CARE HOME ADULTS 18-65
167 Church Road 167 Church Road St Annes Lancashire FY8 3TG Lead Inspector
Phil McConnell Unannounced Inspection 25th May 2006 09:30 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 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.V289032.R01.S.doc Version 5.2 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.V289032.R01.S.doc Version 5.2 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) www.unitedresponse.org.uk United Response Mr Stephen Turner Care Home 3 Category(ies) of Learning disability (2) registration, with number of places 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st February 2006 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 individuals to take part in leisure activities and access amenities. The staff team provide support in all aspects of daily living according to assessed needs and as identified via the care planning process. Individuals 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 personal growth and development. The staff team are supported by an experienced management team and an organisation, which clearly values its employees, and the people they support. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, which meant that the provider was unaware that the inspection was to take place. The inspection started at 10am and lasted for approximately 4 hours. The inspector spent time with and spoke to, the two people living at the home and three members of staff who were on duty throughout the inspection. Both of the service users’ files were inspected along with staff files. Policies and procedures were also examined. There was a pleasant atmosphere in the home and it is apparent that the staff and service users have developed good and trusting relationships. A tour of the home was undertaken and it was reasonably well decorated. However, some of the areas within the home are below the accepted standard of cleanliness and health and safety. The staff on duty were informed of the dissatisfaction with the tour of the home and the inspector later contacted the north west service manager for United Response and informed him about these and other issues, which need to be addressed. The inspector was given an assurance that the concerns raised will be dealt with immediately. What the service does well: What has improved since the last inspection?
Medication is now being stored more safely and securely, with an improved and satisfactory administration process, helping to reduce any potential risks that could cause harm to service users. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 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. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 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.V289032.R01.S.doc Version 5.2 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 Quality in this outcome group is – ‘Adequate’ An appropriate assessment process is in place; helping to identify that any new service users’ needs would be adequately assessed, prior to admission. EVIDENCE: There have been no recent admissions to the home; the present service users have lived at Church Road for a number of years. United Response has good systems and procedures in place, in the event of a new admission to the home. In discussion with staff members, there was a good understanding of the assessment process and one person explained the process in more detail, helping to demonstrate that an individuals needs would be adequately and appropriately assessed before moving into the home. Service users’ files were examined and although the inspector was informed that regular reviews take place, there was no documented evidence available to clarify this. Individual care plans had not been reviewed for over 12 months, therefore this creates uncertainty if peoples assessed needs are being met. The statement of purpose and the service users’ guide were observed during the inspection and found to be acceptable.
167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 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 Quality in this outcome group is – ‘Adequate’ Individuals are encouraged and supported to live as independently as possible. Good relationships exist between service users and staff. Staff members have a good understanding of the service users needs. But this needs to be documented and regularly reviewed EVIDENCE: Service users’ files were examined and they contained separate sections, including: Personal interaction and communication profile, my relationships / schedule of activities, medication profile and health contacts, finances, risk assessments and active support (monitoring ‘keeping track forms’). Overall they were thorough and detailed, containing good support information, however, some of the information had not been reviewed for some time, therefore as previously mentioned this creates a level of uncertainty if the individuals needs are being adequately provided for. In discussion with one of the service users, it was apparent that people are empowered to make their own decisions and choices. This person had with
167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 10 support and encouragement been able to participate in an activity of his choice that had previously caused him anxiety. This risk had been carefully planned and the benefit is that the person has gained in confidence and independence. Members of staff were observed communicating with service users in a respectful, relaxed, and dignified way and the service users were responding in a positive way, helping to demonstrate that service users have the assurance and confidence that they are being listened to and treated with respect and dignity. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 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): 12, 13,15, 16 and 17 Quality in this outcome group is – ‘Good’ Staff support the service users to participate in a range of appropriate community based activities. Contact with service users’ families and friends is promoted and encouraged. EVIDENCE: Service users are given the opportunity to access the local community.Both of the service users have individual daily leisure activities and community links, including: shopping locally, (one person) swimming and going to many places of interest on a regular basis. One service user has a part time job in the local community, which he appears to enjoy. Helping to demonstrate that community participation and inclusion is promoted. The service users have had a number of holidays in recent times and individual supported holidays have been planned for this summer, highlighting that people are given the added opportunity to benefit from a holiday of their choice, with the support staff they choose.
