CARE HOME ADULTS 18-65
183 Ashby Road, Burton On Trent Staffordshire DE15 0LB Lead Inspector
Ms Wendy Jones Announced Inspection 12th October 2005 13:00 183 Ashby Road, DS0000004911.V259054.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 183 Ashby Road, DS0000004911.V259054.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. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 183 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 542636 01283 563447 Robinia Care Homes (2) Limited Mrs Jean Alison Thomas Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 5 LD - aged 18 to 26 on admission Date of last inspection 25th May 2005 Brief Description of the Service: The service is provided from a large semi-detached property, located on a busy main road, in a residential area of Burton-on-Trent. It is close to local amenities and within walking distance of the local shops, park area and pub. The service has its own vehicle but is also close to public transport links. The home provides for up to 5 service users in single occupancy bedrooms: none have en-suite facilities, all have wash hand basins fitted. Communal space is provided in a pleasant lounge, dining room and spacious well-equipped kitchen. The service is registered to provide care for persons over the age of 18 years who have a learning disability. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out on 12th October 2005. Information for the report was provided from a pre-inspection questionnaire; from service user and relative feedback; from feedback from the local GP surgery; from discussion with service users and staff; from observation of the environment and interactions; from inspection of care records and other documentation relevant to the inspection process. Feedback was received from relatives and other agencies prior to the inspection. What the service does well:
The service is registered to accommodate and care for younger adults with learning disabilities. The homes Statement of Purpose and Service User Guide provided service users and prospective service users with details of the services, its aims and objectives. Assessments of needs were detailed and the standard of care planning was good, with evidence of regular review and that the service users were involved in care planning and decision-making. There was some excellent one-to-one work being undertaken with service users. Service users’ health care needs were met by the service with records showing that routine health checks had been carried out. The organisation accesses independent psychology input for service users. Medication records were satisfactorily maintained and staff responsible for the administration of medication had undertaken certificated medication training. Records of food provided showed that service users enjoyed a varied diet and a choice of main meal was available on request. A complaints procedure had been reviewed since the last inspection and records showed that complaints were taken seriously. Information regarding how and who to complain to and the details of independent advocacy service were displayed in the home. The staff team was well established and recruitment records were appropriately maintained. Staff meetings were arranged monthly. Policies and procedures required by regulation were in place. Quality audits of the service were undertaken and monthly reports on the conduct of the service copied to the Commission for Social Care Inspection.
183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 6 Servicing of documentation was undertaken regularly and the records confirmed that the necessary checks to ensure service users welfare were undertaken. Feedback from relatives gave a positive opinion of the service provided. What has improved since the last inspection? What they could do better:
A wasp’s nest provided a risk to service users and staff, the company were contacted to take action during this visit. A review of the home remedies medications should be undertaken and agreed with the GP. Any as-required medications should have protocols agreed for their safe administration. It was recommended that the service encourage good working relations with the GP practice. Further consideration should be given to supporting service users to make healthier food choices. The carpet in the hallway was badly stained and must be deep cleaned or replaced. Service users should be provided with their own bedroom door keys and lockable facilities should be provided in each of the bedrooms. Risk assessments must be undertaken for every identified high-risk activity. All staff must receive a minimum of two fire drills per year. Night staff should receive four. The numbers of staff achieving NVQ 2 qualification should be improved. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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): 1, 2, 4. The home’s Statement of Purpose and Service User Guide are excellent, providing service users and prospective service users with details of the services the home provides, enabling an informed decision about admission to be made. EVIDENCE: A copy of the Service User guide was included in the care records of service users. The Statement of Purpose had been reviewed since the last inspection. Service users discussed their needs, aims and aspirations. Assessments indicated that the service was committed to meeting the needs of individuals. The manager stated that prospective service users had the opportunity to visit the service on a number of occasions prior to moving in. Compatibility with other service users would be assessed during these visits. There was evidence in the records of service users meetings that compatibility was discussed. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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): 6,8,9. There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users’ needs. The systems for service user consultation in this home are good with a variety of evidence that indicates that service users’ views are both sought and acted upon. EVIDENCE: A sample of care files demonstrated that the service had carried out thorough assessments of need, developed care plans, carried out regular reviews and had undertaken risk assessments. In one example a young person used a bicycle for transport - it was agreed that a risk assessment must be carried out and should include the use of a bicycle helmet. Records seen included service users’ daily diaries, which gave an account of the events of the day. Service users were encouraged to write in their own diaries and entries were discussed as part of the one-to-one sessions.
