CARE HOME ADULTS 18-65
Friars Close (11) Dorchester Dorset DT1 2AD Lead Inspector
Marion Hurley Unannounced Inspection 5th December 2005 09:30 Friars Close (11) DS0000026739.V266775.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 Friars Close (11) DS0000026739.V266775.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. Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Friars Close (11) Address Dorchester Dorset DT1 2AD 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) 01305 263479 Leonard Cheshire Mrs Glynis Elizabeth Baker Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Mrs Baker to undertake an adult protection managers course (agreed suitable by the Commission) by September 2005. 23rd June 2005 Date of last inspection Brief Description of the Service: 11 Friars Close is a care home providing personal care and accommodation to three adults who have a learning disability and additional physical disabilities. The home is one of seven similar services in Dorchester that are owned and operated by the Leonard Cheshire Foundation, a not for profit organisation providing services to people with disabilities. The registered manager is Mrs Glynis Baker, who is based at the providers local office in Alexandra Road, Dorchester. The home is located in a popular residential area on the outskirts of Dorchester, within walking distance of the town centre. Dorchester has a wide range of shops, banks, GP surgeries and other amenities, which are used by service users on a daily basis. A structured day programme is also provided to the service users. The home has the use of an adapted vehicle. The home is staffed 24 hours a day, with at least 2 members of staff on during the day and one member of staff sleeps in. Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act, 2000. Friars Close was assessed according to the Care Home for Adults (18-65) National Minimum Standards. The overall time spent to complete the inspection process was a total of five hours; one and half were spent at Friars Close. In the course of this inspection one member of the staff team and the Registered manager were available and two residents were present. What the service does well: What has improved since the last inspection?
Since the last inspection members of the staff team and the Registered Manager have spent considerable time in developing and changing the written format of the Individual Service Plans. The new style reflects a Person Centred Approach to these documents and the reader gets a real feel of the person in addition to good practical information. Requirements and good practice Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 6 recommendations have been met with reference to the safe handling and administration and storage of medicines. A comprehensive programme of staff training events has given staff opportunities to attend statutory training courses. 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. Friars Close (11) DS0000026739.V266775.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 Friars Close (11) DS0000026739.V266775.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): 2 • Service Users would only be admitted based on an assessment of their needs ensuring the home would be able to meet the service user’s identified needs and have the appropriate staffing levels and facilities. EVIDENCE: Since the last inspection no new services users have been considered for Friars Close. The group of people living at this small family style home have done so for many years and a vacancy is not anticipated. In view of this the inspector discussed the principles of a prospective service user being considered for a placement with the Registered Manager and it was clear from these discussions that they have knowledge and understanding of good working practices to ensure any prospective service user’s needs would be fully identified through comprehensive assessments. Many of the prospective service users considered for the Cheshire Home Service have complex needs and very individual methods of communicating and in reality it might take months to complete a full assessment of the persons needs, preferences and wishes. Other records indicated the staff’s ability to seek advice and work well using a multi agency network of specialists. It is anticipated any prospective service user would benefit from this comprehensive approach. Prospective service users would always be involved and the admission process would be based on the individual’s ability to cope with the transition of moving into a new situation. Friars Close (11) DS0000026739.V266775.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): The key standards were not assessed having been met at the previous inspection. Please note a good practice recommendation from the previous report has been fully actioned and the records of one service user reflected the change in style of formulating the resident’s individual Plans which now are Person Centred and holistic proving the reader with a feel of the person’s wishes, abilities and needs. EVIDENCE: Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 10 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): 15 & 17 • Considerable focus is given in supporting service users in maintaining contact with family members and in developing appropriate friendships. • Meals are healthy and mealtimes flexible to suit residents lives. EVIDENCE: The evidence for these standards was obtained from discussion with staff and from reading the Individual Plans of one resident. There was good evidence of regular liaison recorded in the resident’s file including contact details and birthdays. Residents are helped to visit their family and friends and equally visitors are always welcomed at Friars Close. Residents are friends with other service users supported though the Cheshire Home services and also benefit from regularly meeting with their peers at Social and Education Centres. The menu is planned a month in advance and whilst it does not show specific choices there is always an alternative available. Staff know the resident’s like and dislikes and adjust the menu accordingly. Staff are keen to encourage healthy living and the menu was balanced and with a good variety of meals. Ample fresh fruit and juices are consumed daily. Residents are encouraged to
Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 11 help prepare their own meals and especially at breakfast they are encouraged to make decisions about what they want to eat. The Individual Service plan provided excellent practical details concerning the specialist equipment the resident needs at meal times i.e. special adapted crockery and cutlery, where they like/need to sit at the dining table. However, the risk assessment not completed by staff living and working side by side with the resident stated “ it was noted that the service user could choke if: a) not chew food b) put too much in their mouth c) food not cut up/liquidized Action “staff must receive adequate training”. This risk assessment was completed in June 2004 and reviewed 8:06:05 “ no change”. When this assessment was discussed with staff they felt it did not reflect the needs of the resident nor specifically or correctly identify the potential hazards and therefore risks associated with this resident at meal times. Risk assessments should relate to the needs and abilities of the individual residents. Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 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): 18 & 20 • The home provides a high level of personal and flexible support taking into account each resident’s preferences and wishes and ensuring appropriate guidance and support is available for each person living at Friars Close. • NMS 20 was inspected in November 2005 by the CSCI Pharmacist. Requirements and good practice recommendations made at this time have since been met. EVIDENCE: Discussions with staff and reading the records of one resident confirmed that staff offer and provide personal care to all the residents in a relaxed and flexible manner having first assessed and identified any individual preferences the resident may have indicated. The records of the resident were very comprehensive providing good clear practical information and instructions for all the staff to provide reminders/prompts to encourage the resident and ensure their personal respect and dignity is maintained whilst total care is given. Medication records were cross referenced with information in the residents Individual Health care/service plan and the details and references in both sets of records were accurate and matched the information on the MAR charts.
Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 13 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 • • Adult Protection is appropriately and well addressed in staff training. There are both policies and good practice help safe guard service users from potential abuse and harm. EVIDENCE: Cheshire Homes, Dorchester, has clear policies and procedures and a working understanding of the issues concerning the Protection of Vulnerable adults and this information is appropriately cascaded to the staff throughout the network of their small homes in and around Dorchester. Staff are provided with information in their induction programme about the key issues surrounding Adult Protection, and Whistle blowing and staff are currently being nominated for a series of POVA training events. The Registered manager and member of staff spoken with during the course of this inspection demonstrated a good understanding of the issues and are very alert to ensure the residents are safeguarded at all times from potential abuse and harm. Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 14 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): The key standards were assessed and met at the previous inspection. EVIDENCE: Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 15 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 & 34 • Residents are protected by the employment procedures and the staff training programme, which is comprehensive and covers all aspects of the statutory training. EVIDENCE: The Registered Manager and member of the staff team each talked confidently about the needs and preferences and wishes of the different residents. Both had clear insight into the different styles of communicating each resident uses. Brief observations made on the day of the inspection indicated how well staff and residents get on and there appeared to be a positive and open relationship. Residents were unable to verbally confirm these indications but there is no question that through their individual communication and specific behaviour each would clearly indicate any negative feelings they might have towards staff - none were observed. All staff files are retained at Cheshire Homes main Dorchester Office and three files were checked when visiting these administrative offices. Each file contained the required statutory checks and references. Both POVA first and an Enhanced CRB check had been received plus two references. Identification and a photograph was found in each file along with completed interview notes, “letter of offer of employment”, terms and conditions/contract. A useful checklist was at the front of each file and had been completed in each case. An induction/training checklist was found completed in two out of the three
Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 16 files and those completed confirmed which policies and procedures had been provided to the new recruit. Staff training is provided on a rolling programme and a Training Newsletter has recently been circuited confirming which staff have been nominated for the next round of training events. The training programme includes the following: - Health & Safety, Food Hygiene provided by West Dorset District Council, LDAF induction, POVA first, and Care of Medicine Foundation course. Staff for these courses are nominated from all the homes managed through Cheshire Homes Dorchester. Friars Close (11) DS0000026739.V266775.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 • Health & safety checks are adequate and these contribute to safe working practices to protect residents and staff living and working at the home. EVIDENCE: The responsibility for checking the health and safety equipment and servicing records is with the maintenance employee who is based at the Cheshire Homes Administrative Offices, Dorchester. Each home has a generic work base file containing risk assessment and these are reviewed. Other documents relating to individual staff fire prevention training are collated at the Administrative offices and kept with other training records in individual training files. The “responsible individual” representative for Cheshire Homes completes the monthly monitoring visits, Regulation 26 and these reports are comprehensive and extremely useful and practical in providing on going information. Friars Close (11) DS0000026739.V266775.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 3 x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x x x Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Friars Close (11) Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x DS0000026739.V266775.R01.S.doc Version 5.0 Page 19 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 Friars Close (11) DS0000026739.V266775.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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