contained in the Annual Quality Assurance Assessment documentation completed by the Registered Manager was also used to inform this report. What the service does well: This home is being properly maintained, and is tidy, clean and odour free. There are homely touches throughout. The service users have been living together at this home for several years, and are supported by very dedicated and caring staff. The rapport between the staff and residents is relaxed and respectful. The service users have lots of things to do and are supported to make good use of the community (staffing levels permitting). There are good outcomes for them. MCCH shows an awareness of the homes strengths and development, and has the ability to make further improvements. areas for 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. 94 Whitstable Road DS0000032234.V346902.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 94 Whitstable Road DS0000032234.V346902.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 and 2 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although there have been no new admissions, policies are in place to ensure this is managed appropriately. Each placement is subject to terms and conditions governing the rights and responsibilities of both parties. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 9 EVIDENCE: There have been no admissions since May 2004. One other admission was in 2000, but all the rest date from 1986 or, in one case, from 1988 i.e. long before the emergence of the National Minimum Standards. There are no further admissions being actively planned. The Statement of Purpose and Service User Guide were seen and were provided in a pictorial format. A requirement made at the last inspection visit in relation to these documents the Registered Manager said had been met, and copies of the formatted documents had been sent to the Commission Office. Further improvement could be made to ensure that all prospective service users have all the information they need to make an informed choice as it is likely that any prospective service users would have special communication needs, that would need to be catered for. The Annual Quality Assurance Assessment documentation completed by the Registered Manager states that an improvement that could be made would be the provision of a service user assessment form in a service user format, so that existing service users can have their say. 94 Whitstable Road DS0000032234.V346902.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): Standards 6,7,8,9 and 10 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 11 EVIDENCE: Two service user plans were seen, and each file contained critical information obtained from initial assessments, and evidence of assessments, covering a range of healthcare, personal and social support needs. There was evidence of monitoring via charts, observation sheets, activities programmes and risk assessments. Each service user has an allocated key worker who is tasked to ensure the care plans are implemented and developed. There was evidence of monthly reviews being documented and of risk assessments being reviewed on a quarterly basis, but often without change in each case. The extent to which the service user views or aspirations steered the process or were followed up was not clear. There was good evidence of the residents being involved and supported in the day-to-day routines of the home, as far as was currently practicable, within staffing constraints, but staffing levels continue to be raised as an issue requiring further investment. These service users are all dependent on the support of staff, and two are non-verbal. Two staff on most shifts would not appear to offer much scope for flexibility. The arrangements made by the home for keeping confidential information secure against unauthorised access is judged satisfactory, and confidentiality properly features in MCCH policies and staff terms and conditions of employment. 94 Whitstable Road DS0000032234.V346902.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): Standards 11,12,13,14,15,16 and 17 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals’ expectations. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 13 EVIDENCE: This home is judged reasonably well placed in terms of access to Canterbury City Centre and all the community resources and transport links that implies. There was good evidence of activities on and off site, and evidence of the home’s reliance on outside agencies (e.g. day services and clubs, Visiting Persons Team) for other activities. Each service user has an “Opportunities Planner” which is actually filled in retrospectively after each shift so as to be an accurate record of options actually chosen on the day. Daily routines appear to promote independence, individual choice and freedom of movement, subject in each case to risk assessments, so that the service users stay safe. Records indicate that activities inside the home include support in some light practical living skills. For example, one service user’s interest in going around collecting rubbish has been channelled into recycling duties, and another is supported to buy and prepare ingredients for meals. Raised beds are planned for the garden to facilitate one service user’s interest in gardening. All these service users have been judged unable to go out without support, and the front door is secured against unauthorised access and egress by a keypad arrangement. As long as there is a properly documented risk assessment in respect of each service user to justify this – and this was so in the case files selected for care tracking this is judged appropriate (though this will need periodic review to ensure it does not become unduly restrictive). Off site activities include day services (for things like art and craft sessions, sewing, woodwork, music and dance, and group outings) and socially inclusive activities, not readily associated with the service users disability such as horse riding, swimming, bowling, meals out, banking, shopping, theatre and cinema. There are open visiting arrangements, and staff described visits to and from families. One service user was supported to go on holiday with family members in Devon. There is a communal phone in the hallway and service users would also have access to the office phone. Each individual’s nutritional needs and preferences are properly established as part of the care planning processes and carefully monitored and amended on a day-to-day basis thereon. Staff eat with the service users and eat the same food, which is judged a good quality assurance tool. During the site visit, the inspector observed the services users making hot drinks, and having a biscuit to go with their drink. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 14 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 15 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 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 16 EVIDENCE: Records confirm a comprehensive assessment of needs and preferences in the first instance. The home operates a key worker system, and there was good evidence (anecdotal, observed and records) of personalised routines and interventions to support service users with their self-care skills. All the bedrooms are single occupancy, so that there is scope for service users to meet with visitors, including healthcare professionals in the privacy of their rooms, but they are also more usually supported to attend appointments at surgeries and other outlets. The storage and administration arrangements for medication were inspected, and all the current medication administration records appeared to be properly recorded (i.e. no apparent anomalies or gaps) and up to date. Staff have received training in medication and it’s administration and this is competency tested (written test) in each case. Each service user’s medication records are prefaced with a sheet bearing their photograph and key information on their medication, what it is for and possible side effects to watch out for. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 17 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 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and are supported to use the home’s complaints procedure, as required. Service Users are protected from abuse, and have their rights protected. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 18 EVIDENCE: MCCH has a policy on complaints, which is judged satisfactory, and there is also a picture-assisted version of the complaints procedure to make it more accessible to service users. The Annual Quality Assurance Assessment documentation stated that there had been no complaints, and the Registered Manager confirmed this. There is currently no active input from independent advocacy services, though MCCH has information on local resources so that arrangements could be put in place. The Annual Quality Assurance Assessment documentation states that adult protection training is given to all staff, and the home has an adult protection policy. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 19 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 24,25,26,27,28,29 and 30 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home’s location (in terms of access to Canterbury) and layout are generally suitable for its registered purpose, and measures are in place to keep the premises secure against unauthorised access or egress. There has been extensive refurbishment to this home over a period of time and the work has been carried out to a good standard. On the day of this visit, comfortable temperatures and lighting levels were being maintained. All areas of the home were inspected and found to be comfortable and clean. The furniture tends to be domestic in style, of a high standard, and there were homely touches throughout. Although there are steep steps into the rear garden, there are handrails to either side so that service users can access the garden safely. The garden has mature landscaping and requires regular attention, this mainly being carried out by the staff at the home. The home has a “No Smoking” policy. The communal areas of this home are judged spacious. The seating in the dining and lounge areas is uniform in style, but this is appropriate, given all the service users are relatively mobile. The kitchen is light, airy, clean and well maintained, and has benefited by substantial refurbishment. All the WC and bathroom facilities are reasonably accessible to bedrooms and communal areas, and one ground floor bedroom has its own en-suite shower room. All the bedrooms are single occupancy, so that service users can be assured of privacy. All the bedrooms seen were well maintained and personalised. They don’t have all the furniture and fittings prescribed by the National Minimum Standard, but their non-provision is properly justified by fully documented consultation and risk assessments. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 21 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 32,33,34,35 and 36 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are skilled and when the Registered Manager is present in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Registered Manager for the home is currently supporting another MCCH home, and it was found on arrival at the home that there were two members of staff to provide support for the six service users. As two service users were going out with one member of staff, this would leave one member of staff to support four service users, together with covering ancillary duties. The Registered Manager was able to travel back to the home to support the inspection process, and the staffing levels at the home were discussed. It was indicated that service users may not always be able to undertake the activities they choose, and there may also be issues in relation to health and safety due to the level of staffing whilst the Registered Manager is supporting another home. There are no ancillary staff, though MCCH has its own maintenance department - support workers are responsible for cooking and cleaning the home. They are to be commended on the level of cleanliness found. Ancillary tasks are detailed on shift planner documents so that anyone authorised to inspect the records can evaluate their scope for direct work with the service users. Two staff files were examined, and were seen to contain all necessary documentation as required by regulation, indicating that a robust recruitment process is in place. Evidence was also seen of regular supervision being undertaken with written records maintained. The Annual Quality Assurance Assessment documentation confirmed that there is a satisfactory level of investment in mandatory training (e.g. moving and handling, medication, food hygiene, Health and Safety etc) to keep service users safe. Sufficient numbers of staff are trained to NVQ Level 2 or above, and further staff are currently undertaking NVQ training. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 23 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 37,39 and 42 were inspected at this inspection visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 24 EVIDENCE: Since the last inspection visit Ms Karen Loughrill has become the Registered Manager of the home. She is currently undertaking NVQ Level 4, and has recently completed a three day Health and Safety course. The structure of the overall organisation would appear to offer clear lines of accountability, and generally good use has traditionally been made of the regulatory framework to keep residents safe and to promote their well being. The Registered Manager confirmed that regular monthly Regulation 26 visits are undertaken with written records maintained. New documentation is being used and this will then input into the annual quality assurance programme. MCCH has a corporate business plan, but this home needs to set up its own business plan, to reflect local provision and resources – this needs to be linked to quality assurance initiatives and corporate business planning and auditing arrangements, to obtain full compliance with this standard. The interpreted views of service users and feedback from other stakeholders will be crucial to the success of this. The inspector judged the processes for managing this home open and transparent, and judged the delegation of responsibilities within the home appropriate. There was good evidence of service users being supported to make choices on a day-to-day basis. This is a mixed gender team, which reports working harmoniously and flexibly to meet the needs of the service users. The service users all require prompting with their personal care, and the deployment of staff is organised to meet their needs and preferences. Records confirmed regular health and safety audits. The home appeared to be generally very well maintained and hazard free. 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 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 3 3 X 3 X 3 X X 3 X 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 26 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 YA32 Regulation 18(1)(a) Timescale for action Ensure that at all times suitably 30/11/07 qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users’ Requirement 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 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 27 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 94 Whitstable Road DS0000032234.V346902.R01.S.doc Version 5.2 Page 28 - 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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