183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 11 One-to-one sessions were built into service users’ weekly plan; from discussion with a senior member of staff it was evident that the sessions were useful and valuable to service users and staff in building trust and relationships. Service user meetings took place monthly up until September 2005. The records showed evidence of discussion about daily lives, involvement in decision making and discussion about any prospective admission to the home. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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): 14,15,17. Service users were supported to access a range of social, recreational activities that are located in the community and were socially valued. Dietary needs of service users are catered for with a varied selection of food available that meets service users’ tastes and choices. EVIDENCE: Each service user had a weekly activity planner, which provided a record of agreed activities; from the sample seen there was evidence that service users were encouraged to participate in a range of activities. One service user had attended college twice per week and also had a voluntary job for two mornings per week. Other recreational and social activities were in the plan including bike rides, family visits and swimming. Evening activities appeared to be limited to passive activities such as watching T.V. for the majority of nights. One-to-one time was also scheduled in the weekly planner. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 13 All 4 service users had enjoyed holidays during the year. There was evidence that service users were supported to maintain contact with families and friends and family visits are facilitated. Service users were supported to be involved in meal planning and preparation. There was no evidence of service user involvement on the day of this visit. Individual meal records were maintained to provide evidence of dietary intake. The records showed that further work should be considered to ensure that Department of Health guidance regarding healthy food choices were provided. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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 staff have a very good understanding of the service users’ support needs this is evident from the positive relationships, which have been formed between the staff and service users. Personal support in this home is offered in such a way as to promote and protect service users’ privacy, dignity and independence. The systems for the administration of medication are satisfactory with adequate guidance being in place to ensure service users’ medication needs are met. EVIDENCE: Specific health conditions included Autism Spectrum Disorder and Asperger’s syndrome and epilepsy. A number of service users present challenging behaviours. There was evidence that service users were supported to attend health related appointments from the records seen. Feedback from the GP surgery used by service users indicated that there was, on occasions, poor communication between the home and surgery which had resulted in some discord. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 15 All matters were discussed with the manager of the service, and a recommendation made that closer links with the GP surgery are established. The company retains the use of psychology services as part of the contract price for some service users to provide regular counselling sessions. The service has a home medicines record dated 1999 and should be reviewed to ensure that it reflects the current situation for each individual, and should be agreed with the GP. A protocol for the use of as-required medication had not been completed for one service user and must be agreed with the GP. Storage facilities were appropriate, records were well maintained, and staff were reported to have received certificated training in the safe administration of medication. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 16 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): 22 The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. EVIDENCE: The complaints procedure for the service had been revised since the last inspection, and was included in the Service User guide and Statement of Purpose, and displayed in the home. The records of complaints records showed that 10 complaints had been received, and provided evidence that all concerns were taken seriously and acted upon. A “grumbles” book was also used where minor issues and their resolution were recorded. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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, 26, 30 The service provides a comfortable and homely environment, but would benefit from the hallway corridor being replaced. The welfare of service users was compromised by a wasp’s nest outside the home. EVIDENCE: The home is a large semi-detached property set close to the centre of Burtonon-Trent. It is located on a busy main road and provides limited parking to the front of the property. The home provides accommodation over 3 floors. The ground floor is accessed via a large hallway, leading directly to a pleasant and well-maintained and furnished lounge, a separate dining room, with patio doors leading to the rear garden. There is a pleasant and well-equipped kitchen, with a separate utility room containing the laundry. There was also an office/sleep-in room with ensuite facilities off the kitchen. All bedrooms were for single occupancy, and those seen appeared to in excess of the minimum spatial requirements. Matters arising included the immediate need to make arrangements to remove a wasp’s nest located outside the office window; a carpet in the main corridor
