CARE HOME ADULTS 18-65
106 Queens Road Littlestone New Romney Kent TN28 8ND Lead Inspector
Lois Tozer Unannounced Inspection 25th October 2005 10:30 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 106 Queens Road Address Littlestone New Romney Kent TN28 8ND 01797 366620 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) support@communitas.org.uk Communitas Limited Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st March 2005 Brief Description of the Service: 106 Queens Road is a detached property which offers care and support to a maximum of 4 service users who have learning disabilities. It is situated in the Littlestone area, with access to local shops and other amenities about 15 minutes walk away. The town of New Romney is accessible by foot (30 mins walk), by public bus service or by using the homes dedicated vehicle. The home is owned and operated by Communitas. Day to day management has recently changed, and is currently conducted by Mr Ian Pitman. The home is set in its own ground, with parking for several vehicles to the front and side of the home. An adverage size, semi secluded garden with patio space to the rear and a garage area for recreation and storage are available. The home offers 3 communal rooms, a lounge, conservatory (where smoking is permitted) and one dining room that ajoins the kitchen. One communal bathroom and two W.C. facilities are available. All bedroms are registered for single occupancy, one has full ensuite facilities. The main ethos of the home is the promotion of greater independence in skills, social development and responsible decision making. Activites are organised to develop practical skills both within the home and in the community. People are activly supported to maintain employment in the community. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place on 25th October 2005 between 10.30 and 14.40, and was assisted by a support worker, and later a team leader. Two of the people living at the home gave some input, however this was minimal, as one was going out to work and the other had not met the inspector before, and was quite shy. The recently appointed manager was on annual leave during this inspection, but staff clearly understood the inspection process and the two staff members were helpful and accommodating throughout, with thanks The home is registered to accommodate 4 people who have learning disabilities, currently 3 people are living at the home, two were in and one had gone home to visit relatives. The following methods were used to conduct this inspection; discussion with 2 residents, discussion with 2 staff members, observation of the staff supporting residents; documents included – written shift planner, medication administration records and storage; individual support plans, risk assessments, goal plans, and a tour of the communal areas. The two people living at the home said that they enjoyed life there, it was an ‘OK place to live’. What the service does well:
The home itself is as very ordinary residence, and reflects the ordinary life principals of the organisation. The people are actively supported to seek employment (voluntary at this stage) and supported to maintain it. The key worker system in place seems to work very well, and staff are committed to expanding the lives of the people living at the home. The organisation has recently secured a budget to redecorate and refurbish the house. Although some areas look a little tatty, the overall impression is of a well maintained home, and the people living there are supported to keep it that way. Although training needs are outlined below, staff understand that individuals have responsibilities and rights, and they are unique individuals who require support to achieve their own goals. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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): None of these standards were inspected. EVIDENCE: 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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, 7, 8, 9, 10 Individual plans are reasonable, but do have some shortfalls when reflecting the positive side of the person. Individuals are encouraged to take responsible decisions, but documentation (risk assessment) is not clear in all cases what level of support individuals require. Daily participation is encouraged in all household duties. Storage of information is secure. EVIDENCE: Individual plans are currently being reviewed and updated. On the whole, they do describe individual support needs, especially in basic daily living skills and where restrictions have been applied. Improvements are needed to reflect the positive aspects of individuals (pen pictures). Individuals currently living at the home make many decisions about their own lives, but staff, through training and robust supervision, must ward against placing undue restrictions, or making unqualified proclamations about individuals ‘capacity’; such practice was evident within the individual plans. Participation in household tasks is encouraged, and support plans to engage individuals are in place (see text below for shortfalls). Individuals who have difficulty with text need their goals and plans presented in a more accessible format, and work, in consultation with a speech and language therapist, is currently taking place to develop this. Risk assessments are in place, again, on the whole, descriptive of individual needs, however some are misleading, inaccurate and in one area regarding
106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 10 specific medication issues, absent. All documentation is well stored in a secure manner; residents can easily access their personal files with staff support. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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): 11, 12, 13, 14, 15, 16, 17 People are given opportunities and support to develop as individuals, but better task analysis would be beneficial. Activities are chosen by the individuals, these would benefit being linked to development goals, stimulating greater interest, and relevance for the individual. Work placements within the local community are well supported. Contact with friends and family is supported, as per individuals’ wishes. Rights and responsibilities are built into the day-to-day running of the home, but better written guidelines of agreed restrictions needs to take place to prevent ambiguity / unintended belittlement. An adequate budget for food is in place and residents have a major say in what goes on the menu. EVIDENCE: Personal development plans need improvement where individuals are developing skills, for example, support / risk assessments for ironing are not broken down into component parts to enable staff to support consistently, thus increasing successful learning for the individual. As these are seen as goals, more precise recording of each teaching stage would be beneficial, enabling skills development to be accurately assessed. Consultation has taken place with some individuals, but in the main, this is about behaviour management, with little focus on individual aspiration and
