CARE HOME ADULTS 18-65
Edward Road (20) Dorchester Dorset DT1 2HL Lead Inspector
Marion Hurley Key Announced Inspection 24th July 2006 10:00 DS0000026746.V296453.R01.S.doc Version 5.2 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 DS0000026746.V296453.R01.S.doc Version 5.2 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. DS0000026746.V296453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Edward Road (20) Address Dorchester Dorset DT1 2HL 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) 01305 265097 01305 250138 www.leonard-cheshire.org.uk Leonard Cheshire Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places DS0000026746.V296453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th December 2005 Brief Description of the Service: 20 Edward Road is a care home providing personal care and accommodation to three adults who have a learning disability and additional physical disability. The home is one of seven similar services in Dorchester that are owned and operated by the Leonard Cheshire Foundation, a not for profit organisation providing services to people with disabilities. The home is a bungalow that has been converted and extended to meet the needs of all the residents. It is located in a quiet residential street, within walking distance of Dorchester town centre. Dorchester has a wide range of shops, banks, GP surgeries and other amenities, which are used by service users on a daily basis. All service users have single bedrooms and share the communal lounge, kitchen and dining room. There is level access throughout the first floor, and to the front and rear doors. Fees are individually negotiated according to the residents needs. Copies of inspection reports are available upon request from the Leonard Cheshire Home administration Office in Dorchester. DS0000026746.V296453.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place on July 24th, 2006 at 10:00. The visit consisted of discussions with the two staff on duty and the team leader, a tour of the home and records were examined. The inspector met two residents during the visit. The home is currently “managed” by the recently appointed team leader who at the time of this inspection is in the process of applying to become the Registered Manager. The team leader is being advised and supported in this new role by the Leonard Cheshire Home’s Regional Service Manager. No additional visits have been undertaken since the last inspection in December 2005. There have been no reported accidents or incidents and no complaints or concerns have been raised internally or to the CSCI. Three comment cards were returned with no identified concerns. A pre inspection questionnaire was sent on May 23rd but not completed or returned prior to the inspection. What the service does well:
The home provides a pleasant and comfortable environment in which residents live. Residents are supported to personalise their bedrooms with their own belongings. There are adequate levels of staff on duty that endeavour to meet the personal and healthcare needs of residents which were being handled professionally and sensitively. Residents’ benefit from an experienced, knowledgeable and dedicated staff team who aim to protect and enhance the residents’ health, safety and welfare. The service is focused on understanding the needs and wishes of the residents and encouraging residents to lead active and fulfilling lives. The staff demonstrated a good understanding of the residents’ individual behaviour, abilities, interests and needs. DS0000026746.V296453.R01.S.doc Version 5.2 Page 6 The level of activities for residents is widespread, age appropriate and aimed at normal integration into the local community. The residents’ days were mostly structured and included a range of social activities. Within the home, the residents are encouraged to be involved in maintaining and improving their life skills. The staff rotas were designed around the needs of the residents. Medication is well managed in the home with relevant procedures in place for the administration of medicines. The staff are motivated and committed to providing the best care and opportunities for each resident. All staff complete relevant training. What has improved since the last inspection? What they could do better:
The care/support plans contain a wide range of useful information. However, the home needs to ensure that they are practical working documents. Care Plans must be reviewed regularly and in conjunction with the risk assessments. It is recommended that staff who are living and working side by side with the residents should review risk assessments. Risk assessments are an important aspect of the overall care plans. Care plans require further details, which illustrate how staff consult and seek the views of residents especially recording all non-verbal communication skills
DS0000026746.V296453.R01.S.doc Version 5.2 Page 7 the residents may use. Staff describe their work with the residents in great detail and it would be beneficial if this information and understanding could be summarised in the care/support plans Resident’s should be encouraged to develop skills and experiences to attain specific goals objectives and their achievements should be recorded in their care plans. All staff must complete fire training. At the time of this inspection several members of staff had not received training during the previous six months. An effective quality assurance system needs to be implemented. 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. DS0000026746.V296453.R01.S.doc Version 5.2 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 DS0000026746.V296453.R01.S.doc Version 5.2 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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been no recent admissions to the home. Placement assessments have not been reviewed. Each resident must have a written and signed contract and or terms and conditions. EVIDENCE: The team leader confirmed their knowledge and understanding of the principles and good practice for admission procedures. However, they were not fully aware of the Leonard Cheshire Homes’ policies and formal procedures for admissions. The team leader explained that previously the Cheshire Home’s Service Manager has dealt with all enquiries, referrals and admissions. It is important if the team leader is going to succeed in their application to become the registered manager that they familiarise themselves with the Homes policies and procedures and are aware of the National Minimum Standards required to ensure this standard is met at future inspections. Not all the residents have completed contracts and or terms and conditions and this is in part due to the fact that this group have lived and been