183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 18 to be replaced; service users to have their bedroom door keys replaced; and lockable facilities should be provided in bedrooms for the benefit of service users. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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, 35. Staff morale is high, resulting in an enthusiastic workforce that works positively with service users to improve their quality of life. EVIDENCE: Staffing arrangements for the day of the inspection, included the Care Manager from 7.30am, 4 support workers 7.30am-3pm, 4 support workers 3pm-10pm, 1 waking night and 1 sleep-in staff. The manager had achieved NVQ level 4, one team leader had completed NVQ level 3, and a second team leader had almost completed the training. 5 staff were reported to be starting NVQ level 2 training and 1 support worker had achieved level 2. All new staff had completed inductions, which included mandatory training, and service user specific training such as autism and additional training in line with the expectation in Learning Disability Services. Two new staff were spoken to during this visit, and confirmed they had received good support. All new staff were from overseas, with English a second language but there were no significant communication problems experienced in this service. The number of NVQ level 2 trained staff should be increased to provide 50 of the workforce. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 20 A recent recruitment drive had proved successful with a full staff team now in place. A sample of staff recruitment files were inspected and found to be satisfactory, with all records required by regulation in place. Records of staff meetings indicated that they had taken place regularly on a monthly basis up until August 2005. The last meeting had been cancelled. The manager stated that service users were on occasions involved in the staff meetings. Additional team leader meetings were planned monthly - the records seen showed that a meeting had taken place in May 2005 and a second one in August 2005. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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): 39, 40, 41, 42. The manager is supported well by her senior staff and all staff demonstrated an awareness of their roles and responsibilities. EVIDENCE: All service users were in receipt of their personal allowance, 2 service users receive their disability allowance direct, while two others have appointees who manage their benefits on their behalf. A sample of financial records was checked to ensure satisfactory management of finances. Service users were reported to manage their personal allowance independently. The company undertook regular audits of the quality of care. These audits had been evaluated and outcomes produced in an impressive format. It was reported that each service would produce an annual development plan based upon the outcome of the audit. This would be required. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 22 Records of fire safety checks indicated that they were carried out as required including fire alarm, equipment and emergency lighting checks. Records of fire drills showed that some staff had not been involved with two drills in a twelvemonth period, this was a requirement of the inspection. Policies and procedures required by regulation were in place. General and individual risk assessments had been undertaken. Insurance arrangements for the home were adequate and current. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 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
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 x Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 2 X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 2 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
183 Ashby Road, Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score X X 3 3 3 2 X DS0000004911.V259054.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA24 YA42 YA42 YA20 Regulation 16,23 13 23 13 Requirement The carpet to be replaced in the main hall. The wasps nest to be removed. Timescale for action 12/02/06 13/10/05 5 YA42 12 Each staff must receive at least 2 12/03/06 fire drills per year, regular night staff must receive 4. Protocols for the administration 12/02/06 of as-required medication must be devised and agreed with the GP. A risk assessment for the 19/10/05 independent use of a bicycle must be produced. 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 YA26 YA26 YA1 Good Practice Recommendations Service users to be provided with keys to their own bedrooms. Lockable facilities to be provided in each of the service users bedrooms. The service should ensure that inspection reports and the complaints procedure are easily accessible to relatives and
DS0000004911.V259054.R01.S.doc Version 5.0 Page 25 183 Ashby Road, 4 5 6 7 YA17 YA20 YA19 YA32 service users. The service should make further efforts to introduce healthy eating in the home, in line with Department of Health guidance. A home remedies review should be undertaken and agreement with the GP sought. The service should ensure that good working relationships are established with the GP surgery. The number of NVQ 2 trained staff should be increased. 183 Ashby Road, DS0000004911.V259054.R01.S.doc Version 5.0 Page 26 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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