CARE HOME ADULTS 18-65
111 Crescent Road 111 Crescent Road Crumpsall Manchester M8 5SH Lead Inspector
Steve O’Connor Unannounced Inspection 20th September 2005 10:30 111 Crescent Road DS0000021703.V251320.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 111 Crescent Road DS0000021703.V251320.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. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 111 Crescent Road Address 111 Crescent Road Crumpsall Manchester M8 5SH 0161 740 9405 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) Southfields Care Homes Limited Care Home 3 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (2) of places 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named service user requires care by reason of learning disability. Should this named individual no longer reside at the home then the registration will revert to 3 places for mental disaorder (MD) 21st March 2005 Date of last inspection Brief Description of the Service: The care home provides 24-hour accommodation and support for three people who need support because of their mental health problems. In addition one person has additional learning disabilities. 111 Crescent Road is a detached house situated in the Crumpsall area of Manchester. The house is on a main road with access to public transport and local shops. The house has three large bedrooms, two lounges (one of the lounges is a smoking area), a bathroom and downstairs toilet plus a kitchen / dining room. There is a small bedroom used by staff as an office and sleeping-in room. The house has gardens to the front and rear of the property; these are accessible by clear pathways. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 20th September 2005. Time was spent talking with people, the area manager, some of the staff on duty and observing how staff worked with people. In addition people’s files and other documents were inspected. A tour of the premises was also made. The previous inspection in March 2005 had identified that the home needed to improve upon. People’s contract of terms and conditions had been provided, a manager had been appointed but had not yet submitted an application to register with the Commission for Social Inspection (CSCI) and the challenging behaviour training was being arranged but staff had not yet completed the training. The CSCI had not received any concerns or complaints about the home since the last inspection. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. What the service does well: The home supports people who have long-term mental health problems and or learning disabilities. In addition the way that people express themselves can result in behaviour that is challenging to the staff. Without the right environment and support the people living at the home would not be able to live in the community on their own. The house is a nice sized detached property with a choice of lounges that give people the chance to have both some privacy and company if they wish. The furniture, fixtures and decoration are on the whole of a good standard and the place has a nice homely and relaxed feel. There is a good selection of shops, pubs and leisure facilities nearby and public transport links to all parts of Manchester and beyond. All the people are either supported or independently use public transport. From observing and listening to how staff work and talk to people it was felt that a good working relationship had developed between them. Everyone sat together and chatted over cups of tea. People talked about their personal experiences and shared in jokes and day-to-day conversation. At the same time staff were aware that each person had their own problems and issues and
111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 6 knew how to support and help them when people became agitated or frustrated. An area that the home took very seriously was in maintaining people’s general health and mental wellbeing. The home supported people to access local general health services such as the G.P. dentist, chiropodists, etc. Several people had experienced specific health problems and the home had made sure that they had got support from specialist healthcare services and had worked with those services to monitor and maintain people’s health. An example of this was where the home had suspicions that a person may be experiencing some health conditions that affect their behaviour. The home had made appointments to see the relevant specialists to have their suspicions tested and hopefully find ways that can improve the quality of that person’s life. The home recognises that the people they support have often had little or no control over the choices and decisions that affect their lives. The home offers people the opportunity to become as involved as they wish in domestic household jobs; in the clothes and personal items they buy, in how they wish to spend their time, who to spend it with and the activities they want to do. Quite often people may decide not to take up these chances to be involved but it is the importance of having the choice that gives people a greater feeling of having some control over their lives. What has improved since the last inspection? What they could do better:
Guidance from the relevant health specialist regarding a persons choking risk must be sought and implemented. A copy of the guidance to be provided to the CSCI. Medication must be checked on delivery and accurately recorded in an agreed format. The damaged and stained bath sealant and tiles must be repaired/replaced and the cause of the cracks in the bathroom wall must be investigated and provide repairs where needed. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 7 The home must adhere to the HSE guidelines on window restraints unless they can provide the CSCI with written evidence of any such advice from the local Fire Safety Officer. Challenging behaviour training must be provided to all staff who work in the home. The home must provide the CSCI with confirmation of the timescale for the training events. The manager must submit a registered manager application within the timescale stated. Fire drills must be carried out and outcomes recorded on a regular and ongoing basis. 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. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 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 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 People’s needs had been assessed prior to admission to the home. EVIDENCE: No new people had been admitted to the home since the last inspection and all had an assessment from the purchasing authority. The home had developed and provided each person with a contract of terms and conditions. This action met the requirement issued at the previous inspection. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The home had worked with people and significant others to identify and review people’s needs and goals and provided the systems and support to encourage people to be involved in the decisions and choices that affect their lives. The home needed to ensure that the risk assessment systems clearly provided sufficient guidance to minimize risks and hazards that people may experience. EVIDENCE: Each person had their own individual care plan that set out their main needs and goals and the support the home provided to meet those needs. The plans included goals relating to people’s personal, healthcare, social and nutritional needs and these had been reviewed with the person who had signed their agreement to the plan. For those people on the Enhanced Care Programme Approach (CPA) evidence was seen of ongoing CPA reviews with the local mental health services. Any restrictions of choice placed on people was based on a risk assessment and support plan to make sure that the person was not placed in unsafe situations. Staff would encourage and support people to make decisions and choices about their day-to-day lives such as activities and meals and encourage people to become involved in keeping their own space and the
111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 11 house clean. One person is supported and encouraged to manage their own personal finances and the other are fully supported. Finance records were maintained and monitored. The home used a standard format to look at situations, events and behaviour that may cause a risk to people’s wellbeing. Once identified, the home developed support guidance for staff in how to minimize those risks. The issue of the level of detail regarding support plans was discussed with the area manager who felt that staff were given sufficient information to deal with people’s behaviour that may be challenging or aggressive. The area manager did make some changes to existing risk assessment guidance and it was recommended that the home looks at the current guidance for working with incidents of challenging/aggressive behaviour to ensure that it clearly reflects the current working practices and is based on good practice guidance i.e. British Institute for Learning Disability (BILD) Physical Intervention Guidance. It was found that the support guidance for a person who is known to be at risk from choking on food did not contain clear guidance of how staff should react to such an incident. The home must seek guidance from the relevant health specialist regarding this. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 17 The home has the resources to be able to offer people the opportunity to participate in a range of social, leisure, domestic, in-house and community based activities and provides people with a varied choice of meals. EVIDENCE: During the day there is three staff on duty to provide support for people to take part in home and community based activities. People were offered choices of activities and they were encouraged to decide whether they wanted to take part or not. People’s care plans identified the need and goals for social, leisure and meaningful activities and set out examples of the activities that people may be interested in. A record is maintained of the in-house and community based activities that people participate in and also if they have declined those opportunities. It was found that the recording was, at times, very brief and did not fully describe what a person had actually done or how it related to their care plan. It is recommended that the home ensure that social, leisure, domestic and community based activities are fully recorded. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 13 People were encouraged to decide what that wanted for their meals and it was seen that different choices were offered at all times. The meals provided were based on a persons likes and dislikes and their health needs. Guidance was provided in supporting a person at mealtimes. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The home provides the support and encouragement to people to help them maintain their personal and healthcare needs. The homes medication procedures and systems for recording do not fully protect people. EVIDENCE: The home stated that at the current time they did not support people with intimate personal care. People were encouraged and supported to maintain their own personal care and this support was recorded within individuals care plans. The home supported people to maintain their healthcare through accessing general and specialist healthcare providers. Records of health needs and outcomes were clearly maintained in the persons care plan. Medication needs were monitored through the local G.P or allocated psychiatrist. The medication administration system was inspected and found that medication was being stored correctly and administering was recorded accurately. Only staff who have completed an accredited medication course are allowed to administer medication. Medication prescribed ‘as required’ (PRN) was recorded separately and accurately with clear administering guidance. The manager checked the correct delivery of medication. If they were not on duty the day the medication arrives it is stored and checked when she returns.
