CARE HOME ADULTS 18-65
182 Ashby Road, Burton On Trent Staffordshire DE15 0LB Lead Inspector
Ms Wendy Jones Unannounced Inspection 7 February 2006 14:40 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 182 Ashby Road, Address Burton On Trent Staffordshire DE15 0LB 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) 01283 546260 Robinia Care Homes (2) Limited Wendy Ann White Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named service user between the ages of 16 and 18 years This particular category to cease on the 18th birthday of the young person identified, which is 28th February 2004 22nd June 2005 Date of last inspection Brief Description of the Service: Number 182 Ashby Rd is registered for five younger adults with a learning disability. The building is a large period semi-detached house located in a residential area, on the outskirts of Burton upon Trent. The other half of the semi-detached property is owned by this company and registered separately. The home is conveniently situated close to a town, on a bus route and close to shops and all amenities. The house is set back from the main road and has limited parking space. The building is on three floors and comprises; five bedrooms, an office/sleeping-in room, lounge, dining/activity room, kitchen, one bathroom and one shower room, laundry room and storage. The home is not suitable for any person with a severe physical disability. There is a large garden at the rear and a useful patio area. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on 08/02/06, from 2.50pm to 6.30pm. Information for this report was provided from discussion with the manager, a senior member of staff and service users; from inspection of the environment and relevant records and from observation of interactions. There were three service users in the home during the inspection. Since the last inspection the care manager had successfully been promoted to area manager for the organisation. The deputy manager was acting in the care manager role and was submitting an application to the Commission for Social Care Inspection for approval as care manager. The acting manager has provided an action plan and evidence that the requirements of this report have been met within the agreed timescales, and that action is being taken to address the recommendations. What the service does well:
Provides accommodation and support for up to 5 service users between the ages of 19 and 27 years. The accommodation was provided in a semi-detached property which has three floors. The environment was well-maintained, decorated and furnished, appropriate for the age range of the service user group. Care plans gave an account of the assessed care needs of individual service users, each of whom had been allocated a key worker. There was evidence of very detailed and good quality risk assessment. A service user was very positive about his experience at the home, the support and relationship he had with his key worker, and from observation there was evidence of good relationships between staff and service users. Evidence of the inspection and from pre-inspection discussion confirmed that the service had vulnerable adults procedures in place and had appropriately initiated vulnerable adults strategy discussions as agreed in Staffordshire, when issues had arisen. Some of the inspection was spent discussing the vulnerability of individuals. Meals were agreed with service users on a day-to-day basis, there was evidence of real choice and of service users enabled to participate in the planning, preparation and decision-making. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 6 A range of social, recreational and occupational experiences were enjoyed by service users in the community, with one service user having undertaken work experience and others attending college courses. The staff morale was good, despite some staffing difficulties. The evidence of the inspection was of a staff and management team committed to supporting service users to live as independently as possible within the constraints of risk assessment. The health and safety of service users was assured by good policies and procedures, detailed risk assessments and regular monitoring of the service. What has improved since the last inspection? What they could do better:
The service should continue to make efforts to recruit a full staff team and submit an application for the care manager position. Ensure staff have received the training required in implementing the new care planning paper work. Consider the impact the lack of drivers has on the community activities and presence of service users, and review. Give further thought to supporting service users to obtain bank/building society accounts. Give consideration to the provision of toilet facilities on the ground and second floor. Ensure that all staff are involved in fire drills. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 7 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. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 8 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 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 9 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): x EVIDENCE: These standards were not inspected during this unannounced visit. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 10 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, 9 The standard of care planning was good; records indicated that service users’ assessed needs were being met in consultation with them. Individual risk assessments were of a consistently high standard, containing the information staff required to ensure that identified risks were managed appropriately and safely. EVIDENCE: Information seen in care records provided detailed assessments and care plans based upon assessed needs. There was evidence that service users had been involved in care planning and reviews. There was some discussion about proposals to introduce new paperwork to improve the current format to reflect a more person-centred model. Staff were awaiting training before the new records could be introduced. Service users confirmed that they were consulted about day-to-day decisions affecting their lives, and were supported to live as independently as possible. Risk assessments were explicit in their detail, including the action to be taken by staff to minimise the risk and the degree of risk associated with each
182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 11 activity. There was very good evidence that service users’ rights were respected and that they were informed of the reasons for the service taking any action required to ensure their safety. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 12 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, 14, 13, 16, 17 Access to community facilities was adequate, but could be further improved to provide more opportunities for service users to be involved in more socially valued activities. Dietary needs of service users are well catered for, with a balanced and varied selection of food available that meets service users’ tastes and choices. EVIDENCE: Individual service users had records that showed the range of activities accessed. These included access to art and music therapy sessions and college classes. A sample of service users’ interests and hobbies that they were supported to participate in included train-spotting and involvement in an Adopt-a-Station scheme, which involved the interested person in maintaining a local station on a voluntary basis. One service user had completed a 12-week course funded by the Prince’s Trust, did some voluntary work for the local church and was involved in church groups. Some voluntary work for charitable organisations was also undertaken
