CARE HOME ADULTS 18-65
12 High Street Brant Broughton Lincs LN5 0SL Lead Inspector
Alison Marshall Unannounced 26 July 2005 @ 1:30pm 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 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 Stationary 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. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 12 High Street Address Brant Broughton Lincs LN5 0SL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01400 272929 01400 273438 Hesley Care Services Ltd Mr Robert Noble PC Care Home Only 5 Category(ies) of LD - Learning Disability - 5 registration, with number of places 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: A maximum of 5 young adults aged between 16 and 25 years of age, on admission, may be accomodated. Two named Service users, who are both over the age of 25 years, may remain at the home pending plans to identify appropriate move on placements. Young Adults, who have aged beyond 25 years of age, due to placing authorities not having identified and obtained appropriate move on placements,may only be accomodated at the home on an Application for Variation. The provision of care is for medium to long-term placements. Admissions are planned and emergency admissions are not acepted. Date of last inspection 21 February 2005 Brief Description of the Service: 12 The High Street is a 5 bedded home and was registered for younger adults with a learning disability in March 2003. The home is operated by Hesley Care Services and is situated across the road from Broughton College, a larger residential establishment, owned by the same company, for the same service user group. The home is located in Brant Broughton, where local shops are within walking distance. Access to public transport is available and the home has its own vehicle in order to access resources in the wider community. The home is a two storey domestic style residence and in keeping with the local community. All bedrooms are for single occupancy and, with the lounge, dining and kitchen areas; this home provides a homely and comfortable environment for the service users. Attached to the rear of the building is a self contained annexe with lounge/kitchen, bedroom and bathroom to promote independent living. The home is situated within landscaped gardens. The aim of the home is to provide a safe and supportive environment and to promote the emotional, social and independence skills of the service users. The staff promote a clear perspective on respect for the rights of individuals to privacy and dignity and to work in partnership with families and other agencies. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out between 1.30pm and 6.30 pm. Time was spent with the service users, looking at records, and talking with the staff on duty. A tour of the premises was also undertaken. What the service does well: What has improved since the last inspection?
Following the last inspection an addition to the health and safety policy had been drawn up with regards to Legionella. A second requirement had not been fully addressed. It required that arrangements were made for the sluicing of soiled material. The domestic bursar stated that a new washing machine with sluice facility had been ordered. In the meantime soiled material was supposed to be bagged and taken to the main laundry in the college across the road. Staff could not confirm that this was happening all of the time. Although the medicine cabinet had not been moved from the small office that made administration difficult at times, new procedures had been introduced to minimise the risk of disruption during medication administration. Staff reported that this procedure was effective. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 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. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 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 standard(s) None of these standards were assessed. The service users had all lived at the home for a number of years. EVIDENCE: 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 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 standard(s) 6, 7 and 9 Service user individual needs were promoted but some of the documentation was muddled and out of date. EVIDENCE: There were a number of different files for each service user. They were not very clear and it was difficult to determine which was the most up to date information. For example, one file contained behaviour guidelines that had been drawn up in June 2003 with a review date set for January 2004. However, there was a separate folder containing behaviour management strategies and guidelines for all of the service users which had all been recently reviewed. This was similar for risk assessments and individual profiles and care plans. Some files contained out of date information and had not been replaced with the updated version. However, from discussion with staff and observation on the day it was apparent that staff were aware of and working to the latest plan and guidance. One service user had complex needs with behaviour that could challenge at times.
