Care Home: Ivydene

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What the care home does well What has improved since the last inspection? CARE HOME ADULTS 18-65 Ivydene 70 Belmont Road Portswood Southampton Hampshire SO17 2GE Lead Inspector Neil Kingman Unannounced Inspection 12 December 2007 13:25 Ivydene DS0000066694.V353554.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 Ivydene DS0000066694.V353554.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. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ivydene Address 70 Belmont Road Portswood Southampton Hampshire SO17 2GE 01422 544118 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) ILG Limited Mrs Claudia -Maria Mist Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One current service user aged over 65 with a physical disability may be accommodated. 27th October 2006 Date of last inspection Brief Description of the Service: Ivydene is a residential home providing care, support and accommodation for up to 10 service users with learning disabilities and service users with both learning and physical disabilities. Mrs Claudia Mist manages the home on behalf of the proprietors ILG Limited. The home is a two storey domestic property in keeping with other homes in the area. It is located in a quiet residential area of Portswood close to the main shopping precinct, pubs, restaurants, parks and leisure facilities. People who use the service are accommodated in single rooms arranged over two floors. There are accessible bathing and toilet facilities, a separate dining room, lounge, kitchen and a conservatory. Outside the rear garden has a lawned area and patio with seating and a pergola, accessible via a ramp. There is off road parking for up to six vehicles at the front of the building. Weekly fees range between £755.53 and £1083 for the basic support package. The manager states that a copy of the home’s service user’s guide, together with the terms and conditions of residency are provided to all prospective residents, or their representatives where applicable. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Ivydene and brings together accumulated evidence of activity in the home since the last key inspection on 27 October 2006, at which there were four requirements identified as needing to be addressed. Part of the process has been to consult with people who use the service by way of survey comment cards. Responses were received from four service users, a visiting relative and a social services care manager. Included in the inspection was an unannounced site visit to the home by an inspector on 12 December 2007. A support worker was available to assist through the afternoon and the manager joined us towards the end. At the visit we had an opportunity to look at a selection of records, tour the building, speak with staff on duty and meet all the people currently resident in the home. Prior to the site visit the manager sent to the Commission a detailed selection of information about the service including an Annual Quality Assurance Assessment (referred to as the assessment during the report), which has been used with other information to inform the various judgements made about the service. What the service does well: This and the last inspection of Ivydene have judged it to be an improving service. People who live in the home lead fulfilling and active lives. Staff provide the support they need to follow their interests and maintain contact with family and friends. The home works well with external professionals to ensure peoples’ health needs are appropriately managed. Good assessments and support systems help new residents to settle into the home and treat it as their own. Comments in the care managers survey were evidence of this, “I have found the communication system for my service user, her relatives and myself excellent.” “Excellent communication and information systems for residents and staff.” The response to the visiting relative survey commented, “Personal approach, dedicated staff – home does well.” Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 6 The home does particularly well with ensuring residents feel safe and well supported. They have innovative ways to enable them to understand how to make a complaint, and they welcome suggestions about the service. Residents live in a safe and well-maintained environment. The home is well furnished, homely and comfortable. High standards of hygiene continue to be maintained. Staff receive ongoing mandatory and service specific training to ensure they are able to understand and meet peoples’ needs. What has improved since the last inspection? Since the last inspection the home has made the following improvements: • A review of the weekly activities planner for all the residents. Each keyworker has devised individual weekly planners with their keyclients to include activities they currently enjoy, in a format they can understand, and in a place they want it . The continued development of residents’ personal plans in a person centred way to include input from people close to the individuals. The introduction of new bedroom furniture that a resident requested. Holiday arrangements of their choice and a countdown calender. All outstanding requirements from the last inspection have been met. • • • • 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. Ivydene DS0000066694.V353554.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 Ivydene DS0000066694.V353554.