CARE HOME ADULTS 18-65
19 Leicester Villas 19 Leicester Villas Hove East Sussex BN3 5SP Lead Inspector
Jenny Blackwell Unannounced 26 May 2005 10:00 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. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 19 Leicester Villas Address 19 Leicester Villas Hove East Sussex BN3 5SP 01273 295840 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) Brighton & Hove City Council Ms Dee Holborn Care Home 5 Category(ies) of Learning Disability (LD) 5 registration, with number of places 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users to be accommodated is 5. 2. Service users should be aged between 18 and 65 years on admission. 3. Only adults with a Learning Disability who have been assessed as requiring residential care are to be accommodated. Date of last inspection 26 January 2005 Brief Description of the Service: 19 Leicester Villas is a semi-detached property in a quiet, residential road in Hove. It is possible to walk to the shops, and public transport systems are within close proximity.The service is for up to five adults with learning disabilities. At the present time there are four service users who are support 24-hours a day. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. During this summary the people who live at the home will be referred to as people/person, and the people who work at the home as staff or by their job title. The people who live at the home, some of the staff team, the new deputy and manager were present during the inspection. Time was spent with two of the four people who live at the home. The inspection took place over two visits to the home as the manager was out supporting a person at the time of the unannounced visit. The manager and deputy were spoken to individually and three staff were spoken to throughout the two visits. The two visits were arranged to fit around the activities organised for the day. The requirements that were made during the last inspection were checked to see if they had been met. Some had been met within the timescale, however four requirements were outstanding from April 2005. The people who live at the home and the staff were helpful throughout the inspection and contributed to the report where possible. What the service does well:
The people who live at the home are well known by the staff team. They have lived at the home for some years and the manager has worked at the home for several years. Each person’s daily activities are arranged to suit their needs and wishes. Individual activity plans are in place and the staff rota are arranged to support the activities. The staff team had supported a person for an extended period of time to recover from an injury. This meant that the staff team needed to adapt their methods of working with him and learn some new skills in physiotherapy to support the person. The team adapted well and were committed to supporting his full recovery. The manager and team have responded well to the comments from the pervious inspection. They have began to introduce methods of working that supports the people to be involved in decision making and understand better what would be happening each day. A relative was spoken to during one of the visits. She was complementary about the support her relative received at the home. She stated she always felt
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 6 welcomed at the home and described her relationship with the manager and staff as very good. She also felt that the manager was approachable and would feel confident in raising any issues with her. What has improved since the last inspection? What they could do better:
Although the process to involve people had begun, the momentum needed to continue to focus on access around the home. The people who live at the home have historically been restricted in accessing the kitchen. The manager stated this was mainly to reduce risk of accident and to monitor people’s access to food. It was required that the manager develops different ways to support people to use the kitchen safely and responsibly without having to lock the kitchen door. Further work needs to be undertaken by the manager to improve the core documents produced by the home and the people’s funding authorities. The Statement of Purpose needs improving to accurately reflect the home’s function and the home did not have contracts (terms and conditions) for living at the home drawn up with each person. Assessments and reviews conducted by the funding authorities were not up to date for each person, this was a requirement from the last inspection and will need further action from the manager to ensure authorities undertake the reviews. The manager was required to continue to improve the fire procedures and implement the recommendations from the fire risk assessment. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 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. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 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 standard(s) 1,2 and 3. The manager and staff have access to policies and procedures covering new people moving to the home. Prospective people can visit the home before moving in. Prospective people would not have full information about the home’s function or have a contract with the home. Placement assessments were not reviewed in all cases by the funding authorities. EVIDENCE: At the two previous inspections it was required that the Statement of Purpose was reviewed to ensure it accurately reflected the home’s function. The manager had improved the information, however the document still did not meet the required standard. This was now a matter of urgency as this was first required in August ’04. The people who lived at the home currently have lived there for several years and there were no plans for anyone to be moving on or for a new person to move to the home. Procedures were in place to enable prospective people to visit the home on a trial basis. Each person’s care plan was looked at and it was noted that some people had not had their placements at the home reviewed by Brighton and Hove Social Services on an annual basis. This had been required at the previous inspection
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 10 and although the timescale for compliance would be in August ’05 the manager had been unable to secure review dates from Brighton and Hove. The manager arranged “in house” reviews for each person that included family representatives and day care workers. People’s daily opportunities and shortterm goals were reviewed. The home and organisation did not have a contract or terms and conditions of living at the home in place for any of the four people. Again this was required at the previous inspection and is a matter of urgency in order to protect the individual’s rights of occupancy. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 11 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 and 7. Care plans were in place for all four people, containing information that enabled staff to provide consistent support to each person. Each person’s opportunity to be involved in decisions about their daily lives had improved significantly. The manager and staff worked sensitively with individuals to engage them in the decision making process. EVIDENCE: The care plans were viewed during the visits to the home. Since the previous inspection, keyworkers had been given the task of updating and improving the information in the plans. Evidence was seen of staff highlighting the abilities of the individuals rather than a complete focus on their disabilities. For example one person had an “I can do” list that described her abilities to do different tasks and when staff would need to assist. They contained photos of people and included information that described the person’s interest, likes, dislikes, family and friends connections, basic health and social care needs. Activitiy time tables were in the plans and were tailored to each person’s interest. The plans were drawn up from a variety of resources such as assessments, reviews and day centre information.
