CARE HOME ADULTS 18-65
204 Ashby Road Burton On Trent Staffordshire DE15 0LA Lead Inspector
Wendy Jones Unannounced 30 June 2005 2:30 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. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 204 Ashby Road Address Burton On Trent Staffordshire DE15 0LA 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) 01283 536494 Robinia Care Homes (2) Limited Carol Walton CRH 6 Category(ies) of LD(6) registration, with number of places 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 26 February 2005 Brief Description of the Service: Number 204 Ashby Rd is registered for six younger adults with a learning disability. The building is a large period semi-detached house located in a residential area, on the outskirts of Burton upon Trent. The other half of the semi-detached property is privately owned. The home is conveniently situated close to a town, on a bus route and close to shops and all amenities.The house is set back from the main road and has tarmac drives and adequate parking space. The building is on four floors (including basement) and comprises; six bedrooms, an office, lounge, dining/activity room, kitchen/dining room, art room, two bathrooms each with bath, shower and toilet, two separate toilets, laundry room and storage. The home is not suitable for any person with a severe physical disability. There is a very large garden at the rear and a useful patio area. Suitable outdoor furniture has been provided, including swings.A care manager and a team of support workers provide care.The home has its own multi-seat vehicle, which is extensively used for the service users. An activities organiser is employed and suitable activities and events are organised and appreciated by the residents. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted on 30th June 2005, information for this report was provided from discussion with the manager; from observation of the environment, routines and interactions; from inspection of care, training and other relevant records. Service user dependency was high all had a severe learning disability, all required some staff support with personal care, with communicating their needs, with accessing services and community facilities. Service users were in and out of the home during this visit, 1 was at the day care centre another was on holiday. What the service does well:
Staffing levels were good, providing 4 staff throughout the waking day, the manager’s hours were supernumerary. The numbers of staff who had achieved National Vocational Qualification level 3 training and who were undertaking this training was good. Mandatory training was reported to be up to date and the records of planned training indicated that the organisation was committee to provide staff with a range of training opportunities. The arrangements for menu planning and food choice was good, the service has a range of pictures of meals to assist service users to make an informed choice, in addition the manager reported that object referencing was used. Menus’ indicated a well balance, healthy diet, with fresh fruit available at all times. The environment provided comfortable and homely surroundings for service users, all bedrooms were for single occupancy, communal areas provided sufficient space for service users. The lower ground floor provided a sensory/relaxation room, which was available to service users from the home but also other service users within the organisation. This floor was also used to provided art and craft sessions for service users. The service was planning holidays for all service users. The arrangement for the administration, storage, receipt and return of medication were good, with administration records appropriately maintained. Care records were adequately maintained, there was evidence of reviews; risk assessments had been implemented to reduce any identified risk. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 6 Complaints procedures were available for service users; a pictorial format had been produced to ensure that service users could be supported to better understand the procedures. Records of complaints indicated that the service acted appropriately to address and resolve any issues. Service users were supported to attend health related appointments; records indicated that health care needs were met. The arrangements for fire safety were good, with records appropriately maintained regular fire drill and evacuations and evidence that staff had attended fire training. What has improved since the last inspection? What they could do better:
Records of staff recruitment must reflect the requirement of regulation, and maintained in the home. Care plans should be regularly reviewed, good practice suggests a formal review twice per year, and more regular reviews in between. The service standard was understood to recommend monthly reviews. The service should develop Person Centred Planning. Ensure that service users monies are managed in their best interests, by sourcing a savings account and that audits of service users monies are undertaken regularly. The insurance limits for cash in the home should be confirmed to ensure that service users best interests are assured. Pre admission assessments carried out on behalf of the organisation should be included in the care records of each service user. Risk assessments should include explicit information to assist staff to properly respond.