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 – People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. EVIDENCE: Pre-admission assessment People should know that their needs will be met when they move into a home. An important part of ensuring this happens is the pre-admission assessment process. Records showed and the support worker confirmed that there had been two admissions to the home since the last inspection and described the procedure that was followed before the newest individual moved in: • • • A pre-admission assessment was carried out by the Company Placement Manager using the Company’s assessment tool. An assessment from a previous placement was available for consideration. There followed a series of introductory visits including a weekend stay to provide an opportunity for the prospective service user to establish DS0000066694.V353554.R01.S.doc Version 5.2 Page 9 Ivydene • compatibility with others who live in the home, and to judge whether the home would be suitable. The individual finally moved into the home in October 2007. We noted that a copy of the pre-admission assessment was on this resident’s file as were assessments on a sample of two other files viewed. In discussions with the new resident it was clear that they were very positive about the move. They made special mention of it being a small and homely environment where they felt safe. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Within the last 12 months we have had two new service users that received a full pre assessment before moving in to ensure they were suitable for the environment and that the home could meet all their needs. This also included them visiting and making an informed choice, with the help of their care manager. It is evident from their files the transition period they had when they came to live at Ivydene included 1:1 support from the manager to ensure they felt welcomed, and understood the care they should expect from the staff as well as the day-to-day activities we hold and the local area. I used a service user guide for this and minuted the items I went through and the reactions. We specialise in providing quality residential care for people with Learning Disabilities and associated needs. We now have a bigger Prospecting Team based at Head Office that liaises with Home Managers for potential individuals to access our service. There are now no vacancies in the home. We are full with our nine residents. • • • • • • Ivydene DS0000066694.V353554.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 and 9 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ needs and goals are met. The home has a plan of care and support that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. EVIDENCE: Personal plans – The home operates a key worker system with key support workers having additional responsibilities for identified people. Each person has a personal plan, which reflects their individual needs, aspirations and goals. At the last inspection a requirement was made for the personal plans to continue to be Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 11 developed so that they are all in a format suitable to residents’ individual needs. At this site visit we looked at a sample of three plans. The intention was to look at the outcomes for people in general by assessing all areas of care and support for those sampled. It was apparent that significant improvements had been made in the development of personal plans. Information is written in plain language and includes an ‘Essential Lifestyle Plan’, which according to the support worker is developed by the key worker with the full participation of the individual concerned. The lifestyle plans viewed were very ‘person centred’ and easy to understand with the aid of pictures and symbols. Information in personal plans includes: • • • • • • • • • Comprehensive risk assessments Self help information Social skills Communication Personal relationships Academic skills Domestic skills Activities Specific health information charts according to individual needs In discussions with the manager and staff it was understood that a good deal of work had been carried out to develop the personal plans in a person centred format; ensuring that they demonstrate that people using the service play a full and active part in their development. This was confirmed in discussions with one resident who gave us permission to view her personal plan, which included her ‘communication passport’. Decision making Information in Personal Plans and discussions with the manager and staff on duty provided evidence of staff respecting peoples’ rights to make their own decisions. Individuals have their own needs, interests, aspirations and goals, which are reflected in their plans and weekly activities programme. Group house meetings are arranged and minutes kept to action the issues raised. The manager confirmed, and records showed that people are supported with their financial affairs. She explained that two residents have accessed the advocacy service while another has chosen not to. Others have a family member or a solicitor to represent them. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 12 It was clear from discussions with the manager and staff that they are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. This was demonstrated in discussions with people later in the day when they returned from their particular activities. Risk taking – We noted that the home manages risks well, with good risk assessments in place on personal files. There is clear guidance on the steps to be taken to minimise identified risks. In discussions with the manager and staff about examples of challenging behaviour it was clear that staff have had training, and strategies for managing situations have kept incidents to a minimum. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • Risk assessments and guidelines are made with input from the staff and other health professionals, which can be evidenced. They are consistently reviewed via the evaluation forms. All service users also have an up to date PCP plan in their rooms and formats are available in a language the service users understand, i.e., weekly planners. Ivydene DS0000066694.V353554.