CARE HOME ADULTS 18-65
1 Greville Road Shirley Southampton Hampshire SO15 5AW Lead Inspector
Christine Hemmens Unannounced Inspection 17th January 2006 10:00 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 1 Greville Road Address Shirley Southampton Hampshire SO15 5AW 023 8039 3403 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.mencap.org.uk Royal Mencap Society Miss Helen Smart Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (7) of places 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users must be at least 55 years of age. Date of last inspection 5th May 2005 Brief Description of the Service: 1 Greville Road is a residential home providing care and support to 7 older service users with learning disabilities. The home has a condition on its registration that it is unable to admit service users under the age of 55. However the homes standards are measured using the Care Homes for Adults (18-65) because of the complex needs of the service users living within the home. The home is a large domestic style house providing a homely and comfortable appearance inside and out, blending well with other homes in the local area. Each service user has a room of their own that has been decorated and adapted to meet their individual needs and characters. The home is situated in Shirley, a residential area of Southampton. It is close to Southampton City Centre, Shirley High Street and a local amenities store with in easy walking distance. The home is local to Southampton Common and Southampton Sports centre where yearly attractions and community events are held. The home is owned by Hyde Housing and is leased to Mencap, a national organisation providing care and support to service users with learning Disabilities. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second unannounced visit to the home in the last twelve months. The manager was not available for the first part of the visit, however the homes deputy manager competently assisted the inspector. The inspector spoke with one residents and a newly appointed member of staff. From discussion with the manager with the manager and observation it is clear that the home does not meet the changing needs of all residents. The manager is addressing this with their line manager, and the funding authority has a duty to review the residents. The Commission for Social Care Inspection has to be satisfied that the registered persons are able to meet the needs of the residents accommodate. What the service does well:
The service does well to provide a clean, welcoming, homely and appropriately equipped and furnished environment to meet the specialist and individual needs of the residents. The home also does well to provide a relaxed and organised environment. The home is progressively improving its person centred approach in supporting the residents, clear and detailed personal plans enable staff to provide a consistent approach centred around the individual needs and desires of the residents. The homes approach to meeting and advocating on behalf of the residents physical wellbeing is very good. The aging residents are supported by competent well-trained staff who demonstrate very good values and understanding of their roles and responsibilities. The home is proactive in ensuring it is fully equipped to meet the residents, needs by undertaking its own research and providing staff with reference information about specific areas of need. The home does well to employ and deploy staff appropriately to meet the needs and the social activities of the residents, again a demonstration of the person centred approach the home is adopting. Good management skills of both managers and the management systems in place provide a well-organised and relaxed environment for residents to live and staff to work. The home is open and inclusive, regularly undertaking staff meetings and meeting with residents on a monthly basis to review care plans and revisit their dreams and desires. One resident informed the inspector that he continued to enjoy living at Greville and staff were always helpful. Another resident informed the inspector “I am very well thanking you” this was despite recently being very unwell. Another resident drew a picture for the inspector describing a recent day trip on a boat, which he had enjoyed very much.
1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 6 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. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 EVIDENCE: One residents has come to live at the home since the last inspection. The inspector did not get to meet the resident, however assessment information and documentation was seen. The inspector was informed prior to moving in the manager and deputy manager assessed the resident’s needs using the organisations assessment documentation and met with the resident on a number of occasions. A care management assessment was also obtained. The inspector was informed the resident visited the home several times prior to moving in, meeting with others, staff and familiarising with the environment. Through the process of meeting the residents and obtaining a thorough assessment they were able to establish if they could meet their needs, if the resident would be compatible with the other residents and identified a number of areas regarding health and care support needs that would need input from specialist health care professionals and training for staff. The deputy manager fed back that the resident has settled into the home well and gets on with everyone living in the home. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The home positively works with residents to establish their personal needs, wishes and aspirations, however the home could improve their person centred approach by adapting personal plans to meet the sensory and cognitive ability of the residents. EVIDENCE: The inspector has observed consistent positive approaches to the residents’ needs, individuality, wishes and aspirations during the visits to the home. This is evidenced in the residents’ personal plans and the respectful approach undertaken by staff. Personal plans have been neatly and carefully organised to reflect the holistic needs of the residents, such as their strengths, needs, health and welfare, likes and dislikes and social needs. The deputy informed the inspector that the residents had two personal plans, one held securely in the office and another held by the resident, which provides a quick reference guide for staff. However the majority of the residents living in the home have a cognitive, sensory or communication difficulty. Therefore the home is advised to adopt a true person centred approach and empowering the residents to have ownership of their plans and their life by adapting the plans in an accessible
