CARE HOME ADULTS 18-65
2, Saxon Close Flitwick Bedfordshire MK45 1UT Lead Inspector
Carol Mitchell Unannounced Inspection 11th January 2006 09:50 2, Saxon Close DS0000014964.V275144.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 2, Saxon Close DS0000014964.V275144.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. 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 2, Saxon Close Address Flitwick Bedfordshire MK45 1UT 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) 01525 720170 www.macintyrecharity.org MacIntyre Care Mrs Elaine Louise Holliman Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: 2, Saxon Close, residential care home provides long-term care to six people with learning disabilities. The home was purpose built in 1998. MacIntyre care, which is a voluntary organisation, operates the home. The accommodation consists of five single bedrooms, two bathrooms, and one separate toilet on the first floor. The ground floor has a bedroom with en-suite facilities, one separate toilet, a small quiet room, and a large lounge. An office combined with staff sleeping in room is also situated on the ground floor. A conservatory has been installed for a service user who smokes. The home has a large rear garden with two summerhouses, and a green house. The home is within walking distance of the town centre and its shops. There is and area for parking, and easy access to buses and trains. 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning of 11th January 2006. The inspector spent time with the two residents who were at home, two support workers, and the manager. The inspector looked around some parts of the building, and checked two resident files and two staff files. The inspector is very grateful to people living at the home, and to everyone who helped with this inspection. What the service does well:
The home is very good at making sure that people living there are involved in how the home is run. Lots of information at the home is illustrated with pictures or photographs so that the information is easy to understand. The staff know how to understand the residents. People living at the home are encouraged to make choices about things like meals and activities. A resident said, “I choose things.” The staff who work at the home know the residents and they are kind. Staff know how to support the people living there in the right way, they are a good team, and they are well supported by the manager. A support worker said, “we work well as a team, and we have fantastic support”. Another said, “we all get on very well, we talk well together, and we are well supported.” People living at the home are able to carry on being as independent as possible, and they have very busy lives. One resident said, “I’m going to the garden centre today, and I’m going to work tomorrow, (gardening)”. Residents go out to day care activities and also do lots of things at home. The home has a minibus and people living at the home can use this for trips out and holidays. People living at the home have interests and hobbies, and they are encouraged to keep these going. People living at the home are helped to complain, their opinions are really important, and they are listened to. Staff write down the information needed to support and look after the residents in care plans and residents are helped to be involved with this.
2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 6 When residents have health needs that need looking after, the staff are able to help. The staff have been trained in how to give out medicines, and in other matters to do with health and illness. The home is well run, and the manager and director of the home make sure that they keep checking that everything is being done properly. The manager is always thinking about ways of making life better for people living at the home. What has improved since the last inspection? What they could do better:
Even though the people living at the home indicate being pleased with their meals, the manager said that she is going to arrange a meeting with staff and the director to discuss whether the food budget at the home needs to be bigger. The manager said that she will also ask the pharmacist to give the home more printed medicine labels, so that these can be put on the medicine sheets. The manager has also identified areas where the home is doing well but wishes to improve still further. For example, the manager and staff want to continue working hard to help people living at the home to be more involved in care planning and other 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 7 matters. They also want to help people to communicate and be understood better, and are continuing their work on this. People living at the home are already involved in the local community, and the manager and staff want to see if there are any other clubs that might be enjoyable for them. 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. 2, Saxon Close DS0000014964.V275144.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 2, Saxon Close DS0000014964.V275144.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): 2 People living at the home are involved in writing down their needs, and staff are knowledgeable. This means that residents can be sure that their needs will be assessed. EVIDENCE: Detailed and individual information about residents’ assessed needs and aspirations had been recorded in and organised way. Residents had contributed to the information in the two files checked, and staff talked knowledgeably about residents’ needs. 2, Saxon Close DS0000014964.V275144.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, 8, 9 The manager and staff know that people living at the home are important, and the manager makes sure that changing needs are written down properly. This means that people living at the home can be sure that they will be involved in all aspects of life at the home, and that they will be supported in the right way for them. EVIDENCE: Detailed and comprehensive information is recorded within care plans. The information is specific and useful. For example, advice about individual behaviours and behaviour management is included, together with details of any particular verbal, or non-verbal communication methods used by residents. Advice for staff regarding how to help residents make decisions is meaningful and helpful. One example advised how to help a resident make choices to do with dressing. Residents are involved in care planning, and in reviews, as much as they can be, and are encouraged to write in the plan when possible. 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 11 Weekly house meetings are held. Pictorial guides are used at the meetings, and throughout the home, to help residents to make decisions about the running of the home. For example at the meeting just prior to inspection, residents had chosen meals for the following week, and had decided on activities to be undertaken during “personal development” time. A resident spoken to cleans his room, and does his own laundry. Risks to individual residents are assessed, and people living at the home are supported as necessary and as far as possible, to carry on with their lives to full potential. 2, Saxon Close DS0000014964.V275144.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): 11, 12, 13, 15, 16, 17 Every effort is made to make sure that people living at the home are able to occupy themselves in the right way for them. The manager and staff are keen to support people in all sorts of ways. This means that people living at the home do have opportunities for personal development. EVIDENCE: Information about “Personal Development Training” days is recorded for each resident. Decisions about what should be included are often made by residents during weekly house meetings. Activities may include work or college experiences. People living at the home attend Adult Learning Services and day care facilities during the week. A resident was proud of various certificates of learning he had achieved following study time at college. He also talked about his interest in lorries, and how this has been supported by staff at the home. People living at the home have busy social lives, friends and relatives visit, and residents visit their friends and family regularly. One resident enjoys going to church and the museum, and the local pubs and shops are visited by residents. The home has a minibus, and residents enjoy their holidays and trips out.