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): 12, 13, 15, 16 and 17 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 14 EVIDENCE: Education and occupation – During the site visit we had an opportunity to meet with all those who live at the home and view a sample of records relevant to peoples’ daily life and social activities. Personal plans provide information about individual’s likes, dislikes, goals, activities and the support they need. Three of the nine service users attend the City College and take part in activities that help develop basic life skills. All but two attend a nearby day centre where they take part in activities of their choice. In discussions when they returned it was clear that the centres cater for their different interests. The response from the care managers survey commented, “Very positive and sensitive to my service user’s cultural needs.” We noted a pictorial weekly activities planner on the wall in the hall. Staff said that most service users contribute to keeping it up to date. On the day of the site visit two of the older service users were engaged with staff on a one-toone basis with arts and crafts until visiting relatives joined one of them. The visitors were full of praise for the staff, accommodation and the quality of service in general. Community links, social inclusion and relationshipsFrom discussions with staff and information in personal plans it was evident that people enjoy going out from the home. Each individual has a programme of activities, which meets their needs and gives them choices. Photographs and pictures are used to help people with communication difficulties to make their choices known. Activities are accessed in the local community either by way of public transport or the home’s vehicle. Staffing is flexible to allow support for people in the evenings and at weekends. One service user said he enjoyed going to the pub. Another enjoyed attending a local church club and also a church service on a Sunday once a month. Another said she enjoyed shopping trips. Staff confirmed that each has an opportunity to go on holiday away from the home each year. All but one service user has contact with their family, some on a regular basis. The home makes visitors welcome at all times and service users are able to receive them in the communal areas, or the privacy of their rooms. The visitors spoken with on the day of the sight visit confirmed that they were always made welcome and offered a drink on arrival by staff. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 15 Daily routines – All residents are supported to help with chores around the home, included laying up and clearing tables, cleaning their room etc. People are encouraged to undertake domestic tasks but can opt out if they choose to do so. Meals – The support worker explained that food menus are flexible according to peoples’ choices. A visual reference with photographs of meals is used to help them identify their preferences. Menus showed that meals are varied, appealing and nutritious. There was evidence that meat is sourced fresh from a local butcher and fresh fruit and vegetables are always available. Service users are encouraged and supported to make their own drinks and snacks. This was evident in the confident way that a few behaved in the kitchen. Care support workers take turns on a rota to do the cooking and other domestic chores, a system that is felt to work well in what is essentially a domestic setting. The response from the care managers survey commented, “Food is fresh and wholesome and enjoyed by the residents.” Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • • The home operates a full activity programme at home and in the community; that service users are consulted on before it is put in place. This includes educational and leisure activities. We support service users to undertake their chosen hobbies, for example church groups, college and community activities. Service users participate in preparing the food they eat and the home is always well stocked. A rolling menu can be viewed in the home, as well as an activity programme. Other evidence can be obained through interviews with service users. More individualised approach in regards to activities and the demonstration of these on individual weekly planners in formats residents can understand. Daily choices being offered and demonstrated via daily recordings. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 16 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 - People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. EVIDENCE: Personal support – At the time of the inspection there were nine people resident at Ivydene, three of whom require support with their mobility. Peoples’ plans clearly record individuals’ personal and healthcare needs and detail how they prefer their support to be delivered. Staff use a person centred approach to deliver care and support and meet people’s changing needs, e.g., one with physical difficulties has an electronically adjustable profiling bed. The senior support worker said that Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 17 arrangements were in place to provide a similar bed for another resident, as it would more readily meet their needs. The home has been able to meet peoples’ specialist needs with ceiling track hoists in bedrooms and bath/shower rooms, which help staff to transfer residents safely. In discussions with individual staff members it was clear that they have a good understanding of peoples’ individual needs. They confirmed that they had seen significant improvements and were confident that the home provided a very good service for those who lived there. A good example of the home’s person centred approach to supporting people was noted in the outcomes for the newly admitted resident, who had mobility difficulties following an accident. The