Care Home: The Annex

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What the care home does well The Annexe is well run. Both the registered manager and the new manager know the resident and the staff team well. Observation showed that staff have good relationships with them and with the resident. The resident was seen to be treated with respect and spoken to appropriately. The assessment, care plan and risk assessments are detailed, regularly reviewed and clearly identify the support the resident requires to achieve their goals. A range of activities both in the home and in the local community are provided. Menus are agreed with the resident with guidance for healthy eating being given. Contact with family members is encouraged and facilitated. Good staff recruitment procedures are followed which safeguard the resident. The staff training programme is good with a training plan identified for each member of staff which includes refresher training. A system of formal staff supervision is in place with sessions being held every four to six weeks for each member of staff. What has improved since the last inspection? This was the first inspection of this service. CARE HOME ADULTS 18-65 The Annex Penhayes Kenton Exeter Devon EX6 8JB Lead Inspector Susan Samways Unannounced Inspection 16 March 2007 10:00 th The Annex DS0000066078.V325149.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 The Annex DS0000066078.V325149.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. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Annex Address Penhayes Kenton Exeter Devon EX6 8JB 01626 899930 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) chalkhill@moduscare.com Modus Care Limited Stephen Lawson Care Home 2 Category(ies) of Learning disability (2) registration, with number of places The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The categories of registration will be (LD)(2). The home will be occupied by a maximum of 2 service users aged between 18 and 65 years. N/A Date of last inspection Brief Description of the Service: The Annexe is a three bedroomed house attached to Penhayes which was a nursing home but is currently being used as the headquarters for Modus Care Ltd the registered providers. The Annexe has its own entrance from a quiet side street. The ground floor is open plan with kitchen, dining and living areas. One bedroom is used as the staff sleep-in room. The house benefits from its own enclosed garden. Fees charged are based on the assessed needs of each Service User and the degree of staffing input required and are therefore individually determined. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this new service since the resident moved in. The registered manager has been promoted within the company and a new manager appointed who is currently applying for registration with the Commission for Social Care Inspection. The new manager was present for the whole inspection, the registered manager and the responsible individual were available for part of it. The resident was out for part of the day but was seen at lunchtime with the staff who were supporting her. During the inspection discussion took place with the registered manager, the responsible individual and the new manager and a member of staff was interviewed. Various documents and records were also examined. What the service does well: What has improved since the last inspection? This was the first inspection of this service. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 6 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. The Annex DS0000066078.V325149.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 The Annex DS0000066078.V325149.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): 1,2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment is made of prospective residents, who are also given a detailed Service Users’ Guide, which provides sufficient information to enable all those concerned to make the decision as to whether The Annexe is an appropriate home for them. EVIDENCE: The resident’s file was examined and was found to include a comprehensive assessment. This had a detailed history with contributions from the resident, their relatives and the care manager. All aspects of the resident’s health had been considered including their physical and mental health as well as their learning disability. The staff have access to good training programmes which equip them to understand the resident’s condition and behaviour and support the resident in a positive way when meeting their needs. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 9 The registered manager explained that the resident had been visited several times at their previous home as part of the assessment process and in order to get to know them. The resident had also visited The Annexe on a couple of occasions with the support of staff that they knew. The Annexe also has a comprehensive Service Users’ Guide available to the resident. The Annex DS0000066078.V325149.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): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident can be confident that their care plan clearly identifies their needs and how they will be met. EVIDENCE: The resident’s care plan was found to be very detailed. Each area of the resident’s life had been considered separately with the degree of support or assistance required clearly identified. Risk assessments had also been completed for various situations e.g. going to the doctor, visiting relatives, travelling in the car and participating in different activities. These are detailed and clearly show what action should be taken to support the resident and reduce the risk. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 11 The care plan also includes a detailed risk assessment for situations requiring the use of physical restraint. This form of intervention is broken down into different stages with the instructions to explain what is happening at each stage. There is also a list of all those with whom this has been discussed and the dates when this took place. The manager stated that all risk assessments would be reviewed at least every six months and sooner if there were any changes in the resident’s circumstances or behaviour. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good range of activities is provided both in the home and by accessing local facilities. The resident’s contact with family members is positively encouraged. Nutritious meals are provided which include the resident’s preferences. EVIDENCE: A variety of activities has been provided for the resident both in the home and by using local facilities. These range from helping to make cakes, listening to music and playing table games to going swimming, going for walks, visiting cafes and discos and spending time with family. The manager stated that at The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 13 present educational activities are not included as the resident has shown no interest but that this will be re-assessed at regular intervals. Maintaining family contact is an important part of the care plan and the resident is encouraged to visit the family home once a week. Family members are also welcomed when they visit The Annexe. Regular telephone contact is also maintained. During the inspection staff were observed to treat the resident with respect. They included the resident in discussions regarding activities for the day, exploring the resident’s preferences and explaining decisions. At lunchtime they were heard discussing with the resident menu options and offering guidance for healthy options. Past menus showed balanced meals and the manager stated that menus were being developed as the resident’s preferences were established. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 14 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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care is provided in an appropriate way which promotes independence and maintains the resident’s privacy and dignity. Medication is managed in a way which safeguards the resident. EVIDENCE: The care plan details what the resident is able to do for themselves and what assistance they require and how it should be provided. All help given, including prompts, is recorded in the daily records. Risk assessments are in place for all potentially difficult situations so the staff are aware of what action they should take to minimise the risk and support the resident in an appropriate way. Staff rotas show that there is always a female member of staff on duty including at night. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 15 Records show that any health care issues are dealt with promptly and that the staff provide support for the resident when visiting the G.P. surgery or a hospital appointment. The home operates a good system for the administration of medication. All staff receive training in the safe administration of medication and are required to observe an experienced member of staff at least three times before they are supervised administering medication themselves. A monitored dosage system is used. Two staff work together when dealing with medication and both sign to say that the medication has been given. Medication records examined were seen to be in order and the medication stored securely. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 16 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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff training in the protection of vulnerable adults safeguards the resident from abuse. EVIDENCE: A copy of the home’s complaints procedure is included in the Service Users’ Guide. The manager stated that no formal complaints had been received. No complaints about this service have been received by the Commission for Social Care Inspection. Most of the staff have had training regarding the protection of vulnerable adults and recognising different forms of abuse. The manager is a trainer for this subject and she stated that she had arranged a session for those who had not yet had training for the 28th March. She also stated that this had been an area covered in the individual supervision sessions held with staff. A member of staff spoken to said that they would speak to the manager if they had any concerns about the welfare of the resident. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 17 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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Annexe provides the resident with a homely, comfortable and safe environment in which to live. EVIDENCE: The Annexe is a three bedroom house which provides a homely environment. Some modifications have been made to make it as safe as possible for the resident, e.g. ensuring that all glass is safety glass, but these changes do not detract from the domestic nature of the home, its furniture and décor. The home was found to be clean and bright and free from offensive odours. There is a separate room used as a laundry. Hazardous substances, such as cleaning materials, are stored in a locked cupboard. All staff receive training in The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 18 infection control as it is included in the five day induction programme which all staff are required to attend. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 19 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): 32,33,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident is safeguarded by good recruitment procedures. Staff have the skills, training and understanding to meet the needs of the resident. EVIDENCE: Modus Care Ltd, the company which owns The Annexe, has a clear commitment to staff training. The induction programme, which all new staff are required to attend, lasts for five days and covers topics such as challenging behaviour, emergency first aid and manual handling. Records seen during the inspection showed the training each member of staff had received, what they needed to do and when refresher sessions were due. The overall training plan for March to May was also seen. The company has a team of bank staff which can be called upon to cover for staff absences. They undergo the same training programmes as the permanent staff. This system ensures that The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 20 temporary cover is provided by staff known to the resident and who are competent to do the work. Staff rotas showed that there are good staffing levels at all times. This includes at night when there is one awake member of staff and another sleeping who is available if required. During the inspection staff were observed to communicate with the resident in an appropriate way, to treat them with respect and to involve them in decisions in the day to day activities of the home. The home has a good recruitment policy and procedure and the three staff files examined showed that these had been followed. CRB checks were not available as these are held at the head office of the company which owns The Annexe. Staff spoken to confirmed that the recruitment procedure had been followed and that police checks had been carried out. The manager stated that staff supervision takes place every four to six weeks depending on the experience of the staff member. Supervision is shared between the manager and a senior carer with the manager responsible for the senior staff and the senior supervising most of the support workers. A member of staff said that they had found supervision very helpful especially when they were first employed. Supervision records were seen which showed that topics such as specific work with the resident, training and policies and procedures had been discussed. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 21 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): 37,38,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident can be confident that the home is well managed and that their views will be taken into consideration in the running of the home. EVIDENCE: The new manager has NVQ level 4 and is keen to complete the Registered Managers Award. In discussion she demonstrated a good knowledge of the resident and the strengths and weaknesses of the staff team. She is in the process of applying for registration with the Commission for Social Care Inspection. She was observed dealing with different situations within the home and was seen to be competent and considerate in the way in which she The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 22 related to the staff and the resident. Staff were observed to approach her with confidence and they spoke of being part of a good team where there is good communication and their views are valued. The manager stated that quality assurance systems are being developed. She said that any concerns the resident might have would be dealt with promptly and that all incidents are recorded and reviewed to see what can be learnt from them. Staff said that they are listened to. Staff are trained in safe working practices including fire safety, first aid, infection control and health and safety. Records showed that fire safety checks are carried out at the required intervals. Gas and electrical checks have been completed by those competent to do so and environmental risk assessments have been completed. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 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 3 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 x x 3 x The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA39 Good Practice Recommendations The registered provider should ensure that the quality assurance system is further developed. The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 The Annex DS0000066078.V325149.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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