Care Home: Paddock House

What the care home does well There is a relaxed and friendly atmosphere. The people who live in the Service say and show by their relaxed manner that support workers are kind and attentive. People say that they have good meals. People receive the support and assistance they need. Support workers know what they are doing. They have a detailed knowledge of what each person needs and wants. Medication is given safely and people are helped to promote their good health. Sensible steps are taken to reduce the chance of accidents. What has improved since the last inspection? As we`ve already told you, when we last inspected Paddock House, there were quite a few things that we thought weren`t right. These things included developing the individual plans of support and the activities calendar. There were also thing to do with handling medication, the accommodation, staff training, recruitment and health and safety. We`re pleased to be able to tell you that the Registered Provider has made a good deal of progress towards sorting out the problems we raised. A new Manager has been appointed. He has a formal management qualification and he knows about running a residential care service. New and easy to use individual plans of support are being prepared. These should make it much easier for the people who live in the Service to take a more active part in making decisions for themselves. Another thing that will help with this is a new system of each person meeting regularly with his or her key worker. This will give people the time they need to think about how things are going for them and about what they might want to change in the future. Parts of the system used to handle medicines have been made much more organised and reliable. The range of activities that people can do has been extended. Also, the way that this is being recorded makes it much easier to check that no one`s being overlooked. New carpets have been laid in the main lounge, in the dining room and in one corridor. In other corridors, the carpets have been professionally cleaned. New carpets have also been laid in three of the bedrooms. Four new portable heaters have been bought. Most of the support workers have done specialist training about mental health matters. What the care home could do better: There is no record of the meals each person has chosen to have. This is important because we need to know that people actually have the choice that we`ve been told they have. The written staff roster isn`t detailed enough. This is important because we need to have a full account of who is on duty so we can tell you about it. Parts of the training system remain rather muddled. There are quite a few gaps where individual support workers seem to have missed bits of training. This might mean that some members of staff have not yet had the opportunity to confirm relevant parts of their knowledge and skill. The quality assurance system can be developed further. More can be done to actively involve people so that they have a direct voice in how their home is run. The fire safety training system needs to be more organised. This is so that all members of staff are checked to make sure that they know what to do in the event of a fire. CARE HOME ADULTS 18-65 Paddock House 13 Prospect Road Hythe Kent CT21 5NN Lead Inspector Mark Hemmings Unannounced Inspection 29th January 2009 09:00 Paddock House DS0000023503.V374043.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 Paddock House DS0000023503.V374043.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. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paddock House Address 13 Prospect Road Hythe Kent CT21 5NN 01303 230067 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) Mr James Peter McCarthy Manager post vacant Mr James Peter McCarthy Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th March 2008 Brief Description of the Service: Sixteen people who need to be supported to care for their mental health can live in Paddock House (the Service). The premises are a two storey detached property. The accommodation is on both floors. Everyone has their own bedroom. All of the bedrooms have a wash hand basin. One of them also has its own shower and toilet. On the ground floor there are two main lounges and there is the dining room. The kitchen is also on this floor. There is one bathroom and three shower rooms. The Service is in a residential street that is quite close to the centre of Hythe. The town centre is only a short walk away. The Service has its own car. The Registered Provider is a private individual. He is assisted in the day to day running of the Service by the Manager. People who might want to move in can find out things about the Service. There is a Service Users’ Guide. This is a brochure that outlines the main things available in the Service. There is also a document called a Statement of Purpose. This is more detailed than the Guide. The current fee is £411.94 per week. This fee includes accommodation, personal care, meals and laundry. It doesnt include things such as toiletries, clothes and meals out. If you want to find out more about Paddock House you can also have a chat with the Manager or with the Registered Provider. Paddock House DS0000023503.V374043.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 that the people who use this Service experience adequate good quality outcomes. Since 1 April 2006 we have developed the way we do our inspection of care services. This inspection of the Service was a Key Inspection. We arrived at the Service at about 9 oclock and we were there for about seven hours. It was a thorough look at how well things are going. We took into account detailed information provided by the Registered Provider in his self-assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. We spoke with four of the people who live there. Also, we spoke with the Registered Provider, the Manager, three support workers, the senior support worker, the activities coordinator and the house keeper. For convenience in this Report we refer to the senior support worker as being a support worker. We looked at some key records and documents and we had a look around the accommodation. Before we went to the Service we asked ten of the people who live there to fill out a questionnaire for us. We wanted them to tell us what they think of their home. Were pleased to say that everyone kindly filled out our questionnaire. We also asked ten members of staff to fill in a questionnaire for us. We got four of them back. We will tell you what people have said as we go through this Report. The Registered Provider has also asked people who live in the Service to fill out a questionnaire for him. Thirteen replies were received. We have seen the results that he has got back. Well tell you about them as we go through our Report. At our last inspection we required the Registered Provider to make 12 improvements. This was quite a lot. We asked him to write to us saying how he planned to go about doing what wed asked for. We received his reply and later on well tell you about bits of it. The Manager has recently prepared a Development Plan. In this he says what he thinks now needs to be done with things being listed in order of importance. Well refer to this Plan later on in our Report. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? As weve already told you, when we last inspected Paddock House, there were quite a few things that we thought werent right. These things included developing the individual plans of support and the activities calendar. There were also thing to do with handling medication, the accommodation, staff training, recruitment and health and safety. Were pleased to be able to tell you that the Registered Provider has made a good deal of progress towards sorting out the problems we raised. A new Manager has been appointed. He has a formal management qualification and he knows about running a residential care service. New and easy to use individual plans of support are being prepared. These should make it much easier for the people who live in the Service to take a more active part in making decisions for themselves. Another thing that will help with this is a new system of each person meeting regularly with his or her key worker. This will give people the time they need to think about how things are going for them and about what they might want to change in the future. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 7 Parts of the system used to handle medicines have been made much more organised and reliable. The range of activities that people can do has been extended. Also, the way that this is being recorded makes it much easier to check that no ones being overlooked. New carpets have been laid in the main lounge, in the dining room and in one corridor. In other corridors, the carpets have been professionally cleaned. New carpets have also been laid in three of the bedrooms. Four new portable heaters have been bought. Most of the support workers have done specialist training about mental health matters. What they could do better: There is no record of the meals each person has chosen to have. This is important because we need to know that people actually have the choice that weve been told they have. The written staff roster isnt detailed enough. This is important because we need to have a full account of who is on duty so we can tell you about it. Parts of the training system remain rather muddled. There are quite a few gaps where individual support workers seem to have missed bits of training. This might mean that some members of staff have not yet had the opportunity to confirm relevant parts of their knowledge and skill. The quality assurance system can be developed further. More can be done to actively involve people so that they have a direct voice in how their home is run. The fire safety training system needs to be more organised. This is so that all members of staff are checked to make sure that they know what to do in the event of a fire. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 8 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. Paddock House DS0000023503.V374043.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 Paddock House DS0000023503.V374043.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standard 2. People who might want to move in are asked about what support they want. They are then helped to settle in. EVIDENCE: The Registered Provider and the Manager say that if someone is thinking of moving into the Service, they will speak with them to find out what support they want and what sort of life they want to follow. They will also speak with other people such as family members, doctors and care managers (social workers). This will be done so that they can check out points of detail that help them to be clear about what is needed. After this is done, the person will be invited to visit the Service. This is so that they can get a first hand feeling of what Paddock House is like. Also its done so that they can meet the other people who have already made the Service their home. The Registered Provider and the Manager recognise that moving into a new home is a big step for everyone involved and of course mostly for the person Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 11 doing the moving. The Assessment emphasises that the Service wants to do everything possible to make the move a positive experience for everyone. No one has moved into the Service since our last inspection. Therefore, we cant tell you about how these arrangements are working in practice at the moment. However, in our questionnaire for people who live in the Service we ask, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Eight people say that yes they did, one person says dont know and one person says no. This last person doesnt give the reason for their answer. One of the people who says yes then adds, I came here for a week or two to see if I liked it and I did. The Registered Provider and the Manager say that they will share the information they found out with the support workers. This is so that they can support the person in the right way from the point they move in. After this, they can get to know them better as time goes by. We asked support workers about how all of this works out in practice. They say that in the past they have been fully involved in the steps taken to help someone move in. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 6, 7, 9 and 10. There are individual written plans of support. Some of the paperwork is a bit complicated and its not that user friendly. There is a sensible approach to everyday risk taking. EVIDENCE: People say that the support workers offer them all the assistance they need. There is a written individual plan of support for each person. These are important documents. This is because they are one of the means by which people can decide about the support they need. Also, they are a way for them to show their agreement with how this is going to be done. The plans are a source of information for support workers. This then helps them to provide Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 13 support in the right way. We looked in some detail at four of these plans. They have information about a number of relevant things. For example, there is information about how to help the people say what they want and about how to support them in managing parts of how they go about things. There is stuff about how to help them with practical things such as using the bathroom and keeping their bedrooms how they want them. In more detail, there are arrangements to help one person stay safe when they are out of the Service. For another person, there is a plan to support them when they are worried by particular troubling thoughts. A third person is assisted to try to make sure that people dont take advantage of them financially. We spoke with four support workers about whats in these plans. They know about it. They also know how to use the information in practice to give people the support they need. We saw them using this knowledge to good effect. For example, one person was becoming concerned about dealing with their inheritance. A support worker quietly reassured them about the matter and reminded them that the Service has arranged for them to see a solicitor about the matter on a number of occasions. In our questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support (for example in their support plan)? Three people reply that they always do and one person says usually. The last person doesnt say anything else about their reply. The plans are kept up to date so that they are accurate. This involves support workers making daily notes about how things are going. There are then reviews every six months or so. These involve members of the local mental health including a psychiatrist. They are a chance for the person concerned to look back at how things have gone for them and to plan for the next few months. All in all, theres a lot of written information in the support plans. Over time different forms have been used and some of the paperwork is really quite old now. Nearly all of its written in a rather dry management style. As such, its very unlikely that the people who its written about will find it easy to use. Its also unlikely that they will think it interesting enough to spend time on. Were not surprised to hear that people dont really bother about it that much. This is a pity because its all about them. The plans are much more likely to be right if the people theyre about feel a real sense of owning them. The Assessment says that the goal in the Service is to have a person centred support planning system. The Manager recognises that changes will need to be made to achieve this. As part of this, hes in the process of working with each person to prepare a new support plan. So far he has done one of these and we looked at it in some detail. It covers a number of relevant things in a short space. The language is down to earth and theres lots of practical information. As such the new plan is easy to follow. Its much more likely to engage the interests of the person its about and much more likely to be useful for support Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 14 workers. We think that once all of the plans have been put into this new form, this will be a really useful development. The Manager says that he plans to have all of them finished by 1 May 2009. Another important development that has occurred since our last inspection, is the strengthening of the key worker system. A key worker is a support worker who gets to know one of the people who lives in the Service really well. This is so that they can provide them with any extra support they might need. Each person is invited to meet with their key worker once a month. This is so that they can have time to chat about how things are going for them and so that they can decide if they need to do something new. These sessions are recorded and so we had a look at the sorts of things that are being raised. There are all sorts of useful things. Many of these relate to what has been said in the individual plans of support and in the review meetings we have already mentioned. For example, in one of the records we examined, the key worker and the person were talking about how much the person likes mobile phones. They then chatted about the fact that some previous phone purchases need to be paid off before too many new ones are made. In the Registered Providers questionnaire, people are asked to comment about the key working system. Six people say that its excellent and seven people say that its good. Some of the people who live in the Service are helped to manage their financial affairs. This is because they find all of the paperwork involved quite difficult to keep on top of. This help is done by family members or by the local authority. The Registered Provider doesnt get directly involved. This is a good idea. Otherwise, it can result in awkward situations where there are disputes about who should be handling what money and where it should be going. Everyone has their own bank account that they run like we all do. They take money out as and when they need it to buy things. The Registered Provider has been asked to hold some money for one person. The arrangement is that a small amount of cash is held in the Service so that the person can use it to buy what they want. The remainder is paid into their own savings account. We looked at some of the records that are kept of the various transactions that are done for this arrangement. We checked that there are receipts for the purchases made. We checked to see that the sums add up and that the paper balance matches the cash balance. We also looked to see that the cash said to have been paid into the saving account shows up there. Things are okay and above board. Sensible consideration is given to peoples personal safety. In general theyre not over-the-top and so people are still free to do things that they want to. There are some exceptions. For example, the kitchen is normally locked when support workers arent around. This has been done because it was thought that one or two people might have an accident if theyre on their own in the kitchen. The Manager is now going to see what can be done so that most people can use the kitchen when they want to. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 15 There are written plans that say what potential risk is being considered and what needs to be done. For example, support workers have thought about how to keep people safe when they go out and about in the local community. Unfortunately, much of the information is in a management style that most of the people are likely to find difficult and boring. We think that much more can be done to make it interesting and user friendly. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 12, 13, 14, 15, 16 and 17. People can do occupational and social things that interest them. People are helped to keep in touch with their families. They can spend their days as they wish. Good quality meals are served. EVIDENCE: People are free to do things that interest them. Some of these things involve helping out a little bit and in their own way around the house. Over time, each person has developed their own things that they like to do each week. This includes going out to a local resource centre where they can do various activities. They also do everyday things such as going to the shops to buy what Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 17 they need. There are various other things that are organised by the Service. There is an activities coordinator who takes the lead with most of these things. She is around every week day. On the day of our visit, she went out with three people on a day trip to Rye where one of the people used to live. They got back about mid afternoon. Everyone said how much they had enjoyed the day and the meal out they had. Other people went out shopping on their own, spent time in their bedroom, or were generally resting in the lounge. The tone was relaxed without being too sleepy. The Registered Provider says that since out last inspection, each person has been asked if there are any additional activities they would like to do. As a result of this various new things have been added to whats available. The activities coordinator now keeps a much more detailed record of who has done what things. We had a look at what one person has done for a recent period of about three weeks. The records show that they were out and about on most days. The things they did include going to the shops, going along to a local resource centre, having meals out, going to Canterbury, bird-watching and horse-riding. In our questionnaire we ask, can you do what you want to during the day, in the evening and at the weekend. Everyone says that yes they do. The Registered Providers questionnaire asks about this subject too. Four people say that the activities in the day are excellent and nine people say that they are good. When asked about the things to do in the evening, the answers are a bit less positive. Two people say excellent, five people say good and six people say fair. When we were in the Service we asked people about the social activities. In general, they are quite positive in their replies. One person summarises the general mood when they say, its cold outside and I dont want to go out today. Ive done what I need to and now Im having rest. I like having a quiet life. I see (the activities coordinator) about things and I could have gone out to Rye if Id wanted to, but I wanted to stay in. Ill go up town later on maybe. I help out in the kitchen now and then if I want to. I dont have to of course. In our questionnaires we ask, do you make decisions about what you do each day? Two people say that they always do and eight people say usually. Its not quite clear why one of the people who says usually has answered in this way. This is because they go on to say that, I am asked what I would like to do in the morning and then if I wish to do whatever they ask, I would do if I wanted to. People are helped to keep in touch with members of their families. Family members and friends are welcome to call to the Service whenever they want. One person is being helped to make sure that some of the friends who visit them wont take advantage of them. The Registered Provider thinks that they may have done so in the past. The Registered Provider and the Manager keep in touch with family members and with care managers to tell them how things are going. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 18 People say that they have good quality meals and that they have enough to eat. One person summarises the general mood when they say, the meals are good and we get plenty to eat. Ive no complaints about the grub at all. Its done by the staff and we help out sometimes. Im never hungry at all. The foods not an issue here. Theres a weekly menu. However, this is not too rigid. People can and do change it if they want something different. Over time, everyone has got to know what each other likes and dislikes. The menu pretty much reflects this. We looked at the menu for dinner over a period of two recent days. The main lunch time dishes served include salad and ham sandwiches, crisps and biscuits. For dinner it was meat loaf and fish and chips. The Manager says that there is a choice at each meal time. This is done informally on the day in that something else will be done for someone who is known not to like the main dish on offer. At the moment, there isnt a record of the actual choices that people are making. This means that its hard for us to confirm that the choice thing is working for everyone in the way described to us. The Registered Provider is going to record what each person is having in the future. This record will be started by 1 February 2009. The Registered Providers questionnaire asks about the catering arrangements. In their replies, 11 people say that the meals are excellent and two people say that they are good. Later on in our Report well tell you about the house meetings that the people who live in the Service go along to. There they can say how things are going. However, well mention one thing here that we saw in the records of one of these meeting. This is about the use of milk in the Service. The record reads as follows, please remember if you drink too much (milk) you are taking other peoples share. No one minds you drinking milk but be fair. If you like much more milk than everyone else then maybe the fair thing is to buy your own. We dont think that this is a very helpful response. A much simpler thing would be for the Service to buy more milk. Its quite a low cost item and it would solve this problem. Later on too, well tell you in general about the kitchen. However, theres something that needs mentioning now. When we were in the kitchen we noticed that there is padlock on the refrigerator. We asked two support workers about the need for this and they arent quite clear. One thinks it might be needed to help stop one person from eating too much sugary food that will then upset their health. We dont think that this is a normal homely arrangement. The Registered Provider should look into other ways of dealing with this matter. The solution shouldnt involve everyone else being barred from easily getting into the fridge. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 18, 19 and 20. People are helped in ways that are right for them. They are helped to stay well. There are safe systems to manage medicines. EVIDENCE: People are helped in ways that are right for them. A good sign is when people want to talk about things that interest them rather than wait to answer our questions. This happened all the time to us when were in the Service. People talked about their friends, about their families and about things they like doing. They take for granted that their home is how they like it and that support workers are their friends. The Registered Providers questionnaire asks people to reflect upon the quality of their life in general in the Service. Nine people say that its excellent, three people say that its good and one person says that its fair. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 20 The support workers are relaxed and informal in how they are. Things are orderly without being too much so. When things look like they might be getting a bit too much, they gently point people in a different direction. This isnt done in an obvious or bossy way. People are helped to wear neat and clean clothes so that they can look how they want. They are helped to sort out any post they get and they can use the phone when they want. In our questionnaire we ask, do the carers listen and act on what you say? Five people say that they always do, five people say usually. The people who say usually dont give any more information about why they are answering in this way. The Registered Providers questionnaire also asks people how they get on with the support workers. Nine people reply excellent and four people say good. People are helped to keep healthy. Support workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. We looked in detail at what medical assistance two people have had since out last visit to the Service. Both have had various medical consultations. For one of them, the support workers have arranged for the person to see their doctor on several occasions in succession. This is because the person hasnt been well and their condition hasnt really responded so some of the treatments they have had. The Assessment recognises how important it is that people are also helped to take care of themselves in a positive way. For example, they are encouraged to eat a healthy diet. They also are helped to go along to things such as the local Wellwoman clinic. The Registered Providers questionnaire asks people about the medical and nursing care they get. Nine people say that its excellent and four people say that its good. At the moment, no ones doing their own medication. Support workers are managing it for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. We looked at five sets of these records going back for about two weeks before the date of our visit. They are correctly completed. We looked at three medicines in more detail. We wanted to see if the remaining stock matches what should be there. It does. Some medicines can be given as and when they are needed rather than on a regular basis. When we were last in the Service bits of the system used to manage these medicines were rather muddled. There wasnt really a clear account of who was taking what and why. Since then a new system has been introduced and the arrangements are now clear and organised. All in all the medication system is running well. But we think that more can now be done to support some of the people to be more involved in things. For Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 21 example, the form that support workers use to record when a medicine is given is very complicated. Its got lots of small boxes to tick and there is a medical type account of what each box means. A more easy to use form might encourage some of the people to sign for their own medication. This might then lead them on to doing other bits of the medication arrangements for themselves. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 22 and 23. People are free to make a complaint if they want to. People are kept safe. EVIDENCE: There is a written complaints procedure. The Registered Provider has not received any new complaints since we were last in the Service. We havent either. The Registered Provider and Manager say that minor concerns are sorted out there and then. This is so that things are put right as soon possible. We asked people who live in the Service about this. No one spoke about it directly. They say that they dont have anything concerning them at the moment. In our questionnaires we ask, do you know who to speak to if you are not happy? Also we ask, do you know how to make a complaint? Everyone answers yes to both questions. One person adds, I am quite happy with what Ive got. People say and show by their relaxed manner that they feel safe living in Paddock House. In our questionnaires we ask, do the staff treat you well? Eight people say that they always do and two people say that they usually do. The people who say usually dont give us any more information about their thoughts on this. One of the former people adds all the staff help me a lot. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 23 The Registered Provider has a written policy and procedure that tells support workers what to do if they become concerned about someone’s wellbeing. For example, what they should do if someone is being bullied or pushed around in some way. We spoke with four support workers about safeguarding people who live in the Service. They know what to look out for and who to contact if they become concerned. They say that they havent seen or heard anything to worry them. Indeed, they are confident that the people who live in the Service are safe and are well supported. In our questionnaires for members of staff we ask, do you know what to do if a service users, relative or friend has concerns about the Service? Everyone says that yes they do. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 24, 29 and 30. People live in a comfortable setting that promotes their independence. The kitchen is clean and well equipped. There is a separate laundry. EVIDENCE: The accommodation is comfortable and homely. In general, its like anyones home is. Something a bit out of the ordinary is some of the signs that have been put up. For example, there are no smoking signs. There are also various health and safety type posters and staff training certificates on display. The Registered Provider says that he has been asked to display these things in the past by official visitors to the Service. We think that they take away from the Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 25 homely atmosphere in the place. The Registered Provider says that hell be pleased to take them down now. If they are really necessary they can be put up somewhere less obvious. Since we were last in the Service, the smoking lounge has been changed to being an ordinary lounge. This has meant that some people are having to smoke outside. One person spoke with us about this and says, I dont think that we should have to smoke outside in the cold and rain. Its our home and there should be somewhere indoors for us smokers. We agree with this view. The Registered Provider says that he has been under the impression that hes now not allowed to have an indoor smoking lounge. We have explained to him that this isnt right. He says that he will now create another smoking lounge after he has checked out the proposed room with the fire brigade people. When we last called to the Service, we were concerned that some parts of the accommodation were a bit too cool for comfort. Since then, the Registered Provider has bought some additional free standing heaters. We saw these in the places that we had previously been concerned about being too cool. The weather on the day of our visit was very cold. However, the accommodation was quite warm. No one who lives in the Service mentions this as being an issue for them anymore. The Registered Provider says that he intends to install two additional fixed heaters. These should increase the heat level further. The hot water service seems to be working okay. We went to the top of the house furthest away from the boiler and there was plenty of hot water. We noticed that the baths only have a hot tap. The Registered Provider says that the cold taps were removed on our advice in the past. This advice was plainly not right or weve been misunderstood. Any way, the Registered Provider says that he is now going to put the cold taps back as soon as possible. There are special regulator valves fitted to the hot taps on the baths. These are designed to make sure that the water isnt hot enough to scald someone. The one we checked is quite cool really. By the time youd run a bath it would certainly be too cool for comfort. The Registered Provider is going to check the temperature of the hot water taps to make sure that theyre hot enough. The premises are fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the fire safety measures in place meet the national standard. The Registered Provider has prepared a fire risk assessment. This has been done to ensure that the fire safety system continues to work as intended. At the moment there is a special sort of lock fitted to the front door. This is there for extra security. However, it might be fiddly to open if there is a fire and if people need to get out quickly. The Registered Provider is going to do a review of this when he next updates the risk assessment. He is then going to send a copy of the assessment to the fire brigade people. This is so that they can check that the fire safety things in the Paddock House are still okay and up to the national standard. This will be done by 1 May 2009. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 26 The people from the local Department of Environmental Health called to the Service last year. They say that things in the kitchen are running okay. Their report concludes that, the kitchen is showing its age and is beginning to need refurbishment. We looked at the kitchen too. Its quite small but its neat and clean. Some of the drawers are a bit worn and shaky. Still, theyre serviceable and the kitchen looks homely. Theres a system to make sure that the refrigerators are cold enough to store foods safely. Sensible steps are taken to promote good hygiene. For example, support workers know about the importance of washing hands. In particular, if theyve been doing other things like working in the laundry. Once foods are opened they are date marked. This is done so they arent allowed to hang around for too long before theyre used. At the moment, none of the people who live in the Service need a lot of help in the bathroom. Several need a steadying hand to get into and out of the bath. The Registered Provider recognises that more things may need to be provided in the future if people become less able than they are at the moment. The laundry is quite small but its got the equipment it needs. There are two washing machines and tumble drier. Its neat and well organised. There are new regulations that have been introduced to ensure that used water doesnt leak back into the main pipe-work. The Registered Provider is going to check with the local water supply company to make sure that the Service meets whats needed. This will be done by 1 April 2009. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. We looked at Standards 32, 33, 34 and 35. There are enough support workers around to make sure that people get the help they need. Security checks are completed on staff. Support workers know what they are doing. However, bits of the training arrangements are rather muddled. EVIDENCE: There are always two support workers on duty from early in the morning until the evening time. There is a waking staff presence in the Service at night. Also, there are special security arrangements at night. There is also the Registered Provider, the Manager, the activities coordinator and a house keeper around on most weekdays. We looked at the roster in some detail for six recent days. We wanted to see if the various shifts are being filled reliably. We found that they are. However, only the hours being worked by the support Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 28 workers are being recorded. In future, everyones hours will need to show up on the roster. This is because we need to have an accurate account of the way staffing resources are actually used in the Service, so that we can tell you about it with confidence. We looked for things that tell us if there are enough support workers around. We saw people getting the one to one support they need. In our questionnaire for members of staff we ask, are there enough staff to meet the individual needs of the people who use the Service? Two people say that there always are and two people reply usually. The latter people dont say any more about their answers. Its very important that all of the support workers are honest people who can be trusted to spend lots of time with the people who live in the Service. With this in mind, the Registered Provider completes a number of security checks for new support workers. These include checking the persons identity and their employment history, getting references and doing a police check. We looked at what checks have been completed for two recently appointed support workers. Things are in order. New support workers have introductory training before they begin supporting people on their own. The subjects include key things such as fire safety, how to use the individual plans of support and how to manage difficult situations. We looked at the records of this training for a recently appointed support worker. They show that they have done the training concerned. We also spoke with them about this. They say, I learnt all about the residents before I worked alone. I knew about their mental health and how they are and what help they need. The introduction was very good really and (the Manager) knows a lot. In our questionnaire for members of staff we ask, did your introductory training cover everything you needed to know to do the job when you started? Three people say that the training met their needs very well and one person says mostly. This latter person doesnt say any more about the matter. One of the former people adds that I had a structured handover which included detailed case histories of the service users. The Registered Provider says that after their introduction to the Service, support workers start completing a more detailed training programme. When we were last in the Service we found quite a few shortfalls in the training arrangements. Some of the support workers hadnt done some of the courses intended for them by the Registered Provider. There was no clear plan to sort these gaps out. To make matters worse the records of who had done what training werent that clear. When the Registered Provider responded to our last inspection report he said that these problems would be sorted out by now. They havent really. This oversight is recognised in the Assessment when it says that, a more organised and structured approach to staff training will need to be developed. Although most support workers have done an important training course in mental health awareness, there isnt much other progress for us to tell you about. Theres still no real system to note who has done what Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 29 training courses. Also, theres still no clear training programme to sort out any gaps. The Development Plan also recognises the need to sort this matter out. The Manager says that he is keen to begin working on the problem. When doing this he is going to use a national model that we think is very useful. This is because it carefully looks at the skills and knowledge support workers already have, so that any further training can be tailored to each persons needs. This is quite a big piece of work to do. The Manager says that this skills assessment will be completed by 1 August 2009. In our questionnaire for members of staff we ask, are you being given training which is relevant to your role, helps you to understand and meet the individual needs of service users and keeps you up to date with new ways of working? Everyone answers yes to each part of the question. The Assessment says that all support workers are encouraged to complete a relevant National Vocational Qualification (NVQ). This is a good idea because the qualification is designed to support people being helped in ways that are right for them. At the moment, there are seven support workers employed in the Service. The Manager says that three of the support workers currently hold the award and one more is working towards it. When we were last in the Service, we asked some support workers about their key bits of their knowledge and skills. From their answers we didnt think that they knew enough about some quite important stuff to do with mental health matters. Things are better this time. For example, they know about the main sorts of mental illnesses and what the differences mean for the support that they are likely to have to give. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 37, 39 and 42. In general the Service is reliably managed. People are asked what they think about how things are going, but this could be a bit more developed. People’s health and safety is promoted. EVIDENCE: The Manager has been in post for four or five months now. In that time he has worked with the Registered Provider to take a fresh look at how things are going. Hes already done a lot of useful work such as on the new individual Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 31 support plans that weve already told you about. The Development Plan weve told you about shows that hes got lots of interesting ideas for the Service. For example, in the future he wants to put much more emphasis on supporting people to become more independent. The Manager has one of the two formal qualifications that we expect. These qualifications are important. This is because they are intended to help managers ensure that people reliably receive high quality residential care services. He says that he intends to start working towards the second qualification. This