CARE HOME ADULTS 18-65
Mollands Lane (117/119) 117/119 Mollands Lane South Ockendon Essex RM15 6DJ Lead Inspector
Mr Trevor Davey Unannounced Inspection Mollands Lane (117/119) DS0000018058.V272952.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 Mollands Lane (117/119) DS0000018058.V272952.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. Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mollands Lane (117/119) Address 117/119 Mollands Lane South Ockendon Essex RM15 6DJ 01708 851963 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) East Homes Limited Mrs Usha Rani Devan Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Care to be provided to service users with a learning disability excluding mental disorder or dementia between the age of 18 - 65 years. Care to be provided to service users with a learning disability excluding mental disorder or dementia over the age of 65 years. Maximum number to be registered - 6 service users. Date of last inspection 14th June 2005 Brief Description of the Service: 117/119 Mollands Lane is registered to provide personal care and accommodation to six adults with a learning disability. Three of the current residents are elderly and the Registered Provider has submitted an application to the Commission for Social Care Inspection to vary the registration in order to admit people with a learning disability who are over 65 years of age. The homes accommodation includes six single bedrooms, which are situated on the first floor with two dining rooms and separate lounges on the ground floor. There are also two kitchens and corridors on the ground and first floors, link the two dwellings. There is no shaft lift in the home. The home has its own vehicle, which is regularly used to convey residents to shops and other amenities within the local community. There is good bus and train links to the area but not near to the home. Residents within the home are involved in a range of leisure, work and college activities. The property has an attractive landscaped garden at the rear and parking facilities are available to the front of the property. Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 13 December 2005 lasting 3.25 hours. The inspection process included discussions with the manager, three staff and three residents. A tour of the premises took place and a sample of policies and records were inspected. Twelve standards were covered and requirements and recommendations are listed at the end of the report. What the service does well: What has improved since the last inspection?
Requirements from the last inspection have been met including an updated policy and whistle blowing procedure regarding the prevention of harm and abuse to vulnerable adults. Documentation was also in place to show that appropriate recruitment procedures had been followed for staff. Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 6 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. Mollands Lane (117/119) DS0000018058.V272952.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 Mollands Lane (117/119) DS0000018058.V272952.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 Individual aspirations and needs of prospective residents are assessed and taken into account prior to admission to the home. EVIDENCE: The last admission to the home took place in 2003 and evidence was available to show that a detailed pre-admission assessment had been completed by the social worker including background information, personal details, mobility, selfhelp/ability, medication, dietary/language and cultural needs. Other information included religious, family and social contacts. In addition, the manager arranges to visit prospective residents who also have the opportunity of visiting the home as part of the process to determine whether the intended placement is suitable. Care plans were in place together with risk assessments, which had been regularly reviewed, to suit changing needs of residents and their expectations. Mollands Lane (117/119) DS0000018058.V272952.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): X EVIDENCE: Mollands Lane (117/119) DS0000018058.V272952.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 & 16 The rights of residents are respected and there is opportunity given for maintaining family contacts and relationships with friends. EVIDENCE: Some of the residents have regular contact with their families and are able to visit at weekends. Where there is very little family contact, advocates have been appointed and residents are able to see their friends on a regular basis. Some of the residents spoken to, enjoyed their links with the local community, which included church functions, shopping, bingo, pantomimes and some had recently been on holiday supported by staff. In their daily routines, some of the residents enjoyed meal preparation and cooking in the kitchen with the support of staff who had also highlighted the importance of personal hygiene. Some of the residents expressed their disappointment that the local day centres had closed and they were missing the opportunity of taking part in the activities that were provided during the week. Residents are also encouraged in developing their life skills including domestic chores and personal laundering. Decisions regarding their preferred lifestyles and daily routines are made by the residents in discussion and with the support of the staff team.
Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 11 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 & 20 Residents personal and healthcare needs are being appropriately met and medication administered in accordance with agreed policy and practice. EVIDENCE: Residents spoken to confirmed that they received the support necessary in accordance with their wishes and as discussed by staff. One of the residents spoke about his hospital appointments and that he had agreed to have an operation should this be necessary in order to improve his condition. Personalcare records included detailed information regarding treatment provided, occupational therapy advice and risk assessments relating to mobility needs and looking after residents fitted with catheters. The staff team are aware of infection control measures, which need to be observed when changing catheter bags and the proper use of disposable gloves and aprons. Although district nurses had visited the home to attend to residents with catheters, there was no clear arrangement or procedure in place, which would enable the staff to contact the district nurse team should an emergency arise, such as dealing with catheters which become blocked. The management need to ensure that residents can be provided with this service when required. Protocols must also be in place to cover staff if they are to be involved in these procedures. These must be endorsed by the district nurse or other appropriate medical professional, after training, to show that named staff are competent to carry out these procedures. A sample check was made of the medication
Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 12 administrative records which were up-to-date and properly completed. Protocols were in place together with evidence of training from the consultant psychiatrist for named staff to carry out PRN (to be carried out as required), for the administering of rectal diazepam for status epileptics. Mollands Lane (117/119) DS0000018058.V272952.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 There is an established policy on the prevention of harm and abuse to residents and whistle blowing procedure, which staff can refer to should such incidents need to be reported. EVIDENCE: Since the last inspection, an updated policy has been prepared by the Registered Provider together with a whistle blowing procedure, which outlines the correct reporting procedure and agencies to be contacted where incidents of abuse occur or are suspected. All staff should be made aware of this document and the procedures to be followed. Staff have also attended local training on P.O.V.A. issues and procedures, which was provided by the local Social Services Department. Mollands Lane (117/119) DS0000018058.V272952.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): 24 Overall, the standard of the environment within this home is good providing residents with an attractive and homely place to live. In its present state, the premises do not provide suitable means of access to the first-floor for residents who may develop mobility problems. EVIDENCE: The premises are homely and the bedroom accommodation, communal areas and kitchens, are suitable for the residents needs. The bedrooms are well equipped, furnished and arranged to suit the preferences of residents. One of the residents showed the Inspector their room, which included photographs and pictures reflecting personal interests. It was noted that some cracks in the walls need attention as well as re-decoration. All the bedrooms are on the first floor and the only means of access is by two staircases. Three of the residents are over 65 years of age and without a shaft lift, access to the first floor could be restricted where residents become more dependent with increasing mobility problems. Although the Statement of Purpose for the home makes it clear that there is no lift available, the Registered Provider should give consideration as to how residents future needs will be met to enable them to have easy access to their bedrooms as well as toilet and bathroom facilities. This may well include the provision of assisted bathing and hoisting equipment.
Mollands Lane (117/119) DS0000018058.V272952.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): 33 & 34 Residents individual and joint needs are supported by an effective staff team but levels of staff need to be reviewed to take account of changing circumstances with the closure of local day centres. Evidence of recruitment procedures carried out for new staff were in place. EVIDENCE: At the time of inspection, adequate staff were available to meet residents needs in the home but the existing staffing levels only allow for a minimum of two staff which was established when a number of residents attended two local day centres. These centres have now closed which means the staff team have a total responsibility for supporting residents and accompanying them for various daytime activities. Some of the residents expressed disappointment that they were no longer able to attend the day centres. A minimum of three staff would be required for the early and late shifts to ensure residents were still able to pursue social and leisure activities in accordance with their choice. Staffing levels need to be reviewed to take account of these changes. This review should take account of training sessions, which staff may have to attend as well as allowing for the annual leave and sickness. A sample check was made of staff recruitment record and all documentation was complete. Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 16 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): 38, 39 & 42 Residents’ benefit from good management and an effective staff team. The systems for service user consultation are good with a variety of evidence that indicates residents views are both sought and acted upon. Measures are in place to promote the health, safety and welfare of residents. EVIDENCE: The home is well managed with good communication and support amongst the staff team. There is a clear understanding of roles and responsibilities in the home with a good rapport existing between staff and residents. Procedures and policies are in place with recording systems and information properly recorded an updated. Minutes were available of resident meetings which had been signed by all those attending. There is an open-door policy whereby residents can approach the management at any time to discuss issues. Key workers also have a special understanding with residents, which enables any concerns to be dealt with promptly. Staff are pro-active in recognising where residents may be concerned or anxious. The Registered Provider has carried out a recent survey amongst residents about the service in the home and letters have been received by individual residents giving them the results of
Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 17 the survey and that they would be visited shortly to talk about results and to discuss possible action plans. Records were available showing that hot water temperatures had been regularly monitored together with fire procedures/drills. All staff have received health and safety training and are aware as to who to contact for servicing an emergency repairs. The manager made available for inspection risk assessments, which had been carried out for a safe working environment, including the premises and the use of equipment. Mollands Lane (117/119) DS0000018058.V272952.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 2 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 2 3 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Mollands Lane (117/119) Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x 3 3 x x 3 x DS0000018058.V272952.R01.S.doc Version 5.0 Page 19 NO 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 YA19 Regulation 13 & 18 Requirement The Registered Person shall make arrangements for service users to receive where necessary, treatment advice and other services from any healthcare professional including, regular assistance with catheter care and that staff are suitably trained and competent to carry out any procedures. Any such procedures must be covered by a protocol signed by a health-care professional. The Registered Person must ensure that the premises are suitable for the purpose of achieving the aims and objectives set out in the Statement of Purpose. This includes the physical design and layout of the premises and providing suitable access to all parts of the building where mobility of residents may be restricted. The Registered Person shall, having regard to the size of the care home, the Statement of Purpose and the number and needs of Service users, Ensure
DS0000018058.V272952.R01.S.doc Timescale for action 31/01/06 2 YA24 23 30/06/06 3 YA33 18 28/02/06 Mollands Lane (117/119) Version 5.0 Page 20 that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This is in particular reference to the continuing need for residents to be supported in daytime visits and leisure activities. 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 Refer to Standard YA32 YA23 Good Practice Recommendations 50 of staff should obtain NVQ Level 2 by 2005. Copies of the newly updated policy on the prevention of abuse and whistle blowing reporting procedures should be circulated to the staff team. Mollands Lane (117/119) DS0000018058.V272952.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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