204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 7 An annual development plan based upon the Quality Assurance audits findings should be produced. 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. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 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 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 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) x Not inspected. This standard will be reviewed at forthcoming inspections. EVIDENCE: 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 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 standard(s) 6,9. Care planning was of a good standard, and generally reviewed on a regular basis providing the necessary information for staff to deliver appropriate care. Risk assessments were in place ensuring the safety and well being of service users. EVIDENCE: A sample of care records showed that service user needs were being adequately met, the model of plans followed the principle of Person Centre Planning. From discussion and from the records seen it was evident that further work was needed to fully implement the PCP approach to care delivery. A professional assessment form a social worker was on file for each of the service users, there was no record of a service pre admission assessment. It was understood that pre admission assessments were undertaken by a manager on behalf of the organisation. The care manager identified that she had involvement in the transitional arrangements and compatibility checks for service users. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 11 Risk assessments were in place to address identified areas of risk, the need ion to ensure that risk assessments provided explicit detail, to ensure that staff had the necessary information they need to safely support and safe guard service users. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 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 standard(s) 12,14,17. Service users had access to a range of activities appropriate to their individual needs. The standard of menu planning was good, with evidence that service users were supported to make informed choices and a healthy diet. EVIDENCE: Records showed that service users participated in a range of activities, in house and in the community. The majority of activities were geared to address the complex needs of service users such as sensory stimulatory activities and relaxation sessions. The service provides an art and craft centre on the lower ground floor and employed an activity co-ordinator to operate this and other activity sessions. One service user was reported to attend day care service for persons with learning disabilities. Leisure activities included swimming sessions, it was understood that the organisation hires the use of a swimming pool monthly to be accessed by
204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 13 service users within the organisation. On an individual basis service users are supported to access leisure activities accessed by the general public. The service should consider supporting service users to access socially valued recreational, occupational and leisure activities. Menus were reported to be planned on a weekly basis; service users are supported to choose their preferred meals from a selection of pictures of meals and from the food stocks in the home. Any changes to the planned menu were recorded separately. The menu’s showed a balanced and service users enjoyed healthy diet, there was evidence that the main meals were supplemented by the availability of fresh fruit and snacks. The special dietary requirements of service users were recorded in care plans. Records showed that fridge freezer temperatures were recorded daily, the manager reported that staff had received basic food hygiene training. Service users were supported to participate in food preparation. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 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 standard(s) 19,20,21. The personal care and the health needs of service users were recorded and appropriately met, ensuring the well being of service users. The arrangements for the safe administration, storage and recording of medication were good. EVIDENCE: Care records included the personal and health care needs of service users, there was information available to provided staff with clear guidance to meet the identified needs of individuals. Dependency level of service users were described as high, with all service users requiring staff support to address personal care, continence management, communication needs. Two service users were unable to effectively communicate verbally three had limited verbal communication. Input was provided from speech and language services/therapist and most staff had received training in alternative methods of communication such as Makaton, picture and object referencing and symbols. A number of service users were diagnosed with Autism Spectrum Disorders. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 15 In all areas of the home there were pictorial references used to provide service users with information, there was a pictorial complaints procedure; pictures were seen on food cupboards, doors and in bedrooms. An information board in the main hallway included photographs of staff on duty that day, service users individual timetables were located in bedrooms, provided a visual clue and reminder for service users of what was planned for the day. Each of the care records had separately recorded health information including attendance at the GP’s and for other routine health checks. Specialist health input was also evidenced including psychological input, speech therapy and diabetes care. The records of medication administration were appropriately maintained; storage facilities were adequate. A homely remedies list was available. A good practice recommendation was made that the medication file should contain a record of staff signatures. The records contained information regarding the known preferences and wishes of service users in the event of their death. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. The service demonstrated that Adult Protection procedures were in place to safe guard and to protect service users from abuse. The home has a satisfactory complaints system with some evidence that any concerns raised are appropriately addressed. EVIDENCE: Procedures for the protection of service users were in place, the manager confirmed that this training was included in induction of all new staff to the service. The Commission for Social Care Inspection have not received any reports of Vulnerable Adults concerns relating to this service since the last inspection. Complaints procedures were in place, a more user-friendly form of the complaints procedure was provided in the home and in the Service User Guide. Records of complaints indicated that the last complaint received had been resolved satisfactorily. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,30. The service provides a comfortable, homely and safe environment, for the benefit of service users. EVIDENCE: The home located in a residential area of Burton-on-Trent. The home is not suitable for any person with a severe physical disability. The home was clean, warm and tidy. The communal areas of the home included a lounge, a music room and large kitchen. The service appeared to provide a homely environment promoting ordinary living principles. Since the last inspection the carpets on the main stairs have been replaced. During the visit staff were observed repairing curtains in the main lounge, that had been pulled down, there was discussion regarding alternative arrangements to ensure that damage to fittings was minimised. On the lower ground floor the service provide a sensory room and an art and crafts centre, both were well equipped and appeared from observation and from the information provided, to be used regularly.
