CARE HOME ADULTS 18-65
2, The Grove Westoning Beds MK45 5JW Lead Inspector
Ansuya Chudasama Announced 24 May 2005 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. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 2, The Grove Address Westoning Beds MK45 5JW 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) 01525 717098 MacIntyre Care care home 6 Category(ies) of LD - Learning Disability registration, with number of places 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th November 2005 Brief Description of the Service: 2 The Grove provides a home for up to six service users with learning disabilities. It is a purpose-built house on a small, enclosed estate of three registered homes, all belonging to Macintyre. The home is situated in the village of Westoning and is walking distance of local shops, a church, and public houses. The house is divided into two sections accommodating two and four service users. Each section has a separate kitchen and lounge as well as a utility room. The larger section has two bathing facilities with toilets and also a separate toilet. The smaller unit is able to provide accommodation for two people with physical disabilities. One of the bedrooms downstairs was turned into an office and this provided more space for staff. The office room upstairs was turned into an activity/quiet room for service users and has an en-suite shower and toilet. There is a large rear garden with three swings, a slide, football net, a hammock, and a patio area, and a garden shed. The garden is well used by service users and meet their needs. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was undertaken at 09.30, and it took place over 7 hours. The manager, Carolyn Dunbar was present at the inspection. The inspection was comprised of a tour of the communal areas, some of the service users’ bedrooms, talking to staff and link workers of service users, and talking to service users. Two service users’ case records and other documents were inspected in detail. There were five service users living at the home at the time of the inspection. What the service does well: What has improved since the last inspection?
The manager had within a short time of undertaking her role had worked very hard with staff and had improved the quality of care the service users were receiving. She provided leadership and direction for staff to move forward. The manager had also eradicated the barriers that exited between staff and service users in the two units by turning the home into one unit. Evidence showed that all service users were observed mixing well with each other and,
2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 6 they were observed accessing all parts of the home. The staff were also observed to be working well as a team. The home had one sleep in person and one waking staff for the whole house. Prior to this, the waking staff only worked for the downstairs unit. The staff stated that they were now seen to be working well with each other. The staff were provided with regular training, supervision and appraisals. The entrance way to the home was turned into an attractive courtyard garden, which was used by staff and service users. Service users had the choice of using the lounge, and dining areas to relax and eat their meals. The kitchen down stairs was used for preparing and cooking meals for service users. The one upstairs was used as a training facility for service users. One of the downstairs rooms was turned into an office with sleep in facilities for staff. This provided staff more space, and the information in the office was also well laid out. The old office was turned into an activity or a quiet room for service users. The hallway and quiet room and three bedrooms had been decorated and looked very pleasant. What they could do better: 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, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. The homes statement of purpose and service user’ guide provided prospective service users and their families information of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: The home had a statement of purpose and a service user’ guide. The manager had started reviewing the guide to include information in pictorial format that the service users were able to identify with in the home and in the community. The staff and service users were also involved in this process. Service users assessment forms, which were not completed at the last inspection, were now completed well. All service users admitted to the home had visited the staff and service users and the accommodation prior to admission. All service users had contracts with the home. However some of the information in the contract needed reviewing as discussed at the inspection. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 There was clear and consistent care planning systems in place to provide the staff with the information they needed to meet the needs of the service users to a high standard. EVIDENCE: Two service users’ care plans were inspected in detail. The information in the file was clearly presented and described how the personal, social and health care needs of the service users were being met by the home. The staff spoken to were able to give examples of how they empowered service users to make decisions about their lives. It was stated that they used makaton sign language, pictures, and verbal communication to help service users make choices. The two care plans seen had information on how service users communicated and the signs and words used by them were recorded. Person Centred Planning (PCP) was also started to meet service users hopes, dreams and aspirations. Detailed risk assessments were undertaken on all service users and these were monitored and reviewed by staff and management. The staff spoken to stated that they used makaton sign language, pictures, verbal communication, and body language to communicate with service users. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 10 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) 11,12,13,14,15,16,17 Service users have opportunities for personal development to enrich their social and educational opportunities. 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: The service users’ care plans inspected had detailed information on what activities were undertaken at the home and in the community. Some of the activities undertaken by service users included attending the organisations adult training centre and having days back at the home to work on their personal development skills. Service users choose their own leisure activities by using pictures and verbal communication. Information on service users likes and dislikes for activities, food and things in general were recorded. One service users’ case records looked was taken out by staff and on his returned he stated that he liked it at the leisure park and liked the staff. The home encouraged family contacts by inviting them to visit service users at the home, and some families also attended annul reviews to discuss how the
2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 11 service user was getting on at the home. The staff also supported service users to visit their families by accompanying them to their parents when required. The home provided healthy meals for service users and it was stated that service users were encouraged to try different kinds of foods to widen their choice. Specialist services from Twinwoods Resource Centre were accessed when required for any service users who had problems with nutrition. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21 The knowledge of staff, safe systems for administering medication and detailed care planning meant that the health needs of service users are met. EVIDENCE: The care planning document had detailed information on how service users’ personal care needs were being met by staff. This included having morning and evening routines, which were flexible to meet the needs of the service users. The staff spoken to were aware and understood the needs of service users. They also stated that the service users felt secured and their challenging behaviour was greatly reduced by having routines and regular staff. It was also stated by the manager that the “Out Reach” team that helped homes in dealing with managing service users behaviour were very pleased with one of the service users progress. Detailed information was recorded on how service users health care needs were being met by the home. There were regular contacts with the health professionals and visits to service users from the professionals took place in private. The appointments were recorded clearly and signed and dated by staff. The home had a policy on medication, and only staff who had received the accredited training, gave out medication. The manager gave an example of