167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 12 The staff rotas reflected the flexibility that staff have in order to support the service users in all of their varied activities. Both service users are supported to maintain contact with relatives and friends, through visits and regular telephone calls. The weekly food menus were examined and they reflected a good and balanced diet. One service user confirmed that they are involved in helping to plan the menus. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 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, 19 and 20 Quality in this outcome group is ‘Good’ Staff are competent and confident in the storage and administration of medication. All aspects of service users health care are adequately catered for. EVIDENCE: The service users who presently live at Church rd require some support with their personal care and this is carried out with their full agreement. There was an appropriate medication policy in the home and the medications were securely and correctly stored and administered, with medication charts being accurately recorded and up to date. All staff have received satisfactory training in the medication process. In order to maintain this good practice the home would benefit from a copy of the Royal Pharmaceutical Society of Great Britain Guidelines; this would ensure that the good practice that has been established would continue. There was documentation with regular review dates listed for the review of medications with the GP, thereby ensuring that the service users are receiving the correct medication and dosage, with a clinical overview being maintained on a regular basis.
167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 14 The inspector was informed that the GP is familiar with the service users and will visit the home if service users are reluctant to visit the surgery for any reason, for example one person can get anxious and uncomfortable with too many people and likes to have space. There was evidence available to demonstrate that the service users had attended health promotion reviews and there was also documented evidence of some input from a health professional for a service user, in order to help the service user with one of their health care needs. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome group is – ‘Adequate’’ Suitable policies and procedures are in place to ensure that service users are protected and safeguarded from abuse. The policy and procedures relating to concerns, ensured concerns of service users or their representatives would be heard and addressed. EVIDENCE: There was a thorough and adequate complaints policy and procedures in place for dealing with a complaint, which contained appropriate phone numbers and specific details of who to contact. The inspector spoke with three members of staff, who were aware of how to manage any complaint brought to their attention, thereby helping to ensure that complaints are taken seriously and listened to. There were no records of any complaints being received, since the last inspection. In discussion with staff, there was an understanding of the protection of vulnerable adults and what the protection process would be in the event of a suspicion or alleged abuse of a service user. This helps to demonstrate that the staff team have received training in the protection of vulnerable adults; also the provider is committed to the protection and safeguarding of service users. The staff files indicated that all criminal record checks (CRB) and reference checks had been carried out and employment only commences when clearance
167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 16 is given. However, there was no documented evidence in the home to confirm that these checks had been carried out. These documents should be available for inspection, in order to clarify that people are only employed with the required recruitment checks being made. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome group is-‘Poor’ The home is unclean and unhygienic, causing potential health and safety hazards for service users and staff. EVIDENCE: A tour of the home was carried out including one of the service users’ bedrooms. Although the general décor appears to be adequate, the overall cleanliness of the premises was very poor, for example all of the carpeting needs replacing or properly cleaned and some of the carpet grips are missing or damaged, these need replacing, helping to erase any potential ‘trip’ hazards, the spare bedroom and the garage are being used as storage rooms, with both being extremely cluttered, unclean and creating a health and safety concern, the living room is being used by some members of staff as the sleep-in room (observed two lots of bedding placed at the side of armchairs) and again it was evident that the room had not been properly cleaned for some time, the kitchen was not appropriately cleaned, in fact the whole house is unkempt and in need of a thorough clear out. The exterior of the home is also in need of attention and the staff informed the inspector that they use the toilet in the rear yard.