home had arranged a referral to the Community Learning Disabilities Team whose weekly input helped with confidence building. This, together with a referral for physiotherapy, greatly improved their mobility. Healthcare – Personal plans show that peoples’ health care needs are regularly addressed. They receive checks from the GP, dentist, optician and specialist health care professionals. All health care needs are identified in their personal plans. The support worker explained that people have access to GPs at two health clinics in the locality. It was clear from discussions that the home enjoys a good liaison with all other healthcare professionals including the Community Learning Disability Team as and when required. All visits to health clinics are planned between the resident and their key worker. There is a mix of male and female staff (although mainly female) to enable appropriate gender matches for intimate personal care where required. Medication We looked at the home’s arrangements for residents’ medication with the support worker. Records showed that medication is administered by staff who have been appropriately trained and deemed competent by the manager. At the time of the site visit residents’ medication was securely held, and records relating to its safekeeping and administration were found to be in good order. At the last inspection a requirement was made for written guidance to be produced in respect of any resident prescribed PRN (as required) medication. At this site visit we noted that very good guidance had been produced and included in the sample of personal plans seen. The home has accessed support from a neurologist and the Community Learning Disabilities Nurse in respect of one resident who has epilepsy. There Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 18 was clear guidance in place for staff around the administration of medication for this individual. Peoples’ current assessed needs are such that staff administer all of their medication for them. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • Personal care and support that service users require is set out in their personal plans. All service users at the home are registered with a GP and records of any visits to health services are recorded in their care plans. All service users have a Health Action Plan that tracks any health needs and requirements. Service users are supported to administer their own medication where apropriate and policies and procedures are in place to support this. Policies and procedures are in place so that staff members handle and administer medication safely and any staff member that administers medication receives training. Policies and procedures and staff training records are in place and can be viewed in the home, as can all other documentation mentioned above. Recording for the administration of medication is of a high standard. • • Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 19 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 - People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. EVIDENCE: Complaints The home’s assessment indicated that there had been no complaints about this service since the last inspection visit. There is a formal complaints procedure in place that has also been produced in a format understandable to service users. It was clear that the manager and staff have made an effort to ensure that service users know how to complain if they are unhappy about something. We noted the procedure in symbol form, prominently displayed on the wall in the hall. In addition, service users, with support from staff, have produced a series of photographs depicting situations where they have a right to complain. There are several situations where service users have opportunities to raise any concerns, e.g., one-to-one approaches to their key worker or the manager, satisfaction surveys, and at residents house meetings where the complaints procedure is reinforced. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 20 The response to the care managers’ survey indicated they know how to make a complaint and the home always responds appropriately to any concerns raised. Safeguarding adults Information provided as part of the home’s assessment indicated that policies, procedures and codes of practice are in place in the area of safeguarding adults and the prevention of abuse, and records showed that staff receive specific training in the subject. They also have training in strategies for crisis intervention and prevention. The home’s Adult Protection policy is very comprehensive but still has the National Care Standards Commission (NCSC) as the regulatory body. The manager confirmed that she would ensure it was changed to the Commission for Social Care Inspection (CSCI). In practical terms staff have ready access to a one page laminated procedure issued by the City Council. Staff spoken with confirmed that they had received training in safeguarding adults and were very clear about the importance of reporting issues of concern without delay. Since the last inspection there has been one safeguarding of adults referral to Social Services, which has been investigated. The results showed that the issue was dealt with most appropriately by the home and was a demonstration of the effectiveness of the procedures in place. The home provides a secure system of safeguarding service users’ monies. The arrangements were fully explored and judged to be appropriate. In a dip sample of records entries were found to be accurate, monies balanced and receipts were kept of incidental purchases. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • The home has a complaints procedure that is available to staff and service users and any complaint that is received is dealt with, within timscales laid down in policy and procedure, this is also available in pictorial form for the service users. Complaints procedure is also discussed with residents every meeting in a format they understand, especially reiterating their personal rights and POVA has been discussed during staff meetings. Copies of local authority adult protection policies are avaiable in the home. All staff members are trained in adult protection and the home has an open policy of reporting any abuse issues. DS0000066694.V353554.R01.S.doc Version 5.2 Page 21 • • • Ivydene 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 and 30 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is clean, comfortable, pleasant and hygienic. There is enough space, and facilities for them meet their needs. The home makes sure people have the right specialist equipment that encourages and promotes their independence. Their rooms are comfortable and they feel safe when they use them. People have enough privacy when using toilets and bathrooms. EVIDENCE: Premises – Ivydene is a two-storey house located in a residential area of Portswood, Southampton and offers the residents a safe and comfortable home. The building is suitable for people whose mobility is restricted. During the site visit we toured the building with the senior on duty and individual residents invited us to view their rooms. It was noted that Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 22 bedrooms are spacious, reasonably well decorated and equipped, and individually personalised to reflect their individuality. In discussions with the people who use the service it was evident that they liked their rooms. One in particular valued the privacy that his room offered. All rooms are lockable and while service users do not wish to keep them locked, keys are available if they wish them. Three rooms on the ground floor are fully accessible and have ceiling track hoists that enable staff to transfer safely those who have physical disabilities. All rooms have a wash hand basin and there are fully accessible bath/shower rooms with WCs, wash hand basins and ceiling track hoists. The home has a good-sized open plan lounge and dining area, which is comfortable and homely, with adequate seating, and a TV. There is a large modern kitchen and a conservatory. The premises are bright, airy and comfortable. Outside at the front is a hard standing large enough to accommodate up to six cars. There is a lawn and a decked patio area with a pergola, large table and seating, accessible from the building via a ramp. The manager and support worker said that while a good deal of work had been carried out to improve the garden for service users since the last inspection it would not be fully completed until 2008. Cleanliness During the site visit all areas were noted to be clean, tidy and free from unpleasant odours. There is a laundry room in the basement, away from areas where food is prepared, cooked or eaten. Commercial grade machines have programmes to deal with soiled articles at appropriate temperatures. Liquid soaps and disposable towels are sited in all area where communal hand washing takes place. The home’s assessment confirms it has policies and procedures for preventing infection, and managing infection control. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • The home has a maintenance person that visits the home on a weekly basis to ensure that the home is well maintained and decorated. All service users at the home have the choice of how their room is decorated and what furnishings are purchased for shared areas. DS0000066694.V353554.R01.S.doc Version 5.2 Page 23 Ivydene • • • Choice and individuality are positively encouraged. A service user who recently moved in has had a lot of items changed in their room as per request to include, new carpet, sink and vanity unit and change around of furniture. Laundry is facilitated in the lower floor area. Hand washing facilities are in place in the kitchen, bathrooms and toilets, and all health and safety records are up to date. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 24 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, 33, 34 and 35 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their manager. People are supported by an effective staff team who understand and do what is expected of them. EVIDENCE: Staff team – On the afternoon of the site visit there were three support workers on duty with three residents. Others were away from the home at day services, returning at teatime. It was noted that staff were able to devote time one-toone with people, supporting them with activities. Examination of the staff rota confirmed that sufficient staffing levels were in place for the needs of the Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 25 residents. Overnight there are two support workers in the home with one awake and the other asleep on call. There was evidence from records and staff comments that Ivydene enjoys a relatively stable staff group that is flexible and able to support residents with their choice of activities during the evenings and at weekends. The home has a prominently displayed board containing a photographic record of staff, which helps the residents to identify who is on duty through the week. We noted some taking a particular interest in this board. Staff recruitment The manager confirmed that three new care support workers had been recruited since this standard was last assessed. Individual staff recruitment files were available for inspection and showed that the home’s recruitment procedure includes an application form, an interview record, a contract of employment, a health assessment, proof of identification, two written references and police and Protection of Vulnerable Adults (POVA) checks on all staff. We looked at the recruitment records of the three newly recruited staff and found them to be in good order. Staff training, development and competencies During the site visit we looked at the home’s staff training plan, which shows at a glance the position with regard to all staff training. The manager confirmed that this plan is regularly updated. Records demonstrate that the full range of mandatory training is provided together with additional service specific training such as: • • • • • The use of the hoist Strategies for Crisis Intervention and Prevention (SCIP) Medication Epilepsy Safeguarding adults The manager described and produced evidence of the induction programme care support workers undertake when joining the home. The current programme follows the Common Induction Standards recommended by ‘Skills for Care’. Records showed that four of the nine staff have achieved the National Vocational Qualification (NVQ) at level 2 or above. A further three have commenced the training. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 26 Care support workers spoken with said that the home provides a very good staff training package, which equips them well for the work they do. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • • • All service users have a chosen Key Worker assigned to them. The home has good systems in place that protect service users This is demonstrated through the staff training programme. Staff members at the home interact well with all the service users and treat them with respect and dignity. A record is kept of training that members of staff have undertaken. The training provided ensures members of staff can meet and support individual and joint service users needs. The home has a though recruitment process including the requirment to obtain a CRB check and written references. We also have a communication board which demonstrate staff on shift every day in a format that the service users can understand. They can demonstrate this understanding when asked Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 27 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 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: Management – The registered manager Mrs Claudia Mist has been in post for just over two years and is fully qualified, having achieved the NVQ at level 4 in care and the Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 28 Registered Managers Award (RMA). She has a background in managing services for people with learning disabilities and records show that she keeps up to date with regular mandatory and service specific training. All staff spoken with regarded the home as being well run, with regular staff meetings and formal supervision. They confirmed that the morale of staff was good and the manager was very approachable and supportive. The response to the visiting relatives survey commented, “Relations with the manager of the home have been excellent. She has understood the resident’s needs and has been very proactive in meeting her needs.” The manager completed the home’s assessment thoroughly and returned it promptly. Quality assurance – At the last inspection a requirement was made for the home to establish a quality assurance system at appropriate intervals for monitoring the services and care delivered in the home. At this site visit there was evidence that the requirement had been met. The manager gave examples and we saw records of the home’s current approach to quality assurance, which include: • • • • • • • Regular residents house meetings where issues are recorded and addressed. Results are used to improve the service, e.g., the review of the weekly activities planner. Formal surveys with residents and their relatives. Quality assurance monitoring forms used to seek views from the advocacy service and the local day centres. Bimonthly personal plan evaluations involving the resident and the key worker. Regular statutory visits on behalf of the proprietor to monitor the conduct of the home. Regular staff meetings and formal supervision sessions. Ongoing maintenance of the building. Health and safety The home’s pre-inspection information confirmed that policies and procedures were in place to ensure safe working practices in the home. A sample of records was viewed including accident records, fire alarm tests and risk assessments, public liability insurance, gas and electrical certificates, all of which were in good order. Staff training records showed, and staff confirmed that statutory training is scheduled and updated in manual handling, first aid, fire training, infection control and food hygiene. Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 29 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • The manager has completed a RMA and NVQ4 and recently an A1 assessors award which enables a rounded view of the services needs from both staff and service users point of view. The home also has a budget for service users activities so they benefit directly from their placement in the home as well as personal care needs being met. The area manager visits the home every month to complete a regulation 26 inspection. These reports detail actions that are required to improve the service. Regular checks are made of the fire warning system and a fire risk assessment is in place. COSHH records are in place and any COSHH materials are stored in a locked cupboard. Food hygine records are kept in the Better Food Safer Business pack. All accidents are recorded in the homes accident book. We now use keyworkers actively i.e. spend 1:1 time with their keyclients to up date care plans - current likes / dislikes as per weekly planners. • • • • • • Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 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 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 3 x 3 x x 3 x Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 Ivydene DS0000066694.V353554.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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