DS0000026746.V296453.R01.S.doc Version 5.2 Page 10 supported though the Leonard Cheshire Home Services for over 20 years however, each resident must have an individual written contract or statement of terms and conditions. DS0000026746.V296453.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, and 9 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to ensure that care/support plans are reviewed regularly and these reviews are in conjunction with appropriate risk assessments. EVIDENCE: Each resident has a completed Individual Service Plan, which contains a considerable amount of valuable information. However, these plans have not been reviewed since 2004. One file was examined in detail and contained a data sheet, plan of care, risk assessments, health check records, medical information and brief notes from the fortnightly staff meetings pertaining to the individual resident. The Plans did not identify the changing needs of residents or identify any personal goals but it was very clear from discussions with the two staff on duty they had an excellent understanding of the needs of the residents and had identified how they had adapted to their changing needs and set “mini goals”
DS0000026746.V296453.R01.S.doc Version 5.2 Page 12 for each person. Unfortunately none of this valuable information was recorded. Communication for residents living in the home is difficult due to the severity of their learning disabilities. Staff are aware of the different nonverbal methods each resident uses and the file reviewed had the resident’s communication assessment. Staff explained how each resident is given opportunities to make decisions about their daily lives, with appropriate assistance as needed. This includes help to make decisions regarding their choice of activity, daily routines, what they are going to eat. DS0000026746.V296453.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to access a wide range of amenities, which meet their social and leisure needs. Residents are presented with ample opportunities for social inclusion and benefit from excellent staff support to do so. Residents engage in appropriate leisure activities inside and outside of the home, which are linked to their individual interests and competencies. Residents’ rights are respected and the daily routines of the home promote individual choice. Residents are offered a healthy diet based on choice. DS0000026746.V296453.R01.S.doc Version 5.2 Page 14 EVIDENCE: Residents are given opportunities to maintain and develop social, emotional, communication and “interdependent” living skills. However, due to the physical and learning disabilities of the residents in the home, these are small steps. One resident attends Day Services while the other two are supported to undertake personal activities with the homes staff such as personal shopping, hydrotherapy, massage and manicures. Residents take part in varied leisure activities and use local facilities regularly. Examples spoken about were visits to the local leisure centre, cinema, shops, bowling, horse and cart riding, local pubs and restaurants. Residents have access to the homes’ transport and this is used to travel to their chosen activities. Televisions, videos, music systems are available in the home and visitors are always welcome. The care /support plan showed the resident’s likes and dislikes and this information cross-referenced with the activity chart. Residents do not have any specific social contacts outside the network of the other Leonard Cheshire Homes in the Dorchester locality. Some residents have regular contact with their families, whilst for others this is of a more intermittent nature. The menu is planned a month in advance and is seasonally adjusted. A record of all meals eaten by the residents is kept in their diaries. Residents are not involved in the preparation of meals; however, staff will do some simple cookery sessions with them on a one to one basis. Other records relating to the cleaning rota, fridge and freezer temperatures were all being maintained. DS0000026746.V296453.R01.S.doc Version 5.2 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 the following standard(s): 18,19,and 20 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The physical, emotional and healthcare needs of residents are well met with evidence of good multi-disciplinary working taking place on a regular basis. Staff are provided with appropriate information to support residents sensitively and appropriately in the way preferred by each individual resident. The systems for the administration of medication are will managed protecting residents and ensuring medication needs are met. EVIDENCE: All residents require a high level of support to ensure their personal care needs and hygiene is maintained. This information is written in the care plans but as previously stated in NMS 6 the plans need to be reviewed in order to provide up to date information and reflect any changing needs and level of support necessary for the residents well being.