182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 13 by individuals. It was hoped that some of the voluntary work would result in paid employment. Spontaneous community activities was limited due to the lack of staff drivers in the home - it was hoped that this would be resolved during the current recruitment drive. Issues relating to service users’ monies were discussed, as the manager identified difficulty in opening bank/building society accounts for service users. A service user confirmed that he had enjoyed a holiday last year and was hoping to repeat the experience in the summer. Staff and service users confirmed that menu planning was undertaken weekly. On the day of the inspection it was pleasing to note that individual preferences were being catered for. The evening meals provided on the day included two curries (one was a vegetarian), and a sweet and sour meal. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 14 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, 20 The personal and health care needs were appropriately met, with evidence that service users were supported to be as independent as possible. The systems for the administration, recording and storage of medication were good, ensuring the safety and wellbeing of service users. EVIDENCE: Personal and health care needs were being appropriately met. There was discussion about individual healthcare needs, and evidence service users were encouraged and supported to access health appointments and specialist services. Staff had received certificated training in the safe administration and care of medication, and also undertaken an in-house assessment of competency. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 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): 23 Arrangements for protecting service users were satisfactory. The manager demonstrated a sound knowledge of the rights of service users and the procedures for ensuring they were protected. EVIDENCE: The service has very good procedures in place for the protection of service users. The evidence of the Commission for Social Care Inspection is that they respond appropriately and consistently to the needs of individuals. Whistle-blowing procedures were in place and the manager reported that they were often discussed during supervision sessions with staff. Since the last inspection there has been one vulnerable adults strategy discussion and at the time of the visit, a referral through vulnerable adults had been made. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 27, 30 The standard of the environment within this home is good, providing service users with an attractive, clean and homely place to live. EVIDENCE: The environment was of a good standard throughout. Since the last inspection new sofas had been provided in the lounge and areas of the home had been redecorated and re-carpeted. A sample of bedrooms were seen: the service user confirmed that he was happy with his room, had his own bedroom door key and had a lockable facility in his room for storing personal possessions. The bathroom had been redecorated, with service users participating in the choice of colour schemes. Further work was needed and was planned to make the room more welcoming and homely. A recommendation of the previous inspection should continue to be considered in respect of the provision of toilet facilities on the ground and second floor. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 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): 31, 32, 33, 35, 36 Staff morale was good, resulting in a positive workforce that works with service users to improve their whole quality of life. Standards of staff supervision with evidence of good levels of support provided. EVIDENCE: Staffing arrangements for the day of inspection included: 4x 7.30am-3pm, 3x 3pm-10pm, 1x sleep-in and 1 waking night staff. There were 3 fulltime staff vacancies and 1 full time team leader vacancy reported: a recruitment drive had been undertaken but had been unsuccessful. Interviews for 4-5 possible new staff were arranged for the week after the inspection, following a second recruitment drive. The service had an established bank staff list. Regular use of bank staff had ensured that staffing levels had been maintained and the evidence from records was that staff were not working excessive numbers of hours per week. Three staff had trained to NVQ level 3, two had level 2 with proposals for them to undertake the level 3 training, the manager and a team leader were
182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 18 undertaking NVQ level 4. The service exceeds the minimum standard in respect of NVQ training. The manager stated that mandatory training was up-to-date, that regular staff meetings were held (records of previous meetings were provided for inspection purposes). Additional training in autism and mental health issues had also been provided or planned. Staff supervisions were planned every 5 weeks. The manager reported that they were up-to-date and that she and a senior member of the staff team had training in supervision and appraisals of staff. New staff receive an appraisal after 6 months, and annually thereafter. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 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, 39, 42 The manager is supported well by her senior staff in providing clear leadership throughout the home, with all staff demonstrating an awareness of their roles and responsibilities. The health and safety of staff and service users is promoted by detailed risk assessment and regular monitoring of safety systems. EVIDENCE: The manager of the service had been newly appointed since the last inspection. She was undertaking NVQ level 4 in care and management and was to submit an application to the Commission for Social Care Inspection for approval. The organisation had introduced quality monitoring systems, which included seeking the views of service users, families and other stakeholders, and a report on the outcome of the annual audit had been produced. It was not established at this inspection if a development plan based upon the outcome of the audit had been produced.
182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 20 Since the last inspection, an emergency situation had occurred and the home was evacuated for a period of time. Emergency procedures were followed and no significant adverse effects were evident. The matter has been appropriately reported. The fire safety checks required by regulation had been recorded and fire training was up-to-date. It was required that all staff, including night staff, have been involved with fire drills. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 X 29 X 30 4 STAFFING Standard No Score 31 3 32 3 33 2 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 X 2 X 3 X X 3 X 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA42 Regulation 23 Requirement The registered person must ensure that all staff have been involved in fire drills. (Previous timescale 06/07/05) Timescale for action 08/03/06 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 YA27 YA33 YA6 YA13 YA13 Good Practice Recommendations Give consideration to the provision of toilet facilities on the ground and second floor. The service should make further efforts to recruit a full staff team. The service should ensure staff have received the training required in implementing the new care planning paperwork. Consider the impact the lack of drivers has on the community presence of service users, and review. Give further thought to supporting service users to obtain bank/building society accounts. 182 Ashby Road, DS0000004910.V283349.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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