CARE HOME ADULTS 18-65
167 Church Road 167 Church Road St Annes Lancashire FY8 3TG Lead Inspector
Lesley Plant Unannounced Inspection 16th October 2005 02:45 167 Church Road DS0000010060.V267230.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 167 Church Road DS0000010060.V267230.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. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 167 Church Road Address 167 Church Road St Annes Lancashire FY8 3TG 01253 712547 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) None United Response Mr Stephen Turner Care Home 3 Category(ies) of Learning disability (2) registration, with number of places 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14/02/05 Brief Description of the Service: 167 Church Road is a small care home for adults with learning disabilities, registered for three people. The well-established national charitable organisation United Response is the registered provider. The home is a detached two-storey house with an excellent range of communal living space and good access to local services and amenities. The organisation provides a vehicle to enable service users to take part in leisure activities and access amenities. The staff team support service users in all aspects of daily living according to their assessed needs and as identified via the care planning process. Service users are supported and encouraged to develop their independence and take part in all aspects of community living. The service adopts an active support approach, in a stable environment, which enhances opportunities for the personal growth and development of service users. The staff team are supported by an experienced management team and an organisation, which clearly values its employees, and the service users they support. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, started at 2.45 pm and took place over four and a half hours. Three members of staff, including the team manager were spoken to and time was spent with the two people living at the home, both of whom were supported to complete feedback forms. The registered manager of the home was not on duty. Care records and some of the written policies were viewed. A partial tour of the building also took place. What the service does well: What has improved since the last inspection? What they could do better:
A copy of the Statement of Purpose and Service User Guide must be kept at the home, available for any interested person. Although reviews take place, these should be at least six monthly and more often if there are indications that needs have changed. The person centred method of care planning would ensure that people living at the home have 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 6 support to achieve longer- term goals and dreams, and would also provide an opportunity for all supporters to work together. The recent damage to two internal doors means that privacy is compromised and this should be addressed. The garden gates to the home also still need attention. Although progress is being made with NVQ training, the situation needs close monitoring to ensure that targets are met. Staff recruitment information must be held at the home. Regular supervisions and appraisals for all staff including the team manager, would improve opportunities for monitoring performance and providing support and guidance. Previous inspections have raised concern regarding the lack of staff supervision and this must be addressed. There has been poor progress in responding to areas of improvement identified at previous inspections and it is the responsibility of the registered manager to ensure progress is made. 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. 167 Church Road DS0000010060.V267230.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 167 Church Road DS0000010060.V267230.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): 1 Good information about the service is provided, which can help people to make decisions about moving into the home. EVIDENCE: The Statement of Purpose and Service User Guide have been reviewed, updated and improved. These provide clear information, include photographs and pictures and meet the required standard. Copies have been sent to the Commission for Social Care Inspection. Copies of these documents must also be kept at the home, as required by regulation. 167 Church Road DS0000010060.V267230.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): 6,7 and 9 Care plans and risk assessments are in place. Care plans are not reviewed frequently enough to ensure that changing needs are addressed. Staff support individuals to make decisions about their daily activities. EVIDENCE: Records show that one person at the home had a review of his individual support plan in January 2005, with the review for the second individual taking place in February 2005. Communication profiles, medical profiles and risk assessments are also reviewed periodically. One person has a six monthly review by the funding authority. There have been significant changes for one individual, with increased incidents of challenging behaviour, one such incident leading to the loss his of employment. This person is also indicating that he may want to move to another area. The staff team have met to discuss ways of working with this person and a full review of the support plan is due to take place in November. Although reviews take place, these should be at least six monthly and more often if there are indications that needs have changed. The person centred method of care planning would ensure that people living at the home have support to achieve longer- term goals and dreams, and would also provide an opportunity for all supporters to work together.
167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 10 Staff have good communication skills, as demonstrated during this inspection and clearly know the people living at the home very well. Individuals are supported to make decisions and both people living at the home receive support with managing their money. One person commented, “ My money is kept safe and staff help me to save for what I want,” and “we have meetings, about good things, like getting the new carpet.” Risk assessments take place and these are periodically reviewed. A member of staff confirmed that these are discussed and staff sign the assessments to show that they have been read and understood. Risk assessments cover a range of activities and include situations, which may increase the risk of challenging behaviour. There are good written protocols and guidance for staff regarding working with one person who does not like crowded or busy places. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 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 the following standard(s): 14 15 and 17 People living at the home take part in a range of leisure activities. Relationships are supported and family links maintained. Meals and food shopping take into account individual preferences. EVIDENCE: There are two staff on duty during each day, which allows for leisure activities to be arranged on an individual basis. Both people living at the home can display extreme behaviour and therefore activities outside of the home are given careful consideration, risk assessment and support. One person talked about his enjoyment of regular holidays and trips. Other activities include swimming, shopping and cooking. Both individuals are supported to keep in touch with relatives and friends, with some family contacts being recently renewed. Staff play a key role in what can be difficult and sensitive arrangements for contact. One person is helped to use the telephone to keep in touch with relatives and the other individual is supported to visit friends where he stays overnight. The organisation provides good written guidance and training regarding relationships and how staff can provide appropriate support.