DS0000026746.V296453.R01.S.doc Version 5.2 Page 16 All residents have an annual health check up. There is evidence in their care plans that residents have regular check-ups/treatment i.e. eye and hearing tests and dental and chiropody appointments. Additional support is provided through the Learning Disabilities Community Team, where residents can access physiotherapists, occupational therapist and other specialist services if required All staff are involved in the administration of medicines and the two on duty confirmed that they had received training. Records of drug administration were viewed and were satisfactory as were storage arrangements and stock levels. DS0000026746.V296453.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable staff to complain about the service and to contact outside agencies for support. Procedures are established for the reporting and recording of any potential abuse EVIDENCE: There is a complaints procedure available at the Leonard Cheshire Homes Dorchester Administration Offices. This document, which has not been reviewed since 2004, needs amending to include the contact details of the local CSCI offices. There were systems in place to report and record any allegations or suspicions of abuse which link into the local Social Services Adult Protection Procedures. It was noted that body maps were used to record any marks noted on the residents and this information cross referenced with details record in the resident’s diaries and care/support plans. All residents have their own bank accounts but are totally reliant on the staff to manage their monies. There are clear records of all financial transactions completed with and on behalf of each resident. DS0000026746.V296453.R01.S.doc Version 5.2 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, fresh and comfortable. EVIDENCE: The inspection involved a tour of the building, all areas of the home were tidy, fresh and clean. However the refurbishment of the bathroom remains outstanding at the time of this inspection. Where new radiators have been fitted the paintwork needs to be made good to ensure the work is finished to a reasonable standard. The home has a separate utility /laundry room. The home is equipped to meet the physical needs of residents. DS0000026746.V296453.R01.S.doc Version 5.2 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the Home’s recruitment policy and practices. However, residents’ safety was being compromised by an inadequate frequency of fire training for staff. EVIDENCE: Two staff files were examined and were found to contain all elements required by current regulations, regarding recruitment practices. Staff files showed evidence of induction training to Learning Disability Award Framework (LDAF) standards. Progress throughout the Leonard Cheshire Homes is being made with NVQ training. Discussions with staff on duty indicated that they had a good level of relevant experience with a strong personal knowledge of each resident The majority of staff have started / completed mandatory care courses such as moving and handling, basic food hygiene and first aid. However, staff fire
DS0000026746.V296453.R01.S.doc Version 5.2 Page 20 training was not up to date and this potentially has a serious impact on the health and welfare of the residents and the staff. Staff are currently supported and supervised by the newly appointed team leader. DS0000026746.V296453.R01.S.doc Version 5.2 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): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a warm, professional and friendly atmosphere at the home, which encourages residents to communicate their needs. Resident’s health, safety and welfare were being protected despite the lack of fire training a percentage EVIDENCE: The team leader has commenced studying for the National Vocational Qualification level 4. Staff spoken with said the team leader gave clear guidance as to the standard of care expected and was supportive and open. DS0000026746.V296453.R01.S.doc Version 5.2 Page 22 At this stage the team leader has not been given the opportunity and time to familiarise themselves with all the roles and responsibilities of becoming a registered manager for this service and it is important that senior managers within the Leonard Cheshire Homes address this. The team leader explained that monitoring the quality of services at the home remains on an informal basis mainly through direct work with staff and contact with the residents. The Leonard Cheshire Foundation must develop a formal Quality assurance system for monitoring the quality of car and services provided to this group of residents. The responsible person representing Leonard Cheshire Homes undertakes monthly monitoring visits “Regulation 26” and these comprehensive reports are sent regularly to the CSCI offices. There were no obvious hazards noted within the home. Residents’ records were safely and securely stored. The Leonard Cheshire has a number of policies and procedures however it is important these are regularly reviewed and updated. Information on the running of the home is well maintained i.e. servicing contracts. From observations of the residents, it would seem that they felt comfortable in the home and were looked after by staff that genuinely cared and understood their needs and responded to them. DS0000026746.V296453.R01.S.doc Version 5.2 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 Standard No Score 1 x 2 2 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 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 2 x 2 x x 2 x DS0000026746.V296453.R01.S.doc Version 5.2 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. Standard YA5 Regulation 5(1) (b) (c) Requirement The registered provider/manager must ensure that all residents have a written and costed contract/statement of terms and conditions. The registered provider/ manager must develop and agree with each resident an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The plan must be reviewed at least every six months and updated to reflect changing needs. The registered provider/ manager must ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety. The home’s premises must be accessible, safe and well maintained. The refurbishment of the bathroom remains outstanding and was identified in previous inspection reports.
DS0000026746.V296453.R01.S.doc Timescale for action 30/11/06 2. YA6 15 (1) (2) (a) (b) (c) (d) 31/10/06 3 YA24 13(4) (a) 31/10/06 Version 5.2 Page 25 4. YA37 8(1) 9(1) (2) 5. YA39 24 The registered provider must 30/11/06 appoint a manager who is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The home must establish and 30/11/06 maintain a system for reviewing and monitoring the quality of care provided by the home and where possible involving residents or their representatives. 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 DS0000026746.V296453.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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