Care Home: Southfield

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What the care home does well The home treats residents as individuals and this results in a life style that reflects their wishes. Staff were seen as caring, competent and good listeners and constantly engaging residents in meaningful activities. Residents who were able to comment said that they liked living in the home and that staff were supportive. The inspector felt that staff provided the options and information and the residents made the choices about how they spend their lives. All activities which are seen as having risk factors are assessed and reviewed. What has improved since the last inspection? Redecoration in a number of areas to include the lounge/dining rooms. One resident told the inspector that the home was nice and bright now it has been decorated by staff. The work is of a high standard and staff should be complimented on their efforts. What the care home could do better: The question of the review of the care plans has been raised again. It is now essential that the home has an acceptable practice, which is undertaken by staff to ensure there is a regular review, and as important there is evidence of the review. CARE HOME ADULTS 18-65 Southfield Harp Hill Charlton Kings Cheltenham Gloucestershire GL52 6PX Lead Inspector Mr Tim Cotterell Key Unannounced Inspection 28 /29th November 2007 th Southfield DS0000067087.V356044.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 Southfield DS0000067087.V356044.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. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southfield Address Harp Hill Charlton Kings Cheltenham Gloucestershire GL52 6PX 01242 250053 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) www.brandontrust.org The Brandon Trust Mrs Kathryn Skinner Care Home 5 Category(ies) of Learning disability (5), Sensory impairment (2) registration, with number of places Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To reduce numbers to four (4) places when a vacancy occurs in the shared bedroom. 20th April 2006 Date of last inspection Brief Description of the Service: Southfield is a registered Care Home and is registered to accommodate five adults who have a learning disability. The home is an adapted detached house about one mile from the centre of Cheltenham town. The accommodation is on two floors and consists of two lounges and a dining room on the ground floor. On the first floor there are four single bedrooms and one twin bedroom.There are two bathrooms; one of which is an assisted bath, the other a walk-in shower with seat. There is a raised sitting area in the garden and pleasant gardens. The outside area is accessible and provides a pleasant alternative for the service users. The Registered Provider of the home is now the Brandon Trust as of the 1st April 2006. They are a social care organisation based in Bristol and were chosen by the Gloucestershire Partnership Trust in the re-provision of the MEND/Mayfield Trust homes in Gloucestershire. The home and the Brandon Trust are reviewing how best to provide information about the home to prospective service users. The monthly fees charged by the home are £1359.15 Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experience of people using the service. This was an unannounced inspection completed by one inspector. The inspection consisted of two visits, the first unannounced the second announced. The deputy manager was on duty on both occasions and all staff on duty were seen and spoken to. The accommodation was inspected and the records seen included, medication, personal monies, care plans and risk assessments. All of the residents were seen and the inspector was able to talk to those who were able to verbally communicate. Residents who were not able to communicate verbally were communicated with using non-verbal signs. The home was found to be organised, odour free and with a relaxed atmosphere. Surveys were sent from the Commission to the home in respect of asking for the views of the residents/relatives and staff. At the time of sending the draft report they had not been returned. In the circumstances any comments received later will be added to the final or the next inspection report. What the service does well: The home treats residents as individuals and this results in a life style that reflects their wishes. Staff were seen as caring, competent and good listeners and constantly engaging residents in meaningful activities. Residents who were able to comment said that they liked living in the home and that staff were supportive. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 6 The inspector felt that staff provided the options and information and the residents made the choices about how they spend their lives. All activities which are seen as having risk factors are assessed and reviewed. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Southfield DS0000067087.V356044.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 Southfield DS0000067087.V356044.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Any assessment of need would be comprehensive and identify the needs and wishes of the individual and where appropriate other health care professionals are consulted. EVIDENCE: There had not been any admissions since the last inspection. The inspector discussed the procedure for assessments and admissions and was satisfied that they would be undertaken in a sensitive way and one in which the views of the residents would be seen as most important. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home through individual care planning and risk assessments enables residents to take part in a life style of their choosing. Staff are available to support and advise if and when this is necessary. EVIDENCE: The inspector looked at a number of care plans. At the time of the inspection the home was introducing a new care plan format, however, they were able to amend the suggested format to meet individual needs. One plan base on the new format, but amended by the home was seen as excellent. Two of the three care plans seen had not been reviewed for some sime (March 2007), and this was something raised in the last inspection report and brought to the attention of the deputy manager at the inspection. At the time of the inspection one resident was having a meeting with staff to discuss their Individual Plan and the local Adult Opportunity Centre staff attended. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 10 Considerable time is spent by staff on providing residents with adequate information to enable them to make informed choices about matters, which affect their day-to-day lives. Residents have written risk assessments and these were seen as appropriate and evidence of the review was seen. In spite of the dependency levels of the residents the home ensures that whatever their disability responsible risk taking enables residents to pursue a life style of their choice. This risk taking is undertaken within a responsible risk-taking framework. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 15 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home finds out what residents would like to do then provides the corresponding activity. Activities are based on individual need and staff were providing excellent support for residents when this was needed. They are supported to keep contact with relatives/friends and have choice over the food provided. EVIDENCE: Residents have individual programmes of activities and there have been great efforts by staff to ensure that wishes are wherever possible met. One resident was able to tell the inspector what activities they did and said how much they enjoyed them. The home attempts to balance activities in a formal organised sense together with informal trips out to places of interest. The inspector felt that each day is Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 12 busy and filled with appropriate activities. The home also accepted that some of the residents were happy to stay at home and have a nap. The home is active in respect of being part of the local community using local facilities and supports residents to use any the resources available. All of the residents had support from outside the home and this included family members who were visiting regularly. Where necessary the local advocacy scheme would be consulted. The daily routines of the home reflected the wishes of the residents. Evidence of this was seen where after spending a day out at a local Opportunity Centre one resident returned home and promptly said that they were retiring to their room for a nap before tea. The inspector felt that the home was striking a good balance between providing a stimulating environment, and a home where choices could be made to include a relaxing day in the home where this was requested. Residents are able to have choice over the menus and there is a weekly meeting where choices are given and then written into the weekly menus. The home has made great efforts to ensure that residents have enough information to ensure they are able to determine what they would like to eat and the manner in which it is cooked. The home has a box of wooden animals which assists residents to identify the food/meals they like and the models also enables residents to non-verbally communicate their wishes. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a flexible service which ensures individual needs are met in a manner which residents prefer. Every effort is made to enable residents to comment on how they wish to spend their days. Health care needs and the management of medication are dealt with in a safe and effective manner. EVIDENCE: The service provided by staff is very flexible and reflects the wishes of the individual resident. In spite of the disabilities the residents are seen as individuals with the need for personalised care. Health care needs are addressed and full use is made of all of the resources in the community. The home keeps good records of all visits and treatments from doctors, dentist, opticians and chiropodists. Where more specialist health care is required the Community Learning Disability Team is consulted. Evidence of a recent request to this team for a medication review was seen. The continence adviser has been consulted and there were records of the visit and the advice given. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 14 The home manages all medicines on behalf of the residents. Medicines are held securely and there is a record of the receipt, administration and disposal. Individual protocols are written when medicines are “as and when required”. The staff advised the inspector that the dispensing pharmacist has not provided any support for some time, and the Trust should ensure that staff receives this essential avenue of support and advice. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed by caring and competent people who are making great efforts to provide a safe environment with a flexible and personal service. EVIDENCE: Residents felt that they are listened to and this included those who may have communication difficulties. Staff were seen to be patient and gave residents time to express themselves. Pictorial aids are also used where there are matters of choice, and this ensures everyone is able to offer comment. This open approach to residents needs and wishes results in most concerns being dealt with by staff in an informal way. The home also has a complaints policy and procedure and this has been completed in a picture form to. Staff on duty are clear about the identification of abuse and were seen to respond to residents in a competent and dignified manner. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been maintained to a good standard and provides a clean and comfortable physical environment. EVIDENCE: The accommodation has been maintained to a good standard and is appropriately furnished. Staff have completed redecoration in many areas to include the lounges and dining room and the new curtains were seen as an improvement. A number of bedrooms were seen and they reflected the interests of the residents. Whilst it was appreciated that the residents who share a bedroom were happy with the arrangement, this should be a matter of constant review to ensure that the needs and wishes of both are met. There is some work necessary on the stairs as the wallpaper was hanging off, due it appears to either water/damp problems. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed by caring and competent people who are making great efforts to provide a flexible and personal service to vulnerable people. EVIDENCE: During the two visits all of the staff on duty were seen and spoken to, this included the deputy manager. As well as talking to staff the inspector spent time watching the interactions between residents and staff, it was clear that there was a good relationship between them with staff taking time to listen and then if appropriate to explain. Communication was an issue with some residents but this has been addressed by various schemes to ensure residents are aware of the choices available. Staff have opportunities for training and those who were seen had either completed or were completing some social care courses. The staff had a good Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 18 understanding over the issues about prevention of abuse and challenging behaviours, two issues that often concern staff in homes. Staff were seen as working as an effective team ensuring that the wishes of the residents are met. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by competent staff which ensures the safety and well being of the residents who are accommodated. EVIDENCE: The registered manager is at present spending some time at another home to offer support during the absence of their registered manager, but continues to be in control of Southfield. During the inspection visits the deputy manager was on duty and fully conversant with all of the practices within the home. It was evident that the registered manager of the home was seen as competent and well liked by the staff and residents and someone who manages by consent. The deputy manager was seen also as competent, caring and having a good relationship with staff and residents. The inspector sat in on Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 20 a staff hand over during the second visit and was impressed by the content and manner in which it was conducted. The deputy manager was present and clearly showed that she was a good listener ensuring that everyone was able to comment before making any decisions. The inspector felt that the home was well managed and that staff were working together having the needs and wishes of the residents as paramount. The fire and rescue records were seen and there was evidence that all staff had recently attended a staff meeting, which included instructions in the event of a fire. The fire equipment is tested by an independent electrical contractor and there was a record of the last inspection. The inspector discussed Health and Safety issues with the deputy manager. It is recommended that in view of the proposed changes in respect of staff on night duties (from waking to sleeping), the home ensures that the procedures in the event of a fire at night are reviewed and tested to ensure that the arrangements are appropriate and effective. Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000067087.V356044.R01.S.doc 2 3 x 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Southfield Score 3 X 3 X X 3 x Version 5.2 Page 22 3 3 3 3 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation Requirement Timescale for action 31/01/08 1512(1)(a) Care plans must be reviewed and updated. (timescales of 30/03/06 and 31/07/06 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA42 Good Practice Recommendations Ensure night fire policy and procedures are effective Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Southfield DS0000067087.V356044.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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