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 12 The most noticeable change during the inspection from the previous visit was the development of opportunity for the people to be involved in decision making and having access to information about what was going to happen during the day. The staff were seen to embrace the changes and were thinking of new ways in which to engage with the people. A photo rota board had been made with each staff member’s photo being displayed so the people could see who would be supporting them that day. A “today’s dinner” holder was placed in the dining room with a picture of what meal people would be having for dinner. A staff member talked about plans to further develop these tools to engage people with all aspects of their daily lives. This included the idea of having a timetable board in each person’s bedroom where they could be helped to put up pictures of places they would be going and the activities they would be engaging in for the next day. Another staff member was asked about the changes. She felt that the people were better engaged and that some of the methods were on a trial and error basis and may need to be adapted to suit each individual’s understanding. The staff seen appeared to be enthused by the changes and motivated by having clearer keyworking tasks such as developing the care plans. Further work is needed to ensure that the people have access to the kitchen and participate in preparing meals, snacks and drinks. This has improved, however the manager and staff need to develop different ways to support people to use the kitchen safely and responsibly without having to lock the kitchen door. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 13 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 and 17 The manager and staff were commited to supporting each person with their daily interests. The home was concerned with the individual and did not group people together during activities for ease. People were supported to be part of the community. The manager and staff have fostered good relationships with family members who were actively involved in the home. The manager and staff were able to provide a healthy diet for each person and had improved the choices of meals available. EVIDENCE: During the visits to the home all four people were out in the community participating in a variety of activities. Two people were attending day services, another had gone to get some photo I.D and another had gone shopping. The people used local shops and facilities and staff supported people to participate in their own chosen interests.
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 14 A discussion was held with one person’s relative during the second visit to the home. She stated that she was very happy with the care her relative had received at the home and believed he was happy at the home. She described the manager as approachable and that she would feel confident in speaking with her if she had any concerns. In addition she believed her relative’s keyworker was good at keeping her informed of any issues and had supported him well and that the staff team were competent and knowledgeable in supporting her relative. A requirement was made at the previous inspection to improve the participation of the people in choosing and preparing their meals. As previously noted, a pictorial menu was being developed by the staff and had began to be used quite successfully. Some staff spoken to had ideas about developing this method further. Better menu choice was available for breakfast and lunch times. Further work is needed to support people in preparing their meals and accessing the kitchen. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 15 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) 19 Each person’s physical and emotional health needs are met by accessing community health care professionals. The staff team monitors this appropriately. EVIDENCE: Health care checks were viewed in people’s care plans. Each person is registered with a G.P and attends community based appointments for dentist and optician. The relative spoken to believed the manager and staff team responded appropriately to her relative’s health care needs and that they had a good understanding of his particular difficulties. She described a recent situation were he had been taken ill and the manager had come in to the home on a day off to support him going to hospital. One person was recovering from an injury that had significantly reduced his mobility. The staff appeared to have supported him well in accessing guidance from a physiotherapist. One staff member was asked about the person’s recovery and was able to describe in detail the guidance in his care plan about his recovery programme and the risk assessments that are now in place to avoid the injury occurring again.
