CARE HOME ADULTS 18-65
17 Ella Bank Road Heanor Derbyshire DE75 8PA Lead Inspector
Tony Barker Unannounced 25 October 2005, 9.35am
th 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. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 17 Ella Bank Road Address Heanor Derbyshire DE75 8PA 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) 01773 760806 01773 760806 United Response Vacant Care Home 3 Category(ies) of 3 - Learning Disability registration, with number of places 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11/3/05 Brief Description of the Service: 17 Ella Bank Road is a detached house situated on a residential road near to the town centre of Heanor. Service users are provided with adequate accommodation and single rooms. There is a rear garden. The Home offers personal and social care to people with a severe learning disability with associated conditions that may include autism, sensory disability or challenging behaviour. Activities are planned to meet individual needs. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The time spent on this inspection was 4.25 hours and was a routine unannounced inspection. The last inspection took place in March 2005 and was an unannounced inspection. This inspection was the inspector’s first visit to the Home. Four staff members were spoken to, records were inspected and there was a tour of the premises. Service users were not spoken to on this occasion. One service user’s records were examined as part of the case tracking method. The focus of this inspection was on progress made on the requirements and recommendations made, and those standards not assessed, at the last inspection. What the service does well: What has improved since the last inspection? What they could do better:
An assessment of prospective service users’ needs must be made and contracts between the provider and purchasing authorities obtained and kept within the Home. Care plans must be devised by the Home and reviewed every six months. All service user records must be kept in the Home at all times. Staff must be aware when ‘as required’ medicines are to be used and must pay attention to medicine guidelines. The complaints procedure and record of staff training must be updated. The rear garden must be made fit for use and certain handrails fitted outside. Staff must be provided with fire precaution training and supervision at an appropriate frequency. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 6 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. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 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 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 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) 2 & 5 Prospective service users’ individual needs were not being assessed. Each service user did not have a contract in place detailing the agreement between the funding authority and United Response. EVIDENCE: Two of the current service users had been living at the Home since it opened. A third service user was admitted in July 2005 but an initial recorded assessment of need was not available in the Home. A member of staff said that this service user’s care plan and risk assessments had been taken out of the Home by one of her key workers. A member of staff reported that details of the contracting arrangements between United Response and the individual service users’ funding authorities were now held in the Home but no evidence of them could be found on files seen. An individual contract between United Response and the case-tracked service user was seen to be a helpful document. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 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 & 9 Not all service users were benefiting from an individual care plan that guided staff support. Service users made a number of decisions about their lives with staff assistance. Their safety was being well considered through written risk assessments. EVIDENCE: The file of the case-tracked service user showed 6-monthly full care reviews. There was also a record of routines and a Behaviour Management Plan dated 12/7/04. There was no care plan on file that had been devised by the Home, with goals, for use on a day to day basis. However, goals were being written on recorded risk assessments and the service user’s key worker was able to describe a number of goals, from her last care plan review, that she said she follows. There were no care plans, care plan reviews or risk assessments for another service user – as already mentioned in this report. There was, however, a set of care plan review notes recorded for the review meeting held on 12 October 2005. These had four goals recorded. No mention of service users’ cultural needs could be found in the documents available – as recommended at several previous inspections. Staff reported that, due to service users’ learning disabilities, staff guide service users in making decisions about life in and outside the Home. Many
17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 10 decisions are made by service users following them asserting their wishes – for example, with regard to food. Also, staff help service users to choose appropriate clothing for the day. Staff said that they manage service users’ money and periodic checks were made by the Service Manager and Area Manager. Risk assessment documentation on the case-tracked service user’s file was extensive and useful and had been reviewed in September and October 2005. Prior to this, risk assessments had been reviewed in 2003. Staff were able to give examples of considered risk taking that leads to service users’ increased independence. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 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) 12,13,15 & 17 Service users were able to take part in valued activities. They were supported to be part of the local community and to maintain family relationships. Service users were being offered a healthy diet. EVIDENCE: Staff were able to give examples indicating that service users were involved in activities that they valued – these examples showed that staff/service user communication was to a good standard. Each of the service users attended a day service provision three or four times a week. Reports from these day services indicated that a good range of activities took place there. Staff reported that on service users’ ‘personal days’ - week days when they were not attending day services - service users were supported to go to local parks, cafes, pubs and shops. Relationships with neighbours were relatively positive with the only grumble being when cars park in front of some houses in the road. Service users had the use of a ‘people carrier’ purchased by the service users themselves. This was used mainly at weekends and on ‘personal days’. One service user made a trip out, during this inspection, accompanied by two members of staff.