12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 10 There was one risk assessment in place with regards to locking the kitchen door but there was no overall risk assessment with regards to managing his behaviour within the home and also when out in the community which posed some very different risks. The assistant team manager on duty was very aware of the risks involved and strategies to minimise these: these needed to be formally recorded and made available to all staff. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 and 17 Service users had busy and varied lifestyles with opportunities to engage in a range of educational, vocational and leisure activities. However, there were a number of recommendations made with regards to developing and improving practice in these areas. EVIDENCE: Service users followed a weekly activities programme that included things such as: using the local gym, swimming, attending Newark College, 10 pin bowling, horse riding, shopping and carrying out a paper round. On the day, two of the service users went out for haircuts and then to do some food shopping. The home had a people carrier to help the service users access different facilities within the community. As the service users were dependent on staff support to access activities it was essential that sufficient staff were duty to enable the weekly programme to take place. Discussion with staff and examination of the rotas showed that there were times when staff were short. For example, the evening before there had been only two people on duty instead of four. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 12 Most of the in house activities were locked away. Staff explained this was due to the nature of the service users within the home. Ideally this should be documented and risk assessed. The service users did not go on holiday. Staff wore ‘uniforms’ in the sense of a t-shirt that bore the name of the college situated across the road. Although part of the same company and with the registered manager primarily based there, it is recommended that the company review this policy. Given that the service users were encouraged to participate as fully within the community and that they were reliant on staff support to do this it would be more appropriate if staff were not ‘in uniform’. Menus were drawn up a week in advance by a staff team basing them on known service user likes and dislikes. One service user planned, shopped and prepared all of his own meals and ate by himself in the independent annexe. Staff did most of the cooking for the other service users: two sat in the kitchen to eat and two sat in the dining room. Staff did not eat with service users and had to bring in their own meals. Discussion took place with the assistant team manager about improving practice around meal times: for example, allowing service users to help themselves to salad from a bowl rather than having it served to them on their plate by staff; ensuring that service users were offered a choice of drink and allowing them to pour their own drink; reassessing whether plastic plates and cups were necessary for all service users all of the time; and the benefits of staff eating the same meal as service users and sitting with them to eat. Staff also stated that if service users went out for a meal they were not allowed to have a meal as well. Hence service users would be eating by themselves whilst staff watched. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users received personal and health care in line with their needs and independence in all areas was encouraged. EVIDENCE: Entries in the communication book and diary showed that the service users had regular health appointments. Staff were aware of individual service user needs regarding health and personal care. Records of visits to health agencies and relating correspondence were kept on service user individual health files. The medicine cabinet was located in the office area that was also an access route to the staff toilets and cloakroom. There was very limited space in the office area. This had been highlighted as a concern at the previous inspection with regards to the limited space and potential for distraction during dispensing procedures. This had been reviewed but no other suitable space was available for the medicine cabinet. The home had taken precautions and drawn up new procedures to ensure that staff did not use the office whilst medication was administered. Medication records were satisfactory. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Adult protection procedures were in place and put into practice when required ensuring the safety of service users. The complaints log did not detail any action taken to respond to complaints. EVIDENCE: The complaints log showed that there were two recent (27 June and 3 July) complaints listed: one from a neighbour and one from a parent of a service user. Although both complaints were recorded there were no further details of action taken or outcomes reached. This should be recorded. There were appropriate policies and procedures in place regarding the protection of vulnerable adults and staff had received training in these. Discussion with staff showed that they had a clear understanding of the procedures. Physical restraint was rarely used and staff had received appropriate training. Behaviour management plans were in place for each service user. Any incident involving restraint was recorded and the manager monitored all records. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27 and 30 The home was well maintained and well decorated and with the exception of the laundry facilities was suitable for the needs of the eservice users. EVIDENCE: The building was very well maintained and had a good standard of decoration through out. Service users had individual bedrooms with ensuite. They were comfortably furnished and personalised to the service user’s own tastes. The furniture was domestic in style and in good order. Items such as stereos and televisions in service user rooms were locked away so service users could not access these independently. Staff seemed unsure as to the exact reason why they were locked away and there were no risk assessments relating to this. As identified earlier, there is limited office space. Staff stated that the company were looking at making use of the garage to provide extra room. During a tour of the building the inspector found that the home was clean, tidy and free from offensive odours. There was a utility area with washing machine and tumble dryer. The washing machine was of a domestic style and did not have a sluice facility.
12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 16 Staff stated that they often had to deal with soiled material. The home must make suitable arrangements for the sluicing of soiled materials. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Service users were supported by a competent staff team but rotas showed that the numbers on duty could fall to below satisfactory levels. EVIDENCE: The staff were divided into three teams, each of which was headed up by an assistant team manager. There were three other support workers on each team and so ideally there were four staff on duty through out the waking hours. There were two waking night staff on each night. Rotas showed that recently staffing levels had not been maintained and that there was not always four staff on during the waking hours. On the day previous to the inspection there were only two staff on the late shift and one of these was a new member of staff who was supposed to be shadowing. Given that one staff member has to prepare and cook the evening meal, this level of staffing is clearly unsatisfactory. On the day of the inspection there were three staff on duty between 4 pm and 8pm and then only two staff after 8 pm until the waking night staff came on. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed. EVIDENCE: 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
12 High Street Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 20 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 9 Regulation 13(4) Requirement Timescale for action 01/10/05 2. 22 22(3) 3. 30 23(2)(k) 4. 5. 33 18(1)(a) The registered person must complete thorough risk assessments for service users. They must also be drawn up to show why some activities are not independently accessible by service users. The registered person must 01/10/05 ensure that any complaints that are logged include details of action taken and the outcome. The registered person must 01/10/05 ensure that there are suitable arrangements in place for the slucing of soiled materials. This is outstanding from the last inspection. The registered person must Immediate ensure that there is sufficient staff on duty at all times. 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
C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 21 12 High Street 1. 2. 3. 4. 6 13 15 17 The registered person should ensure that all information relating to service users in up to date and that the current version is available. The registered person should review the dress code with regards to staff wearing uniform t-shirts. The registered person should ensure that service users can go on holiday annually. The registered person should review mealtimes with respect to the issues identified within the report. 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unity House, The Point Weaver Road, off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 12 High Street C53 C04 S40002 12HighStreet V240059 260705 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