106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 12 personal goal achievement – having fun whilst learning and using personal interest as a motivator. Where restrictions have been necessarily imposed on individuals within the community, the supporting documents must be accurate and clearly show what measures are in place to limit the restriction (i.e., level of staff support), and be kept under close review. This said, people are benefiting from involvement in social activities within and away from the home, but the level of true service user involvement is not clear. At least two individuals are employed as volunteers, both said that they really enjoyed their work, but would like paid employment. Advice from the Department for Work and Pensions and the Disability Rights Commission should be sought in this respect. The people living in the home are involved in menu planning, shopping, and food preparation. Records show a wide range of fresh food is available each week. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Personal support needs have been assessed and needs are stated in the individual plan. Medication management and staff training require improvement. EVIDENCE: Individual’s currently living at the home require little support with personal care, and this is well documented, through assessment, in each persons individual plan. Very little medication is held in the home, and supporting documentation (mediation administration records) is well kept. Controlled drugs register is in place, and ‘as required’ medication protocols are coherent. However, some practices were not safe, including the practice of medication leaving the home (currently being re-dispensed by staff). Staff said training provided so far was inadequate, as it was a ½ day course for a system they do not use. Administration of a medication to an individual was documented as sometimes difficult, and, to the homes credit, the GP had been advised of the problem. However this had not been thoroughly risk assessed and guidance from the prescribing psychiatrist or care manager had not been sought to agree a multiagency approach to a potentially dangerous situation. This is a major area of concern and needs to be addressed with robust training and re-visitation of policies and procedures in place within the home. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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): 23 A requirement that all staff receive Adult Protection training has been made. EVIDENCE: At the time of this inspection, an Adult Protection alert was ‘live’ and multiagency investigation is pending. Staff advised that they had not received Adult Protection training, but were aware of the Whistle-Blowing procedure from their TOPSS induction. It is essential that staff understand what constitutes abuse and the signs of such; a requirement has been made that staff receive this training. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 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, 27, 28, 29, 30 The premises are comfortable & homely, but some areas a worn and tatty. There is a great deal of communal space, and the home is clean and hygienic. There are adequate toilets and bathrooms. EVIDENCE: The home is an ordinary domestic dwelling, which is about to benefit from a full redecoration and kitchen refit. Staff said that this would include the bathrooms and individuals personal bedrooms. Staff were not sure if each individual had chosen their décor, but felt that this would take place when the work was imminent. There is a very homely feel to the house, and the communal areas are suitably furnished. Residents and staff use the conservatory for smoking; the area has good ventilation and a sliding door prevents unpleasant odours reaching the rest of the house. The home was clean and hygienic. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 16 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): 32, 35, 36 Staff are friendly, approachable, and have training in health and safety issues, but lack training in service user specific areas of knowledge. Staff supervision has improved. EVIDENCE: A staff member described the robust TOPSS induction and relevant health and safety training they had received, and advised they had completed NVQ 2 recently, but none of this had covered training in respect of service user conditions, development or behaviours. Other shortfalls, that have not already been identified are; training to give a robust knowledge base of the service user group; for example British Institute of Learning Disabilities (LDAF) accredited care planning and task analysis / skills teaching. The staff reported that the new manager has already identified training as a concern, and is in the process of auditing needs, therefore no requirement has been made at this point. Staff were happy to say that they are receiving regular supervision. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 17 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): 42 Staff have received a wide range of health and safety training. EVIDENCE: Staff said that they had received the full range of health and safety training, such as food hygiene, manual handling, first aid, fire training and had been supported through NVQ 2 training. No records were seen at this time. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 1 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X 3 3 N/A 3 LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 X X 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
106 Queens Road Score 3 X 1 X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000023147.V261718.R01.S.doc Version 5.0 Page 19 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 YA6 Regulation 15 (1, 2) Requirement Covering YA6, 11, 12 & 16; Individuals positive aspects & aspirations be included in the IP. Skills teaching set out in ‘taskanalysis’ style for consistency & be agreed with individual. Monitor outcomes. All areas of known risk to be assessed and clear actions of risk reduction are stated. Multiagency agreement must be sought where required, (medication management). With reference to the Royal Pharmaceutical Society guidelines; Cease secondarily dispensing medication. Previous requirement, timescale 31/01/05 not met. Staff receive medication training appropriate to the work they are expected to carry out. All existing staff to receive robust Adult Protection training by Timescale for action 01/01/06 2 YA9 13 (4, c) 01/12/05 3 YA20 13 (2) 01/11/05 4 YA20 13 (2) 18 (1, c [i]) 18 (1, c [i]) 01/02/06 5 YA23 01/01/06 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 20 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 YA12YA13 Good Practice Recommendations Seek advice from the Department for Work and Pensions and the Disability Rights Commission regarding paid therapeutic work. 106 Queens Road DS0000023147.V261718.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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