167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 12 Menus and arrangements for meals are discussed and agreed with the people living at the home. Both people confirmed that these discussions take place and that they are generally happy with the meals at the home. There is a three weekly menu in place. One person at the home is involved in shopping for food, the other person does not like busy places and prefers not to take part. He commented “ I’m not happy in the supermarket, but I go to the smaller shops sometimes.” Meal times are flexible, to take into account the individual lifestyles and preferences of both people living at the home. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 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 the following standard(s): 18 and 19 Personal care and healthcare needs are met and take into account individual preferences. EVIDENCE: The two people living at the home need some prompting and guidance regarding elements of personal care, such as bathing and shaving. Files contain assessment information regarding the support required and details of agreed daily routines. Files contain good information regarding healthcare needs and this is periodically updated. Records are kept of all healthcare appointments and outcomes. One person at the home explained that his dentist and GP visit him at home as he does not like crowded or unfamiliar places. A risk assessment and clear guidance are in place regarding any emergency hospital visit for this person. Staff monitor and record all aspects of health care and work hard to ensure that needs are met on an individual basis. Records of weight are maintained. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 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 the following standard(s): None of the above standards were assessed at this inspection EVIDENCE: 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 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 the following standard(s): 21 and 28 The recent damage to two internal doors means that privacy is compromised. The excellent range of living space means that people can choose to spend time separately. EVIDENCE: Some progress has been made in attending to the areas of the home, which needed attention, as identified at the last inspection. The bathroom and toilet have been refurbished and a shower has been fitted. The lounge carpet has been renewed and the dining chairs repaired. The two people living at the home can display challenging behaviour, which has recently resulted in an individual causing damage inside the home. There are now no doors on the bathroom and on one of the bedrooms. There are continual difficulties in maintaining the home to a good standard, due to the nature of the people living there. Privacy however should be promoted and these doors need replacing. The garden gates to the home also still need attention. Both people living at the home appreciate having plenty of space and the choice of where to spend time eating or relaxing. There is a dining kitchen, a dining room, a main lounge and another living room currently housing a hobby display. This range of communal indoor rooms provides excellent opportunities for people to join in shared activities or spend time alone and also means that
167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 16 meals do not have to be eaten together. During inspections one person has regularly commented upon how much he likes his home and the space it provides. During this inspection he stated, “ It’s a nice house. I’m lucky, a big house”. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 36 Staff are competent, good communicators and some progress is being made with NVQ training. Staff information required by regulation is not available. Regular supervisions and appraisals would improve opportunities for monitoring performance and provide essential support and guidance for staff. EVIDENCE: The staff team consists of the registered manager, team manager, three senior support workers and two relief staff, who work regular hours as part of the staff team. Both the registered manager and the team manager are undertaking the Registered Managers Award. One member of staff has achieved NVQ level 3, two are working towards this award and two are working towards level 2. External assessors are now being used and it is anticipated that this will lead to speedier progress with NVQ qualifications. There is a good system of core training and staff have also received specific training regarding challenging behaviour and aggression. The two people living at the home indicated that they are happy with the staff, who showed good communication skills during the inspection. One person said, “they help me and if I have a problem I’d tell them.” United Response operate a thorough recruitment process. There have been no recent appointments, the staff team having remained stable for some years. Contrary to the Care Homes Regulations no information regarding the recruitment of the current staff is kept at the home. Suitable arrangements have been made within the other United Response care homes in the area, but
167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 18 not at Church Rd. Not complying with this regulation could result in information, which might be vital in certain emergency situations, not being available. Regular staff meetings take place. The support staff spoken to confirmed that they have occasional supervision meetings with the team manager, felt that adequate support was available and that there were opportunities to discuss issues and problems during the working day. However the registered manager does not have regular supervision meetings with the team manager and does not actively provide a structured system of staff support or supervision. Staff are working in extremely challenging situations, with one person living at the home showing increased dissatisfaction and aggression, resulting in a member of the team being injured. Regular supervisions and appraisals for all staff including the team manager, would improve opportunities for monitoring performance and providing support and guidance. Previous inspections have raised concern regarding the lack of staff supervision and this must be addressed. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 19 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 There has been poor progress in responding to areas of improvement identified at previous inspections. EVIDENCE: The registered manager was not on duty at the home during this inspection. The registered manager has many years experience and is soon to complete the Registered Managers Award. Under the current arrangements the registered manager is responsible for four United Response care homes in St Annes. The poor progress in responding to requirements and recommendations made during previous inspections may be due to this wide span of control. The registered manager must have a more a proactive role in the management of the home 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 20 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 3 X X X X Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x 4 x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x 1 x 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
167 Church Road Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 2 x x x x x x DS0000010060.V267230.R01.S.doc Version 5.0 Page 21 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 2 3 4 Standard YA1 YA6 YA34 YA36 Regulation 17 (2) Schedule 4 15 (2) (b) Schedule 2 and 4 18 (2) Requirement A copy of the Statement of Purpose and Service User Guide must be kept at the home. The registered manager must keep the service users plan under review. Staff documents required by regulation must be kept at the home. All staff must be appropriately supervised. Timescale for action 30/11/05 30/12/05 30/11/05 16/10/05 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 2 3 Refer to Standard YA24 YA32 YA37 Good Practice Recommendations All areas of the home should be well maintained. Progress with NVQ training should be monitored. The registered manager should achieve NVQ level 4 in management and care. 167 Church Road DS0000010060.V267230.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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