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 16 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 17 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. The manager and staff were responsive to the concerns of the people living at the home. A formalised complaints procedure is in place for the home that adheres to the organisation’s policy. EVIDENCE: Since the previous inspection the manager and organisation have produced a complaints leaflet that was more accessible than the organisational policy. The manager was asked about how she dealt with complaints and she was able to describe the process that she would undertake and the different levels of a complaint. She went on to confirm what the relative had previously mentioned that some “minor” complaints are dealt with immediately with relatives and on an informal bases. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 18 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, 25 and 30 The home was domestic in scale and had an improved homely environment. Health and Safety had improved in the home although further actions were needed to address the recommendations from the Fire Risk Assessment. EVIDENCE: Since the previous inspection, effort had been made to improve the homely feel of the building. New pictures had been put up and the photo rota board and menu choice had improved the people’s involvement in the home. The lounge was relatively small, however staff were seen to support the people’s use of other parts of the home so that the room did not feel crowded. One person sat with his relative in the garden making use of the good quality garden furniture. The relative commented that she and her husband regularly came to the home to participate in some gardening with their relative and other people if they wished. Time was spent with one person in his bedroom. He showed the inspector his personal items of interest and was able to access his personal belongings. His room was well kept and personalised and the inspector was able to engage with the person, as there were many items available to talk about. The person
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 19 indicated that he was happy with his room and appeared to be able to use it for times when he wanted to be alone. The home was generally well kept and clean. The exception was the kitchen. It was in need of refurbishment and re designing around the needs of the current group of people living at the home. The flooring was poor as were the kitchen units. It was required that the manager ensure the kitchen is refurbished to suit the needs of the people. A requirement from the last inspection for all staff to undertake infection control training had not been met and will be carried forward to this report. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 20 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) 34 and 35. The organisations policies and procedures for recruitment of new staff are followed by the home. The people are protected by a robust procedure that meets the requirements in the National Minimum Standards. The organisation’s training plan meant that the people’s needs were generally met by appropriately trained staff. EVIDENCE: Since the previous inspection the manager and organisation have met the requirement to hold specific documents relating to each staff member at the home. These are stored securely and are under the responsibility of the manager. It was noted that the organisation has a training programme that contains induction training and mandatory courses. One person had been highlighted to attend an “Active Support” course about how to improve ways of supporting people with profound disabilities. The manager had arranged for that member of staff to cascade the information back to the team. The whole team had recently attended an in depth fire training course at the house. External trainers came to the home and the team practiced evacuation and use of the fire equipment.
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 21 As in the previous section, a requirement for all staff to attend infection control training had not been met. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 22 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 manager has improved the promotion of the health and safety and welfare of the people and staff at the home. The senior managers of the organisation have improved the monitoring of the health and safety at the home. Further action was needed to meet the required standards. EVIDENCE: Since the previous inspection, each fire door had been fitted with a fire alarm sound detection closure devise that allowed the door to be held open. Fire training had been provided for each member of staff and regular fire detection and equipment checks were being completed. In addition, external consultants have conducted a comprehensive Fire Risk Assessment. The manager have demonstrated a commitment to improving her own and the staff team’s awareness and performance in addressing Health and Safety issues. This will need to be monitored carefully as previous practice had been poor.
19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 23 This assessment highlighted further environmental adaptations need to be implemented to ensure the containment of a fire. The manager had passed this information through to the organisation’s maintenance department and was waiting on dates for the commencement of the works. It was required that the manager provide the inspector with a plan of the schedulable work. 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 24 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 2 1 x x 1 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x x x 2 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 x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
19 Leicester Villas Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 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 1 Regulation 4(1)(b) Requirement Timescale for action Immediate 2. 2 3. 5 4. 23 5. 6. 24 30 7. 42 That the home reviews its statement of purpose and service user guide. (from previous inspection 31/8/04) 14(1)(a) It is rquired that the maager (b) ensures a suitable qualified person reviews the service users placement at least annually. (from previous inspection 26/1/05) 5(1)(b) It is required that the manager ensures that terms and conditions of living at the home are in place for each service user. (from previous inspection 26/1/05) 23(2)(a) It is required the manager assesses each service users lock to ensure it suits individual needs. (from previous inspection 26/1/05) 23(2)(a) That the manager ensure the (d) kitchen is refurbished to suit the needs of the people. 16(2)(j) That the manager ensures staff attend infection control training. (from previous inspection 26/1/05) 23(4)(a-c) That the manager implements the recommendations from the fire risk assessment.
H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Immediate Immediate. Immediate. 30th September 2005 Immediate 30th August 2005
Page 26 19 Leicester Villas Version 1.30 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. Refer to Standard Good Practice Recommendations 19 Leicester Villas H59 H10 S31913 19 Leicester Villas V22928 260505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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