204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 18 The laundry facilities were inspected and found to be in order. Bedrooms were all for single occupancy and provided on the first, second and third floor; none had en-suite facilities all had suitable furnishing and fittings to meet the individual needs of service users. Adaptations had been made as necessary to ensure service users safety and comfort. All bedrooms were fitted with bedroom door locks that could easily be overridden from the inside, by turning a small handle. Bathrooms and toilets were provided on the first and second floor. To the rear of the property, mature and spacious gardens were being improved by the maintenance team, to provide more accessible and usable space. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,36. Staffing levels were good and staff morale appeared to be high providing an effective care team to assist and support service users to develop. EVIDENCE: Since the last inspection a full staff team have been recruited, providing 4 staff throughout the waking day 7.30am-10pm and two night staff. The manager’s hours were supernumerary on the day of the inspection. 5 staff had achieved NVQ level 3, three other staff were undertaking the training, a number of staff were undergoing induction, that included topics required in Learning Disability services. Each service user is allocated key workers to support them in their every day life. Staff meetings were planned monthly and records of these meetings maintained. The manager reported that mandatory training was up to date, the records showed that a range of training opportunities were available to staff. Staff supervision is planned bi monthly, responsibility for supervision was shared between the manager and the team leaders.
204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 20 The manager was reminded that any recruitment information must be included in staff files, it was understood that some information for one new member of staff remained with the organisations central human resources department. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 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 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) 39,41,42. The health and safety of service users was assured by a well run home. EVIDENCE: The manager reported that she was undertaking NVQ level 4 and the Registered Care Managers Award. A quality assurance had been undertaken by the organisation, the outcomes of the audit were available in the home, the need to produce an annual development plan based upon the findings of the audit was discussed. A sample of service users finances were checked, there was discussion regarding the amounts of cash held on behalf of service user in the home, and also how the service could best manage large amounts of money on behalf of service users. Recommendations included, supporting service user to save money in a bank or building society account, and ensuring that the amounts of cash held on site does not exceed the services insurance limits. It was also
204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 22 suggested that regular audits of service users finances should include check of actual amounts stored on behalf of service users. Fire safety records were appropriately maintained, with weekly fire alarm tests, monthly emergency lighting tests, very regular fire drills and an up to date fire safety risk assessment. Fire training had taken place on the 7th June 2005. Environmental risk assessments had been undertaken, risk areas such as hot surface temperatures of radiators had been addressed. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x 2 x x 4 Standard No 31 32 33 34 35 36 Score x x 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
204 Ashby Road Score x 3 3 3 Standard No 37 38 39 40 41 42 43 Score x x 2 x 2 3 x E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 24 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. 2. 3. 4. 5. 6. Refer to Standard YA20 YA9 YA6 YA41 YA14 YA39 Good Practice Recommendations Include a record of staff signatures and initials in the medication file. Ensure that individual risk assessments provided staff explicit information, to enable them to recognise and minimise the identified risk. The service pre admission assesment record should eretained on the individual care file. Ensure thst service users monies are responsibly managed on behalf, by supporting them to save in a bank or building society account. Give further consideration to supporting individual service users to access integrated leisure, recretational and occupational opportunities. The organisation should produce an annual development plan based upon the outcome of the recent Quality Assurance audit. 204 Ashby Road E51-E09 S4912 204 AshbyRoad V236439 010705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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