167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 18 The yard is overgrown with weeds and the toilet is unclean and unhygienic, with no running water to the sink, therefore no hand washing facilities, which has infection control concerns. The members of staff on duty were given some feedback regarding the poor environmental standards of the home and were informed that this would be raised with their management. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome group is-‘Adequate’ An adequate recruitment policy and procedures are in place, but there is no evidence of employee checks being made. Staff are adequately and appropriately trained. Supervisions are irregular and disorganised. (Standard 36) EVIDENCE: The recruitment policy was thorough and appropriate, with clear procedures, however, as previously mentioned although staff files indicated that criminal record checks (CRB) and reference’s for staff had been obtained, there was no evidence of them being received. It is necessary for these documents or copies of them to be available for inspection in order to confirm that appropriate checks have been carried out, helping to ensure that vulnerable adults are protected. Staff files contained information with regards to the experience, skills and training that staff have received. All staff are in the process of achieving National Vocation Qualifications (NVQ), helping to give the assurance that service users are supported by suitably qualified and skilful staff.
167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 20 Staff members have varied experience in working with people from different cultures and faiths. In discussion with staff, there was an understanding and awareness of peoples’ different needs. Members of staff were observed interacting with service users and there was an obvious rapport between staff and service users. The staff were listening and interested, which gave an indication that the staff were committed to the people they supported and cared for. Formal supervisions for staff, appear to be infrequent and irregular. One member of staff said, “Supervisions are about every six months” were as another said “every 2 to 3 months”. No records of supervisions for staff were available for inspection. Regular supervisions would help ensure that staff are motivated, encouraged and their performance is formally monitored, this would benefit the service users and staff alike. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome group is-‘Poor’ The home is not well managed at the present time. It is unclean and disorganised. EVIDENCE: The registered manager was not present at the home during the inspection. The present registered manager has many years experience and has achieved the Registered Managers Award. In the current arrangements the registered manager is responsible for four United Response care homes in St Annes. Although the team manager carries out much of the day-to-day management duties, it is vital that the registered manager maintains a proactive role in the management of the home. The previous report indicated that the manager had received Person centred planning training (PCP). This training was aimed at improving the care planning process for the service users; unfortunately this has still not happened. As already mentioned service users care plans are in need of being 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 22 reviewed, even if PCP’s are eventually being introduced. This would help ensure that peoples assessed needs are being effectively provided. The provider United Response has been successful in maintaining the Investors in People Award, which is a quality assurance-measuring organisation. As previously reported the home at the present time is not particularly well run. The office was untidy and disorganised, with various documentation either being misplaced or missing. Some of the health and safety certificates were unable to be located by the staff on duty. All of these certificates need to be up to date and available for inspection, in order to confirm that individuals are protected and safeguarded from any potential health and safety hazard or risk. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 23 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 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 24 CHOICE OF HOME Standard No Score 1 X 2 2 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 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 (2) (b) Requirement The registered manager must keep the service users plan under review. (Previous timescales have not been met) Staff documents required by regulation must be kept at the home. (Previous timescales have not been met) The premises are to be suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. The registered manager must ensure that the premises are kept in a good state of repair externally and internally All parts of the home are to be kept clean and hygienic. Timescale for action 31/07/06 2. YA34 Schedule 2 and 4 31/07/06 3 YA24 23 (1) (a) 31/07/06 4 YA24 23 (2) (b) 31/07/06 5. YA30 23 (2) (d) (j) (O) 31/07/06 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 26 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 4 5. Refer to Standard YA24 YA32 YA36 YA28 YA37 Good Practice Recommendations All areas of the home should be well maintained. Progress with NVQ training should be monitored. The registered should ensure that regular formal supervisions for staff take place and are recorded. The registered manager should ensure that staff only sleep in the designated room provided and not in any other room. The registered manager should achieve NVQ level 4 in management and care. 167 Church Road DS0000010060.V289032.R01.S.doc Version 5.2 Page 27 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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