Care Home: Zacchaeus

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What the care home does well Zaccheaus offers a homely, comfortable and friendly environment for the people who live there and people say that they are happy living in the home. In order to ensure that the staff team have the information they need to support people well, there are detailed accessible care plans in place that are regularly reviewed and updated. The people living in the home have access to their local community, religious needs are met and they attend educational and day care opportunities. Holidays and outings are also enjoyed and people are supported to keep in touch with family and friends. People are supported by the staff team with dignity and respect and in order to protect people there is a robust recruitment process in place. Healthcare needs are met and the home works well with a variety of healthcare professionals. People tell us that they enjoy a variety of home cooked meals and occasional meals out and that they have someone they can talk to if they feel unhappy or have a complaint. What has improved since the last inspection? People continue to have a full and varied lifestyle and are part of their local community. Some people have been on holiday, there have been some improvements made to the environment and one person has recently had their bedroom redecorated. What the care home could do better: A review of staff training is recommended to ensure that the staff team have the skills and confidence they need to support people with complex needs. CARE HOME ADULTS 18-65 Zacchaeus 37 Servite Close Bognor Regis West Sussex PO21 2DE Lead Inspector Annie Taggart Unannounced Inspection 21st February 2008 3:00 Zacchaeus DS0000014866.V357058.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 Zacchaeus DS0000014866.V357058.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. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Zacchaeus Address 37 Servite Close Bognor Regis West Sussex PO21 2DE 01243 828532 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) L`Arche Mrs Hanna Lizakowska - Campkin Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (0) of places Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users should not exceed five persons at any one time 28th October 2006 Date of last inspection Brief Description of the Service: Zaccheaus is a care home providing personal care and accommodation for five adults with learning difficulties. The home is one of three homes operated by the LArche organisation in West Sussex. The building is owned by The Servite Housing Association and consists of two adjoined semi-detached houses. There is a communal lounge, a dining room and a kitchen. Private accommodation for service users consists of five single bedrooms. The house is located in a cul-de-sac in a residential area of Bognor Regis, close to shops and other amenities. Zaccheaus was first registered with the previous registration authority in July 1989. The Responsible individual is Mr. Roy Pickett and the Registered Manager is Mrs Hanna Lizakowska-Campkin. Current fees are £549 to £856 per week. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. In order to prepare for the visit, surveys were sent to families, service users and other professionals involved with the home. Four service user, one professional, one family and six staff surveys were returned and comments received in these surveys have been used in the report. The acting manager of the home had completed an Annual Quality Assurance (AQAA) and this gave us very clear and detailed information about the service being provided. Information for the AQAA and the last inspection report was also used to inform this visit. The unannounced visit was carried out at 3pm on 21/2/08 and lasted for three and a half hours. During that time we spent time with the people living in the home, both in their private bedrooms and in communal areas and we spoke to the staff on duty and observed staff practice. Four care plans and all supporting documentation such as daily records were looked at and we also looked at four staff records and the system for the recording and administration of medication. We spoke to the staff on duty and also observed staff practice. During the visit we looked at menus and food records and we asked people what choice they had in the meals that are provided. Records for the running of the business including the quality assurance process, health and safety and incident and accident recording were seen. The acting manager was present and received feedback following the visit. What the service does well: Zaccheaus offers a homely, comfortable and friendly environment for the people who live there and people say that they are happy living in the home. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 6 In order to ensure that the staff team have the information they need to support people well, there are detailed accessible care plans in place that are regularly reviewed and updated. The people living in the home have access to their local community, religious needs are met and they attend educational and day care opportunities. Holidays and outings are also enjoyed and people are supported to keep in touch with family and friends. People are supported by the staff team with dignity and respect and in order to protect people there is a robust recruitment process in place. Healthcare needs are met and the home works well with a variety of healthcare professionals. People tell us that they enjoy a variety of home cooked meals and occasional meals out and that they have someone they can talk to if they feel unhappy or have a complaint. What has improved since the last inspection? What they could do better: A review of staff training is recommended to ensure that the staff team have the skills and confidence they need to support people with complex needs. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 7 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. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 8 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 Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 9 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 and 4 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their families can be confident that people’s needs will be assessed and that they will be able to visit the home or have short stays there before moving in. EVIDENCE: There is a Statement of Purpose and Service user Guide in place, both of which are provided in an accessible format using words, symbols and pictures. To ensure that the home can meet people’s needs, detailed pre-admission procedures are carried out with the involvement of service users, families and other professionals involved in their care. No new service users have been admitted to the home since the last visit but we were able to see records that showed that the probation period for one person had been extended in order to give more time for the home to be sure they could meet the person’s changing needs. Visits and short stays are encouraged before people move in and the other people living in the home are consulted to ensure compatibility. Zacchaeus DS0000014866.V357058.