2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 13 At home activities such as beauty and video nights are arranged in line with residents’ particular interests. A resident indicated an awareness of the need for people living at the home to try to get on with one another, and he knew that he has the right to voice his opinion, and how he can do this. He feels that he is listened to. No one is allowed into residents’ rooms unless they are present and have given permission. The menu is presented in picture form, to help residents to take responsibility for the menu. A resident said that he is able to choose the menu, with others, and that he enjoys taking his meals in the kitchen/dining room. 2, Saxon Close DS0000014964.V275144.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 manager and staff are trained, they know how to support the people living at the home and they write down this information. Therefore residents can be sure that they will be looked after in the right way for them. EVIDENCE: Detailed intimate care guidelines are included within care plans, together with a summary of what makes each resident vulnerable, or feel vulnerable. The advice is very clear, easy to understand, and helpful. Any health requirements are also carefully described, and staff receive training in any relevant areas, for example staff have been trained in diabetes management. Health care appointments are recorded. Staff have also received training in the administration of medicines, and a series of regular checks is made to ensure that a sound system for medicine administration is in place at the home. 2, Saxon Close DS0000014964.V275144.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): 22, 23 The manager and staff make sure that they find out about what people living at the home think as much as they can, and they are very keen to put right any problems. Staff are trained to protect from harm the people they are supporting. Therefore residents can be sure that they will be listened to and kept safe. EVIDENCE: A friendly and open atmosphere in the home means that residents feel able to express themselves verbally, or in other ways. For example, a support worker described how she interprets a resident’s expressions in order to assess what is being communicated. Within each care plan checked was a detailed and specific summary concerning how the resident might complain. Residents have attended a self advocacy group, and staff have been trained in how each resident has been taught to complain. The weekly house meeting had taken place during the evening prior to inspection. Three residents had raised an issue. The matter was recorded in the complaints record, and was being investigated and dealt with at manager and director level. The manager at the home is a provider of training in the protection of vulnerable adults and all of the staff have received training. Staff were able to discuss what they would do if they become aware of unsatisfactory or questionable practice. Information in the staff files shows that proper checks are made before anyone is employed at the home. 2, Saxon Close DS0000014964.V275144.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, 30 The manager and staff want people to feel at home, and to be safe. Staff have also received the right training to achieve this, and they do the right things. Therefore, people living at the home feel comfortable there. EVIDENCE: All areas of the home seen during the inspection were clean and comfortable. The staff spoken to are very keen to make sure that residents feel at home and very comfortable with their environment. A resident showed the inspector his bedroom and bathroom with pride. The resident keeps his own room clean. He has photos and items of personal interest around him, and talks about these with enthusiasm. Any maintenance problems at the home are identified by staff and dealt with, and two bedrooms, and the kitchen have been decorated recently. Staff are trained in matters to do with health and safety, and the proper checks of equipment such as fire extinguishers are done. 2, Saxon Close DS0000014964.V275144.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): 32, 33, 34, 35, 36 People living at the home benefit because staff at the home know them, and because the staff are well trained and supported. EVIDENCE: Residents are relaxed, comfortable and able to communicate with staff at the home. Staff are friendly and kind in their manner with residents. Staff are undergoing or have completed recognised training in learning disabilities, and training in other key areas is also given high priority at the home. Staff are able to describe their role in supporting residents with clarity and in detail. Handovers take place to make sure that all staff are aware of any changes, and staff meetings are held. Staff are supervised regularly and receive annual appraisals. Staff feel that they are supported very well, and that the team works well together for the benefit of residents. Prospective employees are interviewed, and references and other checks are made before employment. 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 18 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, 38, 39, 42 The manager is knowledgeable and cares about the people living and working at the home. The residents can be sure that their views about the running of the home are taken very seriously indeed. EVIDENCE: The manager has undertaken relevant training, is knowledgeable, and is supported by a director. The manager is keen to maintain high standards, and is approachable and friendly. She helps and supports both staff and residents. The manager runs the home in such a way that the views of residents are always sought and taken into account. For example residents are actively encouraged to complain, even if there may seem to be obstacles in the way of this. Pictorial guides are also used a lot throughout the home to help with communication, and each resident has a communication book for each day. The books are used as a prompt to make sure that the views of residents are continually established. Residents therefore feel involved in the running of the home in a very real way. The views of other service users, such as relatives are sought informally, during reviews, and through the use of questionnaires.
2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 19 The manager and director have checks in place to make sure that things are done correctly, and they keep records of the checks that they make. For example they check that medicines, and the safety aspects of the home are being dealt with correctly. The manager makes sure that all of the staff have received important training such as fire, and health and safety training. 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 3 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 4 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 3 x 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 21 No. 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 2, Saxon Close DS0000014964.V275144.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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