17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 12 One service user had retained contact with family and was visited regularly. Another had regular telephone contact with family. The third service user had no family contact. Ex-staff from her day service centre were looking to provide her with a personal advocate. Service users also received occasional visits from friends who had been members of staff at Morley Manor, from where two service users were admitted. Staff confirmed that service users assist, when possible, with housekeeping tasks, and said that this is now specified within their plans of care. However, no mention of this could be found on documents seen. Other aspects of Standard 16 were not assessed at this inspection. Records indicated that service users received a balanced and nutritious diet. A choice of meals was made available at each meal for service users and menus showed that ‘take-aways’ were provided. They were offered three full meals each day and a cooked option was available on most occasions. Service users ate out on their ‘personal days’. Hot and cold drinks and snacks were available at all times. Files viewed showed a record of service users’ food preferences. There were good levels of foodstocks on the day of this inspection. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 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 & 20 Service users were receiving personal support in the way they prefer and require and their health needs were being met. Service users were not being fully protected by the Home’s policies and procedures for dealing with medicines. EVIDENCE: Records indicated that service users were supported in their personal needs to a high degree, particularly using verbal prompts and repetitive signals. Staff enabled flexible arrangements to be in place – for example, around the timing of bedtimes and mealtimes – within the framework of individual service users’ needs – for example, the need for routine of one service user with autism. A keyworker system was in place using two members of staff for each service user - the responsibilities of this role were broad and comprehensive. None of the service users was assessed as having a substantial physical impairment and there were no aids or adaptations within the Home except for handrails in the bathroom. One service user had limited sight, was sometimes unsteady on her feet and had epileptic seizures. Staff spoke of considering additional handrails in the bathroom and advice from an occupational therapist was advised. All service users attended clinics or outpatient services with staff support. Files examined showed that appointments with specialists took place – such as a speech therapist, psychiatrist and continence advisor. Also, there were routine health checks with dentist, optician, chiropodist and other health
17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 14 professionals. Staff spoke of a ‘Pamper Night’ each Friday when service users received hand care and foot massage. Service users received regular reviews of their medication. One service user’s medical care plan gave details of when Diazipam should be administered as a ‘as required’ dose. However, there were no written guidelines to show when to administer Lorazipam, ‘as required’, to another service user. The medicine record of this service user indicated that she should be administered a maximum ‘as required’ dose of 1mg Lorazipam in a 24 hour period. But the record showed that 2x1mg tablets were administered the day before this inspection. Otherwise, medicine records were seen to be satisfactory. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 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 standard(s) 22 Service users, their families and other stakeholders could not be sure about who to complain to about the service. EVIDENCE: The Home’s complaints procedure included the use of symbols and was displayed in the entrance hall. It still made reference to the previous inspector and to the National Care Standards Commission. There had been no complaints received during the previous 12 months. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 16 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 & 26 Service users were living in a comfortable environment although some safety considerations needed addressing. EVIDENCE: The kitchen had been refurbished since the last inspection and the premises had been re-decorated throughout. Records showed that new carpets had been provided upstairs and those downstairs had been cleaned. It was noted that all toilets and bathrooms were provided with towels and soap. The rear garden sloped up steeply to the rear and was covered in rough grass and weeds. Staff spoke of plans to address this rather unsightly and unsafe area within the following few weeks. There were still no external handrails to assist service users when accessing the garden and the front door. As previously recommended in this report, advice from an occupational therapist should be sought before fitting these rails. Bedrooms were clean, tidy and reasonably personalised – one was particularly attractive. They were well furnished. Missing handles from cabinets had been replaced and the door to one bedroom’s washbasin cupboard had been re-hung so as to provide better use of space in the room. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 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) 32,33,34,35 & 36 Service users were being supported by a mainly qualified staff group and protected by the Home’s staff recruitment policy and practices. They were not benefiting from well-supervised staff. EVIDENCE: 57 of care staff were qualified to at least National Vocational Qualification level 2 in Care. Records showed that United Response had provided relief staff on 31 shifts over an eight week period in May/June 2005. Staff said, during the inspection that relief staff were used at least once a week to provide cover for staff sickness and holidays. Also, agency staff had been used during September to provide cover for staff holidays. There had been no staff turn-over since the previous inspection. The staffing rota was not examined at this inspection. One staff file was examined and recruitment practices were found to be satisfactory. Records indicated that Criminal Records Bureau (CRB) disclosures had been received for all staff. One recently appointed member of staff confirmed that she did not start work until her CRB disclosure had been received. She also described other aspects of her recruitment that met Regulation requirements. She said that she was working supernumerary to the staffing establishment for the first six weeks of her appointment.