111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 15 Medication must be checked on delivery and accurately recorded in an agreed format. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this inspection. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The home was clean, hygienic and had a comfortable and homely atmosphere. However, there were areas of maintenance that needed to be addressed. EVIDENCE: The home’s premises offer people the flexibility of layout to allow them both communal and private space. The home is generally well maintained and decorated with evidence of recent decoration. Furniture, fixtures and fittings are all of a domestic and homely nature. The bathroom was found to have damaged and stained sealant and discoloured tiles and grouting around the bath area. There were also several cracks in the wall plaster. The home must make good the sealant and tiles and investigate the cause of the cracks and provide repairs where needed. None of the windows above the ground floor had any form of devise to restrict the opening. The Health and Safety Executive (HSE) Health and Safety in Care Homes states that, ‘Any windows that are accessible to vulnerable service users (2m above ground level), can be opened and are large enough to allow people to fall out should be restrained sufficiently to prevent such falls.’
111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 18 The area manager stated that the local Fire Prevention Officer had advised against window restrictors. The home must provide written evidence of such advice or adhere to the HSE guidelines. The premises appeared clean, hygienic and free from offensive odours. A domestic washing and drying machine was situated in the kitchen. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 33 People living at the home benefit by being supported by an effective staff team who have a range of skills to meet their needs. However, although the staff have had access to a variety of training events the area of challenging behaviour has not yet been fully addressed. EVIDENCE: The home maintained a regular staff team to provide consistency of care. Three staff were on duty throughout the day, two in the evening and two staff undertook sleep-in duties. The staff team reflected the cultural background of people living at the home. Staff spoken to were able to demonstrate that they had an understanding of people’s needs and were observed working in a respectful and appropriate manner. People living at the home had complex needs and presented some challenging behaviour. Staff had worked in conjunction with a psychologist in relation to one person to monitor behaviour and provide appropriate responses to behaviours exhibited. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 20 The staff at the home had not yet had any specific training with regards challenging behaviour but this was being organised with a community psychologist. At the time the manager hoped to be able to arrange the training within the next two months. This issue was raised at the previous inspection and was reiterated. 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 As the manager had not applied to become the registered manager it could not be shown that they were fully qualified, competent and experienced to run the home. The homes fire safety procedures and systems did not show that they fully protected people’s safety. EVIDENCE: A requirement issued at the previous inspection identified the need to appoint a manager for the home and for that manager to make an application to the CSCI to become the registered manager. A manager had been appointed from within the staff team but an application had not yet been submitted. The manager must submit the required application within the timescale stated. Fridge and freezer temperature were monitored and recorded. Evidence was seen of the servicing of gas, electrical and fire equipment. The fire log was seen and found that all visual checks were being made but there was no evidence that the home were undertaking fire drills.
111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 22 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 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 3 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
111 Crescent Road Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 2 X DS0000021703.V251320.R01.S.doc Version 5.0 Page 23 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 YA9 Regulation 12 Requirement Timescale for action 10/10/05 2 3 YA20 YA24 13 23 4 YA24 23 Guidance from the relevant health specialist regarding a persons choking risk must be sought and implemented. A copy of the guidance to be provided to the CSCI. Medication must be checked on 30/09/05 delivery and accurately recorded in an agreed format. The damaged and stained bath 31/12/05 sealant and tiles must be repaired/replaced and the cause of the cracks in the bathroom wall must be investigated and provide repairs where needed. The home must adhere to the 10/10/05 HSE guidelines on window restraints unless they can provide the CSCI with written evidence of any such advice from the local Fire Safety Officer. Challenging behaviour training must be provided to all staff who work in the home. The home must provide the CSCI with confirmation of the timescale for the training events. The previous timescale of the 31.07.05 was not met.
DS0000021703.V251320.R01.S.doc 5 YA32 18 10/10/05 111 Crescent Road Version 5.0 Page 24 6 7 YA37 YA42 8 23 The manager must submit a registered manager application within the timescale stated. Fire drills must be carried out and outcomes recorded on a regular and ongoing basis. 30/09/05 10/10/05 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 YA9 Good Practice Recommendations It is recommended that the home looks at the current guidance for working with incidents of challenging/aggressive behaviour to ensure that it clearly reflects the current working practices and is based on good practice guidance i.e British Institute for Learning Disability (BILD) Physical Intervention Guidance. It is recommended that the home ensures that all social, leisure, domestic and community based activities are fully recorded. This recommendation also applies to standards 13 and 14. 2 YA12 111 Crescent Road DS0000021703.V251320.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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