Care Home: Foster House

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What the care home does well Foster House is a friendly and comfortable place. Staff are very good at listening to people and seeing what they need. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 7Staff help residents to look after their health.Staff help residents make choices about how they want to live.Residents can choose activities they want to do.They go on outings. They are planning nice things to do in the garden. What has improved since the last inspection? This is the first inspection since Foster House opened. CARE HOME ADULTS 18-65 Foster House 249 Ham Drive Pennycross Plymouth Devon PL2 3NG Lead Inspector Stella Lindsay Key Inspection (unannounced) 28th May 2008 11:00 Foster House DS0000070621.V363847.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 Foster House DS0000070621.V363847.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. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foster House Address 249 Ham Drive Pennycross Plymouth Devon PL2 3NG 01752 510 362 01752 510 362 Louise76@btinternet.co.uk 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) Premier Care (Plymouth) Ltd Mrs Karen Lesley Davies Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 2. Date of last inspection New Service Brief Description of the Service: Premier Care (Plymouth) Ltd has been established to provide care homes for adults with a Learning Disability. Foster House is in the Pennycross area of Plymouth, and has been established to meet the individual needs of people who may have behaviour that can be challenging. This may include people with autistic spectrum disorders, behavioural needs, or specialised patterns of living. The home is a three bedded semi detached house. One bedroom is for staff sleeping in at night. Bedrooms have wash hand-basins, and there is a bathroom and toilet. These rooms are accessed via the staircase and would therefore not be suitable for people with severe mobility problems. Downstairs is the comfortable lounge with a large screen television. The kitchen diner has a lobby that leads on to the garden. This is mainly grassed but has a decked area near to the house. To the front of the house there is a gravelled area for car parking. Outings for residents are arranged according to their wishes, and there is a vehicle available. The homes emphasis is on developing communication, and encouraging residents to develop their expression and abilities, and settle into a positive way of life. At the time of this inspection, fees for a place in the home ranged between £1,600 and £1,800 per week. Foster House DS0000070621.V363847.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 2 star. This means the people who use this service experience good quality outcomes. This is what we did for this inspection. • Before the inspection Karen sent us some information about how the home is run. We looked around the home. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 6 We met people who live and who work in the home, and spoke with people who visit regularly. We looked at Care plans. Karen showed us other records about the home. What the service does well: Foster House is a friendly and comfortable place. Staff are very good at listening to people and seeing what they need. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 7 Staff help residents to look after their health. Staff help residents make choices about how they want to live. Residents can choose activities they want to do. They go on outings. They are planning nice things to do in the garden. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 8 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. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 9 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 Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 10 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 and 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Admission to the home was very well managed with all efforts directed to understanding and meeting the individual’s needs. EVIDENCE: The statement of purpose/service users guide is available in widget format as well as the printed word to help prospective residents understand it. The Manager said that she intends to use more photographs in promoting good understanding. The first service user was assisted by their mother to understand, in order to minimise any distress. There had been one admission to the home. The Manager carried out a comprehensive assessment, and asked for further assessments to be carried out by the Challenging Behaviour Service (CBS) and Occupational Therapist, in order to assess the complex needs. This person’s long transition was carefully planned. His advocate said that Foster House staff worked ‘hand in hand’ with staff from the respite unit. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This service is effectively organised around meeting the needs of the service user. EVIDENCE: The key principle of the home that the service user is central to everything that is done. A visiting professional said that they were most impressed with the value base of the home, and see that the staff team keep the resident at the centre of everything they do. The resident’s advocate said they were ‘so impressed’ with the staff recognition of the service user’s communication needs, and that everything had been put in place to make sure they were understood. ‘They embrace the help of other professionals’. Care plans were seen to be written clearly with enough useful details to enable staff to offer care in a sensitive way, and respond to the service user in a way that promoted trust and understanding. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 12 Care plans included guidelines and support provided by other agencies, risk assessments, an action plan, progress sheet and date of review. Risk assessments were seen to cover the areas of possible self injury and aggressive behaviour. Staff spoken to were aware of the content of the care plan, of changes that had been made, and the agreed way of responding to the resident. All documentation was found to be written in a sensitive and appropriate manner and records were stored safely. An independent appointee had responsibility for the resident’s finances. Cash for daily use was kept safely, with transactions recorded and receipts kept. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines, activities and plans of the home are centred around the resident, and though there is not yet a wide variety of activities, the range is being extended sensitively in response to the resident’s changing needs and abilities. EVIDENCE: The staff are working at the pace of the service user and with the support of the CBS and Speech Therapist building a programme of activities in the house and outdoors, to promote the resident’s well being. They are building together a repertoire of signs to make communication easier. The resident was seen to be included in preparation of snacks and drinks and choosing films to see in the lounge. A staff member said that when they go walking, the resident could show by pointing which way to go. They said he particularly enjoyed picnics in the park, and picking grass and allowing it to rain down over himself. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 14 Because of his clear enjoyment of sensory experiences the Manager is planning to provide a sensory room in what is currently the garage, and to provide a sand-pit and ball park on the decked area of the garden. Social activities acceptable to the resident are gradually being introduced. These included a day-time club, discos, and a walking group as well as creative activities at home. The service user’s advocate said that the staff had been sensitive to the needs of the family, particularly during the transition to this service, and were aware of the importance to the resident of their family relationships. A holiday was being planned, with the resident’s keyworker taking a leading role. Staff said that the resident had eaten little when he arrived, but now enjoyed all sorts of food. We saw that he enjoyed watching toast under the grill. For safety reasons the main meals are cooked elsewhere, and heated if necessary in the microwave. This avoids any need to exclude the resident from their own kitchen. Staff said that they sit and eat the main meal together, and take supper into the lounge. Foster House DS0000070621.V363847.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): 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. Effective personal and health care was provided using a person centred approach. EVIDENCE: Staff were very pleased with the progress they had made helping the resident to adopt regular times for getting up and going to bed, and acceptance of regular tooth care, and reasonable bathing and shaving. A visiting professional agreed that they had not seen the resident looking so well. The Health Monitoring Record showed that he had attended dentist appointments, and seen the GP for medication reviews. His advocate said that, ‘every time I see him he is more settled and more communicative.’ The resident’s care plan included the discussion with the GP and advocate with regard to the resident’s consent to taking medication, as he was not competent to make this judgement himself. The Medication Administration Record was highlighted to alert staff to an alteration in the strength of one of the medicines they were administering, and showed an explanation when PRN medication had been given (a painkiller). Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 16 There was suitable storage for medication, and though there was no Controlled Drugs storage, there was no current need for this. The Manager said that a CD cupboard was on order. Foster House DS0000070621.V363847.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): 22 and 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Manager and staff are proactive in promoting the rights of the individual service user, and organise their work to promote his well being and development without recourse to restraint. EVIDENCE: There is a complaints policy provided in symbol format, and all staff, service users and other professionals including independent advocates had been made aware of the policy. The Commission for Social Care inspection had not received any complaints about Foster House. The home had received an informal complaint about noise levels and had dealt with it effectively. The home had a policy for the ‘Protection of Service Users’ providing procedures for responding to suspicion or evidence of abuse. The staff knew how to make an alert, and the manager had experience from another home of working with the Safeguarding team. The Manager had clearly worked in the best interests of the service user. She insisted on clear and consistent information about their varied and complex needs, in order to make good decisions and preparation, and referred him to a ‘best interest meeting’ to determine his level of capacity to consent under the Mental Capacity Act. She had also tried to ensure that his advocate is present at all important meetings. Foster House DS0000070621.V363847.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): 24, 26, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good providing service users with an attractive, homely and safe place to live. EVIDENCE: The house is in walking distance of parks and shops. There is a gravel area for parking at the front, and an enclosed garden to the rear, which is suitable for the outdoor activities that the Manager was planning to provide, to suit the current resident. The bedrooms have hand basins, and all features required by the National Minimum Standards were provided unless there were reasons for their removal, either for the safety of the occupant or by their choice. The doors are fitted with suitable locks for privacy and dignity. A communal toilet and bathroom is on the first floor with another toilet on the ground floor. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 19 The lounge had attractive and comfortable sofas, and a large screen television/DVD player. The large bay window overlooking a busy road was frosted to maintain the privacy and dignity of the resident, who was able to watch the road from his room above without problems. The kitchen was domestic in size, with room for the resident to watch or help drinks and snacks being prepared. The care home has a separate utility room so soiled clothes do not have to be taken through the kitchen. The washing machine has a temperature control system to ensure hygienic wash programmes take place, minimising the risk of infection. Liquid soap was available by communal hand-basins, though provision of paper towels would be good practice. The water system is controlled by a combination boiler that can be adjusted to meet the temperature requirements. Foster House DS0000070621.V363847.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): 32, 34 and 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This service is proactive in recruiting, training and organising staff its staff to meet the needs of the service user(s). EVIDENCE: One to one support is provided for the current resident at all times. A rota made of photos was displayed by the front door, to show the resident who would be with him. Staff had arranged their working hours to suit the resident. It had been found that change of staff during the day was very disturbing to him, so staff came on duty at 9am, worked till 11pm, did their sleeping-in duty then handed over to the next staff member in the morning. They do not work two long shifts together. Staff told us that this works well as they get thoroughly in tune with the resident and understand how he is feeling and what he wants. The Manager had recruited and retained staff with the attitude to their work and to uphold the rights of the service users in order to develop the service. The recruitment process included time spent with the service user, to see how Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 21 they interacted. There was evidence that all checks had been carried out in order to protect residents from potential harm. All staff had achieved or were working towards NVQ2 in health and social care, or above. All staff had an individual training record, which details the training they had attended. These showed that all mandatory training was on-going. Training specific to meeting the needs of individual service users was provided, often carried out by the Challenging Behaviour Service. Staff confirmed they receive regular supervision and support from the Manager, that they do not have to wait to discuss any anxiety, and that appraisals have been arranged. Foster House DS0000070621.V363847.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): 37, 39 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Manager communicates a clear sense of direction, gives priority to person centred thinking, and works for continuous improvement. EVIDENCE: Mrs Karen Davies is the Registered Manager. She is currently working towards the Registered Managers Award and NVQ level 4 in health and social care, and has experience of teaching and assessing students at Plymouth City College for NVQs including tutorials & monitoring. She has a clear job description to support the understanding and development of her role. She is also registered Manager the sister home four doors down the street. A senior carer has been appointed in each home, so that Mrs Davies can oversee both establishments in a managerial role. Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 23 Tracy Underwood is the responsible individual for Premier Care (Plymouth) Ltd. She holds a National Vocational Qualification level 3 care award, level 4 registered manager’s award plus a qualification as an adult teacher for moving and handling training, and has experience of running training sessions and assessing candidates for National Vocational Qualifications at Plymouth College of Further Education. She visits at least monthly, and completes reports on the performance of the home in accordance with Regulation 26. As the home has only recently opened, the Quality Assurance system is in the early stages. Since opening some questionnaires have been sent out to the families of service users who have moved into the home. We saw some that had been returned, showing positive comments. The Manager spoke of plans for improvement in response to ideas for enhancing the life of the current service user. The Manager had not yet produced a summary to present these plans. Other plans may develop following the admission of a second resident. The service user’s advocate said that this home is ‘constantly improving’, that the Manager and staff ‘don’t stand still’, and that they are always seeking new ways of meeting the needs of their service user. The Manager had ensured that all health and safety checks were carried out, fire alarm checks and drills were undertaken, risk assessments completed on the environment, staff and service users to ensuring the health and well-being of all individuals are maintained. First aid equipment is available alongside a accident book which all staff are inducted to. First Aid training was being up-dated. Food hygiene practices are followed through temperature checks on food, fridge and freezer these are recorded. All staff had received training in the safe handling of food. The test of the electrical circuit, gas, fire equipment and PAT testing had all been carried out. Foster House DS0000070621.V363847.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 4 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 4 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 4 X 4 X X 3 X Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 25 N/A 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 Foster House DS0000070621.V363847.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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