will be done once the Development Plan is well under way. The Registered Provider will need to apply to us to register the Manager in his post. This is necessary because the Manager needs to explain to us how he is going to make sure that the Service can reliably support people in ways that are right for them. The Registered Provider says that he is going to make the application by 1 May 2009. Various things are done to help staff work as a team. There are handover meetings at the beginning and end of each shift. These are when support workers say how things are going and what needs to be done on the next shift. Also, there are staff meetings. We looked at the records of the most recent meeting. A number of useful things were discussed. These include the new key working system weve already mentioned. Support workers also talked about how to make the handover sessions more detailed so that nothing important gets missed. In our questionnaire for members of staff we ask, do the ways you pass information about people who use the Service between staff (including the manager) work well? One person answers always and three say usually. The latter two dont say any more about why theyre answering in this way. Support workers say that there is good team work. We saw plenty of evidence of this. Support workers check out with each other who is going to do what, with whom and when. Also, they plan their work in advance so that they use their time to the best effect. In our questionnaire for members of staff we ask, does your manager meet with you to give you support and discuss how you are working? Everyone says that he regularly does. One person adds, I feel very supported. People who live in the Service are asked about how well they think things are going in their home. This includes informal everyday discussions. There are also each persons one to one sessions that we spoke about earlier. Each six months or so people are asked to fill out the questionnaires from the Registered Provider that we already told you about. We think that this is a very useful thing to do. However, several things can now be done to get more out of this questionnaire exercise. The Registered Provider needs to be a bit more active in finding out why some people are giving the occasional critical reply. Also, the Registered Provider needs to develop a response to what Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 32 people have said. This is so that they can be told what is and what is not going to be done to respond to peoples suggestions. At the moment, there are no questionnaires for members of staff. We think that this is a pity. This is because members of staff have a detailed knowledge of how the Service works in practice. Theyre bound to have lots of useful suggestions to make. The Registered Provider and the Manager say that these points will now be sorted out. Theyre going to do this in time for us to be told about what has been done when they send us their next Annual Quality Assurance Assessment later this year. As weve already said, theres a system of house meetings. These are when each month the people who live in the Service come together with a member of staff to say how things are going in their home. We looked at the records of the sorts of things that are talked about. All sorts of important things are being discussed such as the social activities some people would like to do. The Registered Providers questionnaire asks about these meetings. Five people say that they are excellent and eight people say that they are good. The house meetings might be the obvious place in future to feed back to people about the questionnaires that we were talking about above. Regular checks are done to make sure that the Service’s fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells and regular more detailed checks completed by a contractor. There are unannounced fire drills. When we were last in the Service we found that there were shortfalls in the system of fire training for members of staff. This training is very important. This is because the level of fire safety protection in the Service largely depends on staff doing the right thing at the right time. Since then, all members of staff have received fire safety training. However, some of this training hasnt been recorded. We asked two support workers about some of the things that they will do if the fire alarm sounds. They know what to do. The Registered Provider is now going to introduce a new system that will better record each time a member of staff has fire training at least once every six months. Hes going to do this by 1 March 2009. An electrician who says that its safe to use has examined the electrical wiring installation. The electricians report says that several minor things do need attention. The Registered Provider says that all of these things have been done. An engineer has looked at the gas appliances in the Service during the past year. He says that all of them are in good working order. We looked at the record of accidents and other untoward events that have occurred in the Service this year. There is nothing out of the ordinary that we need to make further enquiries about. The handyman checks the place over regularly to make sure that theres nothing broken that needs fixing. He keeps a record of the repairs he does. We Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 33 had a look at this. It shows that things are being attended to quite promptly. There is also a system where members of staff check on certain things. For example, they look to make sure that things like bleach arent left around where someone might misuse them. We kept our eyes open when we were walking around the building. We were looking for things that might cause someone to have an accident. This includes things such as frayed carpets or something sharp that might catch people as they walk by. We didnt see any obvious hazards. Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 34 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 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 2 X Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 35 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 Paddock House DS0000023503.V374043.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone 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. 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