17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 18 The Acting Manager indicated, on the completed Pre-Inspection Questionnaire, that staff had been provided with all mandatory training courses during the past 12 months. However, the ‘training matrix’ seen at the inspection, showing dates that staff undertook training, was dated March 2004. Also, there were no Fire Training course certificates on file from 2005. A recently appointed member of staff confirmed that, during her first working day, she had been shown service users’ files including risk assessments and had been through the Home’s fire precaution system with staff. She had been given three dates for her induction training. The last supervision session recorded on one staff member’s file was dated June 2004. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 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 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) 42 The health and safety of service users was being promoted and protected. EVIDENCE: Records indicated that equipment was being maintained, and health and safety checks made, at appropriately intervals. Staff confirmed that they had received instruction in the control of infection. Cleaning materials were being securely stored in the laundry room. A chart of first aid measures to be taken in the event of accidents involving cleaning materials was displayed in the same room. Completed accident/incident forms were seen to be well-designed with well-recorded entries. The Home’s current Employers Liability Insurance Certificate was displayed in the entrance hall. Good food hygiene practices were being followed. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 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 x 1 x x 2 Standard No 22 23
ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 3 x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
17 Ella Bank Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 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. Standard 2 Regulation 14(1)(a) (b) 17(3)(b) Requirement The registered person must provide a recorded assessment of need before admitting a service user to the Home. This assessment must remain in Home at all times. Contracts between purchasing authorities and the provider organisation must be in place on all individual care records. (Previous timescale was 30/09/04) Care plans must be prepared for each service user and be reviewed every six months. Recorded risk assessments must also be available. These records must be available for inspection in the Home at all times. The registered person must ensure that details of when as required medicines should be administered are kept clearly available for staff. The registered person must ensure that staff pay attention to written guidelines regarding the administration of all medicines. The Homes complaints procedure must be updated and make reference to the Timescale for action 01/12/05 2. 5 5(3) 01/01/06 3. 6 15(1) 15(2)(b) 13(4)(c) 17(3)(b) 01/12/05 4. 19 13(2) 01/12/05 5. 19 13(2) 01/12/05 6. 22 22(1)(7) 01/01/06 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 22 7. 8. 24 24 23(2)(o) 23(2)(n) 9. 10. 35 35 17(2) Sch2.6(g) 17(3)(a) 23(4)(d) 11. 36 18(2) Commission for Social Care Inspection (CSCI). Reference to a named inspector should be deleted. The rear garden must be made fit for use by service users. The registered person must arrange for the fitting of handrails to assist with mobility at the entrance to the home and in the garden. (Previous timescale was 31/12/04) An up to date record of all staff training undertaken must be maintained in the Home. The registered person must ensure that staff are provided with fire precaution training at a frequency no less that twice a year, if they undertake night shifts. A record of this training must be kept in the Home. All staff must receive formal supervision at least six times a year. 01/12/05 01/02/06 01/01/06 01/02/06 01/01/06 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. 2. 3. 4. 5. Refer to Standard 6 6 6 9 16 Good Practice Recommendations Care plans should be devised by the Home, with goals, for use on a day to day basis. Behaviour Management Plans should be reviewed on a regular basis Cultural needs should be detailed in the assessment and care plan. (This recommendation was unmet on 14/7/04) Risk assessments should be reviewed on a consistently regular basis. All housekeeping tasks in which Service Users are encouraged to take part should be listed within the Service Users Plan of Care and mentioned in the Service Users Guide to the Home. (This was a recommendation from 11/03/05)
C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 23 17 Ella Bank Road 6. 7. 19 & 24 33 Advice should be sought from an occupational therapist regarding the fitting of any additional environmental aids. The Homes staffing establishment should be reviewed in order to minimise the use of agency staff and reduce the need for relief staff. 17 Ella Bank Road C02 C52 S19979 Ella Bank Road V246751 140905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection South Point, Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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