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 and 10 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. There is clear and detailed information in care plans to guide the staff team to the needs and wishes of each person, risks are assessed and regular reviews are held. EVIDENCE: For each service user living in the home there is a detailed plan of care in place that gives very clear guidance to the staff team about the needs and preferences of each person. The plans contain photographs and pictorial prompts to enable service users to identify which is their plan and while we were tracking the plans a service user said, “this one is about me”. The person confirmed that they were involved in writing the care plan. We looked at the plans for all of the four people currently living in the home and there were detailed references to routines, personal preferences, nutritional needs, likes and dislikes and daily routines. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 11 There were also daily reports completed for each person that gave an overview of activities, healthcare issues and community involvement and regular reviews and updates of the plans are completed. There are also annual reviews carried out, which include families and other professionals involved in the person’s care and these are recorded with personal goals for the person’s future needs and wishes agreed. The plans contain risk assessments both personal and environmental and these were outcome based to support independence, for example how one service user who wishes to smoke is being supported to do this safely and without risk to other people. Zacchaeus DS0000014866.V357058.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 15 16 and 17 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. The people living in the home have a varied and full lifestyle, they are supported to keep in touch with their families and friends and are offered a choice of fresh home cooked meals. EVIDENCE: Daily records and activity plans show that people have a full and active lifestyle. People attend various day care facilities and colleges and also work in the L’Arche garden project and workshops. People are also busy in their local community and records show that people enjoy holidays, going to meals out, clubs to see their friends and to the local pub. People told us that they enjoy going on holiday and one person said that their favourite activity was going to the shops. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 13 Some of the people living in the home use Makaton signing to aid communication and both service users and the staff team attend workshops to further their skills. Service users had just returned from a three-day retreat in a monastery and gave various feedback on how they had enjoyed this. Two people said that they had especially enjoyed seeing the church; one person said they liked the music and two said they had enjoyed some of the time there but were glad to be home. From looking at daily records and talking to the people living in the home it is clear that people are supported to maintain relationships with their families and friends and there are lots of celebrations and joint meals and outings with people from other houses. In one person’s care plan it was detailed how they would be supported to regularly telephone their family and how staff were to help them dial but then leave the room to respect the person’s privacy. In a survey a family member said, “ my relative has been in Zaccheaus now for 30 years, she has always been looked after very well. They are a great crowd, the home is always clean, and the food very good and as we are in our 80’s now and can’t visit they bring her to see us”. Menus and food records show that people enjoy a variety of fresh home cooked meals. Likes and dislikes are recorded and nutritional needs assessed and monitored. People said they really enjoyed the meals provided and each person chooses the meal of the day in turn. People also prepare their own packed lunches for day care. During the visit as people had eaten their main meal at lunchtime a wholesome soup was being made for supper with fresh ingredients. Zacchaeus DS0000014866.V357058.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 and 21 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to good personal and metal healthcare support and their medication is well managed. EVIDENCE: Service user records show that people have access to a variety of healthcare professionals and are supported to attend medical appointments. Records are kept of visits to, for example, doctors, dentists, audiologist clinics and the health centre. Some of the people living in the home have complex needs and can at times be challenging. Records show that people have regular input from a psychiatrist and the local learning disability team and plans are in place for behaviour management approaches and agreed diversion strategies. For people who have conditions such as epilepsy or asthma, there are detailed step-by-step plans in place to guide the staff team on how to address this and records show that when necessary appropriate medical help is sought. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 15 Care plans show also that the ageing process is acknowledged for service users and provided for by people choosing to lead a more “retired” lifestyle. For each person there is a detailed medication profile in place, which shows what medication people take, and the reason it has been prescribed. Medication is safely stored in a locked cabinet and all staff members that administer medication receive training. The Medication Administration Sheets were all current and medication is well managed. When people go to their families or out for the day the person receiving the service user’s medication signs a form to say they have taken it from the home. There are currently no service users who self medicate living in the home. Zacchaeus DS0000014866.V357058.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 and 23 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. Service users and their families can be confidant that their complaints and concerns will be recorded and acted upon and that the home’s working practices are designed to protect people from risk of abuse. EVIDENCE: There is a complaints procedure in place that has been produced in an accessible format using pictures and symbols in order for service users to better understand the process. Weekly house meetings are held and at this time people are encouraged to say if they have any concerns or have anything they are not happy about. One person said they would talk to a member of staff if they were unhappy and records show that concerns from service users are recorded and acted upon. No formal complaints have been received since the last visit. As part of the induction process, all staff receives abuse awareness training and the staff on duty at the time of the visit were aware of their responsibilities and said that they would report any suspected abuse straight away. In two surveys, staff members said that they did not feel confident in this area and would welcome further training in the protection of vulnerable adult from abuse. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 17 The manager told us that an incident where a service user had become vulnerable after wandering away on holiday had been risk assessed and that extra staff would be allocated to this person on holidays. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 29 and 30 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, comfortable and homely environment for the people who live there and people say that they are happy with the facilities being provided. EVIDENCE: Communal areas are comfortable and well furnished and people also enjoy an attractive well-maintained garden to the rear of the building. People’s private bedrooms have been personalised to meet their individual taste and there is evidence of hobbies and interests being supported. One person had chosen the colours for their room, which had been decorated while they were away and they were very pleased with the finished results. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 19 Records are kept of water temperatures, which are kept at a safe level, and all staff receives health and safety and infection control training. Handrails , grab rails and other equipment is in place as required by individual service users. Environmental risk assessments have been completed and where a risk to service users for e.g. wandering away from the home has been identified, action has been taken to minimise the risk. The people living in the home are encouraged to take part in daily tasks and looking after their bedrooms and each person has a pictorial rota of their cleaning and household duties. The home was clean and pleasant throughout. A service user said, “ I like my house and my room and it was nice to come home”. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 and 36 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a competent and caring staff team and are protected by the organisation’s robust recruitment procedures. This would be further improved by the provision of more specific training opportunities. EVIDENCE: Staffing rotas show that there are sufficient numbers of staff on duty to meet the need of the people currently living in the home. For one person, who has been identified as needing some extra staffing on holidays and outings this is provided. The acting manager also told us that negotiations are being carried out to give extra staffing at busy times in the home, especially at week ends to further meet people’s complex needs. To lessen the anxieties of service users the staffing rota is pictorial with photographs of the staff to identify which person will be next coming on duty changed at each shift. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 21 To ensure the safety of service users there is a robust recruitment process in place. We saw the records of four of the permanent staff currently employed at the home and all had the required documentation including a current Criminal Bureau Check (CRB) and two references. Records show that all staff receive a detailed and structured induction during which time they attend mandatory training and basic training is also given in understanding learning disability and managing challenging behaviour . In the AQAA we were told that 50 of the staff team have NVQ 3. The people living in the home said that they liked all of the staff working with them and the atmosphere in the home was friendly and supportive. In a survey a healthcare professional who visits the home said that they had some concerns regarding the turnover of staff due to most people being from overseas and only working at the home for a set time and they also felt that the staff team did not have all of the skills and understanding needed to support some of the more complex and emotional needs of service users. Three out of the six staff surveys returned also said that although they felt well supported, further training for example in autism awareness, specific syndromes and further abuse training would help them to be more confidant and effective. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. The home is being run by a caring and competent acting manager in the best interests of the people who live there and records are current and in good order. EVIDENCE: The Registered Manager is on extended agreed leave and in her absence the home is being run by acting manager who has previous experience in working with people with a learning disability both within the L’Arche organisation and in other homes. The staff on duty said that the acting manager was very supportive and open in his approach and that he was very focussed on good outcomes for the people living in the home. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 23 There is a quality assurance programme in place in order for people to give their opinions of the service being provided. This begins with weekly house meeting in the home, regular meetings with senior managers and service users from other homes and a formal quality assurance process is also completed annually by the organisation. One of the service users in Zaccheaus was away at a meeting during the visit as he was one of the service user representatives involved in setting the future mandate of the local Bognor Regis part of the organisation. Records show that all staff members receive regular structured supervision and detailed notes are kept on file. Regulation 26 Providers visits are carried out regularly and we saw the reports are kept on file in the home. We also saw records for the running of the business including fire checks and staff fire training, maintenance reports, health and safety and accident and incident reporting. All records were current and Regulation 37 incidents are reported to the Commission when appropriate. Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 x 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 x 35 3 36 3 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 X 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 3 x Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 25 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 Zacchaeus DS0000014866.V357058.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone, Kent 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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