2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 13 how they had managed to get a service users medication changed from tablets to liquid form to encourage and help the person take their medication. Records showed that service users’ medication was reviewed and guidelines were put in place for those service users who refused to take their medication. Information on service users burial arrangements was recorded for most of them. The manager was going to seek advice on this issue for one service user from the funding authority. The manager had vast experience on ageing, illness, death and bereavement. She was going to undertake refresher training with staff on these issues in their staff meetings. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 14 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) 22,23 The staff have good knowledge and understanding of adult protection issues, which protect service users from abuse EVIDENCE: Service users’ comment cards received from families stated that the service users were well cared for, and staff treated them well. It was also stated that they felt safe at the home. The home had not received any complaints. The manager had complied a simple and easy to understand complaints procedure and this was displayed in the home. The organisations complaints policy needed reviewing and the inspector was informed that this was being reviewed. All staff had received induction training on adult protection issues. The staff except the new ones had also received POVA training. The new staff were booked to attend the training in June 05. The service users’ files inspected had information on what made them vulnerable to abuse, and there were also reduction methods put in place to minimise these risks. The staff spoken to stated that they understood the service users behaviours well and they were able to tell if something was wrong by how service users behaved. The home had four service users with challenging behaviour and four service users used makaton sign language. All the staff had received training on physical and verbal aggression and challenging behaviour. Some staff were attending training on anger management. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 15 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) 24,25.26,27,28,29,30 The premises were well maintained so as to allow all those living at the home to enjoy a homely and comfortable environment that was safe, clean, and hygienic. EVIDENCE: The home was well maintained and clean. The premises were accessible to all service users since the two units were turned into one unit. This also made the home more spacious, and very homely for all the service users. The home had two lounges, two dining areas and two kitchens. All service users had single rooms and those seen were individualised and had ornaments, pictures and sensory items that service users liked. The manager stated that one service users’ room was going to be decorated next week, however four rooms had been decorated. The garden at the back was well organised with activities and it was used by the service users on a regular basis. The manager had also created a courtyard garden at the side entrance and this was very pleasant. Since the last inspection, the bathing facilities on the ground floor had been sorted and now met the needs of the service users with physical disabilities. The office room was turned into a quiet/activity room and one of the rooms
2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 16 downstairs was turned into an office. A maintenance book was available and work was being carried out on an ongoing basis. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The home provided very good training so that the people living at the home had their needs met by competent and suitable staff. EVIDENCE: The staff spoken to stated that they had worked very hard, and there were lots of good changes made to the running of the home. It was said that the service users had “come along way and for the better”. The staff demonstrated very good understanding of the needs of the service users. They stated that they received very good training from the organisation and some of them were completing the certificate in working with people with learning disabilities course. The staff training records provided evidence of both mandatory training and a wide range of additional courses covering the special needs that the home was meeting. The home had one full time and one part-time vacancy. One member of staff had also been off sick for two months. The manager had recruited three new staff and they were due to start at the end of the month. The vacancy hours were covered by relief staff and the homes permanent staff to provide continuity to service users. The manager stated that they very rarely used agency staff. The home had a minimum of three staff on duty per shift. At
2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 18 weekends and when an activity was being undertaken, four or more staff were put on duty. Staff spoken stated that they received supervision on a six weekly basis and one staff had been at the home over a year and had received her first appraisal. Many of the staff had not received their annual appraisals because they had not been working at the home for a year. One staff had completed their NVQ level 3. The staff files seen were satisfactory and contained all the relevant information needed. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,40,41,42 The home has an experienced and committed manager who ensures strong leadership, and safe working practices so that service users health, welfare and safety are safeguarded EVIDENCE: Staff spoken to stated that they had been involved in fire drills and they were given training on this when they had their induction. Fire alarm and emergency lighting was carried out on a regular basis. Also health and safety audits were undertaken on a regular basis. The staff spoken to stated that the unit was in crisis and the manager came and “pulled it up”. The manager was described as being very supportive and open with excellent management skills. It was also stated that the house was much calmer and service users were settled and most of the staff worked well as a team. The manager stated that the staff had build up trusting relationships with service users and continuity of staffing was maintained. The manager was able to create an environment where staff were made to feel
2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 20 valued, respected, supported, and for them to enjoy their work. The manager had NVQ level 3 and she had registered to undertake the RMA and NVQ level 4 in management and care. She had also undertaken training courses to up date her skills and knowledge in undertaking her role. The home had regular staff meetings and seniors meetings. 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 4 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
2, The Grove Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 4 x 3 3 3 x I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 22 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. 1. 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. 1. Refer to Standard Good Practice Recommendations 2, The Grove I51 S14906 2 THE GROVE V214001 240505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Clifton House 4a Goldington Bedford MK40 2NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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