1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 10 format. The deputy was keen to take on board advice and where to seek help in adapting the plans. This is a large piece of work required to be done with the resident and at their pace. The inspector was advised that staff would be recieving training in person centred planning soon. The inspector saw signed evidence that residents are involved in the review of their care plans and annual reviews within the home take place. However the needs of the residents have changed significantly over the last 18 – 20 years they have been living in the home, especially their health care needs. The home has approached social service repeatedly to request that a full assessment of their needs takes place and funding will be agreed in line with the level of care and support they now need. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards 11 – 17 were viewed on this occasion. Please refer to inspection report 5th May 2005 for a full overview of lifestyle for residents living at 1 Greville Rd. EVIDENCE: 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 The home is proactive and adopts a sensitive approach to meeting the physical and health welfare needs of the residents. The home has good systems in place for the administration of medication, however staff must be provided with clear guidance on when to administer “as required” medications. EVIDENCE: The home supports residents who have complex health and emotional needs associated with their learning disability and age. All the residents are over the age of 58. The staff with whom the inspector spoke with including the manager and her deputy were very conscious of the individual health care needs of the residents and discussed at length the steps they had taken to ensure their needs are appropriately met by primary and specialist health care professionals. The inspector was informed that a recent decision by a GP to place a resident back on a specific medication had caused them some concern and arrangements were being made to personally meet with the prescribing GP to challenge the decision. This demonstrates that the staff have the best interest of the residents at heart. The home also ensures the staff are fully briefed on the individual health care needs of the residents and specific detailed
1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 13 information is provided in the form of fact sheets in the residents individual personal files, these include diabetes and its effects, supporting the visually impaired and epilepsy to name but a few. Staff receive training in specific areas of care such as diabetes and epilepsy and are encouraged through the NVQ and other resources to research specific conditions. The deputy manager informed the inspector that he has a particular interest in the inside world of people with Autism and had recently undertaken some research and is intending to share this with staff. The home uses a dossett monitoring system supplied by a well-known high street pharmacy. All medications viewed were safely and correctly stored and accounted for. The home currently supports all service users with the administration of their medication including the administration of “As Required Medications” (PRN). The inspector noted that the home has failed to maintain the standard of providing guidance for staff in the form of a care plan when the medication is to be given. The home was first issued with a requirement in respect of PRN care plans in June 2004. The home sustains its previously met standards and requirements or further action may take place. All staff are trained in the administration of medication. A newly appointed member of staff informed the inspector that she had received training, however was waiting to be trained by the district nurse in the administering insulin. The manager was advised to keep a record of details of conversations had with prescribing practitioners, especially if made over the phone, which result in a change of medication and an alteration to the medication administration record. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were not reviewed on this occasion please refer to the previous report dated 5th May 2005, which provides details on how the home deals with complaints and protects residents from potential harm. EVIDENCE: 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 27 1 Greville Road, provides a homely and comfortable environment for the residents to live, however the manager must ensure she safeguards residents from the risk of burning on exposed radiators in bathrooms. EVIDENCE: The residents living at 1 Greville Road are provided with a large spacious, clean, airy and tastefully decorated home. The rooms are domestic in style, comfortably furnished and fitted with the “mod cons” of daily living, such as wide screen TV’s, computers and a dishwasher. The kitchen is the centre of the home where residents share quality time talking with staff and where they are involved in the day to day running of the home. The home has recently undergone some redecoration and refurbishment and the damage to the ceiling in the entrance hall has been repaired. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 16 An alteration to the bathroom and shower rooms to accommodate the increasing frailty of some of the residents has recently occurred. However the managers expressed their disappointment that these had not been completed to a high standard and finished off properly. The inspector was informed that discussions have taken place with the landlord Hyde Housing to rectify the problems, however the home must ensure the redecoration and tiling of the bathroom are undertaken as part of the repairs. In addition the exposed radiators in the bathroom and both shower rooms must be covered to prevent the risk of residents burning if contact is made. In the interim the home must undertake a risk assessment on all residents deemed at risk. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 and 34 The resident’s benefit from a well run home where staff understand their roles and responsibilities and are safeguarded from harm by appropriate employment procedures. EVIDENCE: The home continues to fall short of its full establishment of staff, however the rota demonstrates that the home deploys staff to ensure residents daily needs are appropriately met and they have opportunities to undertake social activities if they wish. At the time of the visit the inspector observed staff spending quality time with residents and one resident informed the inspector that he was off out to pay his rent with the support of staff and they may take a walk to the local shopping precinct. The manager is in the process of recruiting to the vacancies. The inspector undertook the main part of the inspection with the deputy manager. He showed confidence and competence through out the time he was in the home and was very clear of his roles and responsibilities. He demonstrated a good understanding of the manager’s role and the roles and responsibilities of staff. The deputy and staff on duty at the time demonstrated very good values and a sincerity towards the residents. The home is very proactive in ensuring staff receive the training required to appropriately support the residents. Evidence in staff training records supported this. The deputy manager informed the inspector that he had
1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 18 achieved NVQ (National Vocational Qualification) level 3 and has recently undertaken a train the trainers course which is accredited by the Open University and was now planning to work with the organisations’ training department to role out specific training in the home such as person centred planning, abuse awareness and respond and respect (Managing Challenging Behaviour). The inspector viewed the records of the newest appointed member of staff and found all necessary checks such as CRB (Criminal Record Bereau), POVA (Protection of Vulnerable Adults) and references to be in place. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The home has good systems in place for monitoring the standards in the home, however further work is required in seeking the views of the residents. The home as far as feasibly possible safeguards the residents from the risk of harm by adopting good health and safety procedures, however as stated in standard twenty-seven the home must protect the residents from risk of burning on exposed radiators. EVIDENCE: The inspector was informed that the manager and deputy manager undertake regular meetings with staff, meetings are planned in advance and a specific day in the month is identified on the rota in order that all staff attend. The inspector was informed that an agenda is displayed a couple of weeks in advance in order that staff can raise issues. The meetings take place to discuss concerns, current trends, to review standards and discuss the needs of the residents, minutes of the meeting are taken, and this is seen as good practice. The inspector was informed that residents have chosen not to have resident meetings, as they prefer to discuss privately any concerns they may have.
1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 20 There is evidence to suggest the residents meet monthly with their keyworker to review their care plans, the inspector was informed that this is usually when a resident will discuss any issues they may have. However the inspector did observe an open and inclusive approach to the residents at the time of the visit and residents being provided with support to make choices. The service has very good documentation in seeking the views of the residents, the manager is advised to develop a system where the views and ideas of the residents can be recorded and evidenced that they have been actioned. The home/service must consider undertaking a quality audit report (Regulation 24(2)), and forward to the Commission for Social Care Inspection. The manager undertakes a quality audit once a month of another home within Mencap. The service provides very good documentation for auditing the quality of the service and these are received monthly in the office of the Commission for Social Care Inspection, however the quality of the audit process must be improved to provide better information, such as seeking the views of residents and staff at the time of the visit. The manager produced evidence that she takes seriously the health and safety of the residents and staff. Good record keeping, staff training and evidence of checks on fire equipment and service certificates for utilities. However as stated in standard 27 the home must protect residents from the risk of burning on exposed radiators. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 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 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X X X 2 X x 2 X 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA6YA20 Regulation 13(2) 15(1) Requirement Timescale for action 28/02/06 2 YA42YA27 3 YA27YA42 4 YA27YA24 5 YA39 The registered manager must ensure staff are provided with guidance on when and how to administer (PRN) “As required Medications” for each individual resident. 13(4) a)(b)(c) The registered manager must ensure exposed radiators in all bathrooms and shower rooms are covered. 13(4)(a)(b)(c) The registered manager must undertake with immediate effect risk assessments on each resident in respect of the risk of burning from exposed radiators. 23(b)(d) The registered manager must ensure the bathrooms and shower rooms are decorated to a minimum standard and appropriately finished off. 24(1)(2)(3) The registered manager must develop an appropriate tool to seek the views of the residents. 28/02/06 23/01/06 30/05/06 30/04/06 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 23 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 2 3 4 Refer to Standard YA20 YA6 YA39 YA39 Good Practice Recommendations The registered manager is advised to record information provided over the phone from prescribing practitioners when changes to residents’ medication takes place. The registered manager is advised to develop person centred plans in an accessible format for the residents. i.e. pictures, easy to read text. The registered manager is advised when carrying out regulation 26 visits that she seeks the views of residents and staff and clearly records actions. The registered manager is advised to consider sending to the Commission for Social Care Inspection the outcome of quality audits undertaken with residents, staff, relatives and professionals. 1 Greville Road DS0000012088.V255947.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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