CARE HOME ADULTS 18-65
Exbury Place, 12/13 12/13 Exbury Place St Peter The Great Worcester Worcestershire WR5 3TP Lead Inspector
Christina Lavelle Unannounced Inspection 21st February 2006 04:20 Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Exbury Place, 12/13 Address 12/13 Exbury Place St Peter The Great Worcester Worcestershire WR5 3TP 01905 611147 01905 612958 andrew.deakin@scope.org.uk 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) SCOPE Mr Andrew Joseph Deakin Care Home 4 Category(ies) of Physical disability (4) registration, with number of places Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is for service users with physical disabilities but may also accommodate people who have associated learning disabilities. 17th August 2005 Date of last inspection Brief Description of the Service: Exbury Place was first opened as a care home in 1993. The service provider is SCOPE, a national organisation which provides a range of services for people with cerebral palsy and other physical disabilities. This home is part of a local community project set up by SCOPE called 1st Key Worcestershire. The property is actually owned by a Housing Association and is leased to SCOPE. The home provides accommodation with personal care for four adults who have cerebral palsy and/or similar physical disabilities. Service users may also have an associated learning disability. Most of the service users have complex needs and so are highly dependant on staff for all their care needs. The main stated aims of the service are to offer service users the opportunity to have an independent lifestyle and to participate in the local community. Exbury Place is a bungalow situated on a large modern housing estate a couple of miles from Worcester city centre. There are local shops and other amenities nearby on the estate as well as reasonably easy access to the many facilities of Worcester. The home has two suitably adapted vehicles to provide transport. The property was especially adapted for its purpose. Therefore all the internal areas and the garden are accessible to wheelchairs. Each of the service users has a single bedroom, none of which have en-suite facilities. There is a shared sitting room, kitchen/dining area, shower room and assisted bathroom. The kitchen has low-level surfaces to allow people in wheelchairs easier access for cooking and/or assisting with food preparation. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine, statutory inspection was carried out unannounced in two and a half hours on a late Tuesday afternoon in winter. The main aim was to obtain a snapshot of life at the home by spending time with service users and staff on duty to discuss their experience of living or working at Exbury Place. It was intended in this way to check the home is still offering a good service, which is valued by service users and to confirm it is meeting its stated purpose. For more detailed information about the care, service and facilities provided at Exbury Place you are advised to also read the report arising from the last fuller inspection of the home, which was undertaken on the 17th of August 2005. Some of the home’s required records were looked at and all contacts and the written correspondence between the home and Commission since the previous inspection were also taken into consideration. What the service does well: What has improved since the last inspection?
There were few matters needing action following the previous inspection. In addition because of the limited scope of this inspection (also as the manager was not present) developments to the service were not reviewed. However it is apparent that Exbury Place continues to provide a good service. Service users are happy living there and the home is meeting its stated purpose of promoting their independence and participation in the community.
Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards are not assessed and in any event there had not been any new service users admitted to the home for some time. However it was confirmed in the previous inspection that SCOPE provides all the required information documents on the home for current and prospective service users. These include a statement of purpose, a service users’ guide and a Service Level Agreement (contract). Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards are not fully assessed. However it was previously confirmed each service user has a care plan, detailing their needs and the action needed from staff to meet them. Service users’ care records also included information about their background, physical health, disabilities, reports of any significant events in their lives and their preferred daily routines and likes/dislikes. Service users are allocated keyworkers from the staff team, which can help to make the support given them more personal. Keyworkers were also involved in drawing up and reviewing care plans with the service users’ involvement. One person’s care records were looked at briefly and although there had been few changes in their needs their plans and risk assessments had been signed as being reviewed twice annually, which is the frequency the Standards specify. Service users confirmed they are able to make choices in their daily lives and other routines. Staffing is arranged flexibly to accommodate this to the extent possible, given the high level of support some service users need. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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): 12, 13, 14 & 16 Service users are enabled to lead full and active lives and their participation in the wider community is encouraged. Staff also ensure service users’ individual rights are respected and that they are able to make choices and decisions in their daily lives and routines. EVIDENCE: All the service users were at home on the inspector’s arrival, although one person went out to the local supermarket during the visit. Staff discussed how service users continue to lead busy lives, in line with their choice and interests. One service user talked about their college course and that they also attend a social club and other day services for people with physical disabilities Another service user discussed how they regularly go out to local pubs, shops and Tescos. Whilst at home service users can also choose whether to be with others in the sitting room or stay in their bedrooms. There they can watch their own TVs, use their music centres and one person also has a computer. They also decide on their daily routines and staff promote their independence.
Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 11 Some staff time was available to support service users with their activities on a one-to-one basis and additional time from an external enabler. The home also has two vehicles (one larger one with a tail-lift for wheelchairs) for outings and for when using the cities facilities. One service user said they were soon going to Blackpool for a 4-night break and had also been to a holiday camp. Although food provision is not fully assessed it was one person’s birthday today and they were choosing their favourite meal this evening. Staff and two other service users all had this chosen meal, although another person wished to have and so was prepared something different. Service users always choose their meals individually and do their own food shopping with staff. Staff also encourage them to be involved in cooking and other household tasks, although the extent to which some are able to is rather limited due to the nature of their disabilities. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards are not fully assessed. However it was previously confirmed that service users’ plans reflected all the help they need from staff with their personal care and in their daily lives. This information included any support in respect of particular health related issues, such as epilepsy. Care records also showed that annual health care checks and input from health care specialists (such as a Psychiatrist) were being sought and/or arranged. SCOPE provide general policies & procedures for the management of medicines in all their care services. There were also specific procedures for Exbury Place. One service user’s care records included information about their prescribed medication; why they required each type and possible contra-indications. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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): EVIDENCE: These Standards are not fully assessed. However it was previously confirmed that SCOPE provide an appropriate complaints procedure and the organisation also has a Complaints Resolution Manager to investigate complaints if needed. There were policies and procedures relating to safeguarding vulnerable adults from abuse or neglect, including whistle blowing. There is also an Adult Protection co-ordinator for SCOPE and staff had access to a copy of the local multi-agency procedures for Protection of Vulnerable Adults There had not been any complaints or vulnerable adults concerned raised with the Commission since the last inspection. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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 Exbury Place provides accommodation that suitably meets the service users’ needs and an environment which is homely and comfortable. EVIDENCE: The property comprises of an ordinary bungalow, which is compatible with the local community. Its location is convenient for local shops and pubs etc. and there are also many other facilities and amenities in Worcester city. The impression obtained is very homely and comfortable and those areas seen were reasonably clean and tidy. The premises are appropriately adapted, and are also fitted and equipped to allow service users’ easier accessibility in their wheelchairs and for staff to be able to assist them more safely. The property is leased to SCOPE by a Housing Association and this organisation has responsibility for its structural repairs and upgrading. There can be a delay apparently in them affecting major work, although not so for minor repairs and providing new equipment. Work had started to clear the garden, although parts of the fencing still needed repair, which staff hoped would be done when the weather improves. Since the last inspection the sitting room had been redecorated, sofas replaced and a new blind fitted, which all looked very nice.
Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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): EVIDENCE: These Standards are not fully assessed. However there were two support staff on duty, one of whom would be sleeping in on call during the night. This has previously been confirmed as being an appropriate level to meet service users’ needs, which had also not changed since the last inspection. One staff member has a relief contract, although she only covers Exbury Place and had therefore got to know the home and the service users well. This is positive for consistency of care. The permanent staff member confirmed she completed an accredited induction programme when appointed. She had also achieved an NVQ qualification in care and undertaken all the mandatory health & safety training topics. Staff said that team meetings are held monthly, which service users can also attend if they wish. Staff also received individual supervision about 4-6 weekly from the home’s senior. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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): EVIDENCE: These Standards are not fully assessed. However management arrangements for the home have not changed. The registered manager is the Community Services Manager for 1st Key Worcestershire (Mr Andrew Deakin) who has many years experience with SCOPE and has been in post since 2003. He visits the home at least weekly and so the day-to-day management of the service and staff team is delegated to a team leader and senior support worker. SCOPE were introducing a formal Quality Assurance & Monitoring (QA) system for their care homes. This will appropriately include obtaining feedback from service users to inform the home’s planned and ongoing development. Such QA systems are required, and will play an increasingly important role, in ensuring the quality of care homes is continually reviewed and they develop as service users and other involved people (e.g. families and funding authorities) wish. This process must result in a development plan and in periodic reports; copies of which must be sent to the Commission and made available to other
Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 17 interested parties. To date however the Commission has not received a report of any quality reviews of Exbury Place. The Commission must also be kept informed about care homes through reports made following required monthly visits to the home from a representative of the service provider. However during the last year only five reports had been submitted by SCOPE, the latest one from November 2005. These visits are important as they are one of the ways the provider can monitor the standard of care through inspecting the premises, checking events and complaints and by obtaining feedback about the home from service users and staff. In respect of health & safety in the home there were no hazards noted during this inspection. The fire log was checked and although weekly tests of the fire alarm system were recorded as having been carried out, the monthly checks on the fire safety equipment had not been recorded for January. Staff were sure these checks had been carried out and it must be ensured the records are completed accordingly. The records also showed fire drills had been arranged regularly as required and the home has a written fire risk assessment, which had been reviewed last year. Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X N/A X X X X X X X Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 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. 1 Standard YA43 Regulation 26 Requirement Copies of the reports made by a representative of the provider following their required monthly visits to the home must be supplied to the Commission. Timescale for action 30/04/06 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 YA7 Good Practice Recommendations Consideration should be given to implementing a more person-centred approach to care planning and assessment. Not reviewed in this inspection and so carried forward. Consideration should be given to recording all information about service users individually. This would ensure that all records could be accessed by them and also be part of the ongoing record of their progress and events in their lives. Not reviewed in this inspection and so carried forward. 2. YA6 Exbury Place, 12/13 DS0000018651.V283997.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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