CARE HOME ADULTS 18-65
204 Ashby Road, Burton On Trent Staffordshire DE15 0LA Lead Inspector
Ms Wendy Jones Unannounced Inspection 31 January 2006 9:30 204 Ashby Road, DS0000004912.V280152.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 204 Ashby Road, DS0000004912.V280152.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. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 204 Ashby Road, Address Burton On Trent Staffordshire DE15 0LA 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) 01283 536494 Robinia Care Homes (2) Limited Carol Walton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 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, DS0000004912.V280152.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The service provides care and accommodation for up to six service users who have learning disabilities. 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. Care planning was of a good standard with evidence of review. The provider has commented on the draft inspection report, amendments have been made to the report, to reflect changes to timescales. The provider has provided evidence of compliance with requirements What the service does well: What has improved since the last inspection? What they could do better:
Social and recreational opportunities outside of the home must be improved and personal information relating to service users should not be included in a communal record.
204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 6 Protocols for the administration of as-required medication should be agreed with the prescribing doctor. The instructions for administration of medication must be readily available to staff. The service must ensure that the wellbeing of service users is not compromised and act to replace the curtains and flooring in the bedroom identified during this visit. To provide suitable door retainers on fire doors on the lower ground floor and ensure that a hot water supply is provided in the lower ground floor wash hand basin. Staffing levels must be maintained to a level that ensures service users’ social and recreational needs can be met. Confirmation that the percentage of staff trained to NVQ level 2 meets the recommendations and that all staff have received mandatory training. Risk assessments must be followed to ensure that the service users are not placed at unnecessary risk. All staff must be involved in fire drills and fire training and evidence that the fire safety officer has been consulted regarding the changes to the environment must be provided. Financial transactions on behalf of service users should be countersigned. 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, DS0000004912.V280152.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: These standards were not inspected during this visit. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 9 There was a care planning system in place to adequately provide staff with the information they need to meet service users’ needs. EVIDENCE: Care plans were in place to address any assessed need and reviews of plans had taken place. Individual risk assessments had been undertaken to address known risk areas. It was of some concern that in one example, risk assessments were not being followed. The potential hazard to the service user was significant. It was clear that senior staff had recognised there had been an issue and a reminder to staff was recorded in the communication book to this effect. A second service user had a care plan/ risk assessment regarding alcohol consumption. There was evidence that this plan had not been followed and the service user behaviour was affected because the plan had not been followed. The staff communication book was used to remind staff of issues and specific events. Unfortunately the records also included personal details of service
204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 10 user care needs. This was inappropriate documentation and did not reflect the requirements of confidential information handling. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 11 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): 13, 14, 15, 17 The records of service user activity showed that service user involvement in activity outside of the service and their community presence and participation was limited. Dietary needs of service users were catered for with a balanced and varied selection of food available that met service users’ tastes and choices. EVIDENCE: Records showed that service users were supported to maintain contact with relatives and friends, as agreed in care records. The service provided a sensory room and an arts therapy room on the lower ground floor and had a vehicle to provide transport to community based activities. On the day of this visit, two service users had enjoyed a horse riding session. Another service user had remained in bed throughout the inspection. The other service users were engaged in daily routines in the home. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 12 Four examples of activity records for the period 6th – 31st January 2006 were sampled and showed that 1 service user had participated in 3 art therapy sessions, 2 swimming sessions, 3 drives out, 1 day trip, 1 football match, 2 music therapy sessions and 63 other activities recorded, including watching tv, videos, dvds or an activity not recorded. A second service user had 2 outings from the home recorded throughout the same period. A third service user had participated in 2 music therapy sessions, 2 horse riding sessions, 4 drives, 2 shopping trips and 2 sensory sessions. A fourth service user accessed day care services for a number of days per week. The record appeared to indicate that service users were not actively engaged in activities for periods of time and lacked meaningful community presence and participation. Menu records gave a satisfactory account of meal choices available to service users and records complied with basic food hygiene guidance. Service users are supported to choose their preferred meals from a selection of pictures of meals and from the food stocks in the home. The special dietary requirements of service users were recorded in care plans. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 13 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): 20 The medication at this home was generally well managed promoting good health, further work to improve the information available to staff was recommended. EVIDENCE: Medication was stored in suitable locked cupboard; medication records were appropriately maintained. Samples of staff signatures were included in the medication file. Records of medication received into the home and returned to the pharmacy were available, and a medication policy was in place. Matters arising included the need to have a written protocol for the administration of as-required medication and an agreed homely remedy list. It was also recommended that up-to-date information relating to the purpose and effects of medication is available for staff. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 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 the following standard(s): 22, 23 Arrangements for protecting service users were satisfactory, with evidence that appropriate action had been taken to safeguard individuals. Complaints procedures were in place and records showed that action had been taken to resolve any concerns identified. EVIDENCE: Since the last inspection, one Vulnerable Adults Strategy meeting had been convened. There was clear guidance and instruction for staff to follow to ensure the safety and well being of service users. It was understood that this guidance had been provided following discussion in this multi-agency forum. Records confirmed that the Commission for Social Care Inspection had been notified of the issue. One complaint had been received from neighbours regarding loud music during the early hours of the morning over the Christmas period. The records showed that the manager had acted appropriately to address the concerns with the complainant. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 27, 30 The standard of the environment within this home was generally good providing service users with a homely place to live. More work was required to ensure that service users’ bedrooms were suitably furnished. Fire safety and health and hygiene were compromised on the lower ground floor, placing service users at risk. EVIDENCE: This visit did not include a detailed inspection of the environment. The general appearance of the home was of a good standard, and was well maintained and decorated. Matters arising included the need to replace curtains in one service users bedroom to promote dignity and privacy, and repair or replacement of the flooring in that bedroom. The lower ground floor provided an art therapy room, a sensory room, a new laundry and a room that contained a toilet. It was confirmed with staff that service users and staff used this facility. It was disappointing to note that the hot water tap in the wash hand basin did not work at all, and no soap, soap solution or toilet tissue was provided.
204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 16 The laundry room door was propped open with a fire extinguisher - it was removed during this visit. Requirements were made regarding the need to provide more suitable door retainers for this room, and to provide evidence that the service has consulted with the fire safety officer regarding the change of use of the lower ground floor to include the laundry facilities. 204 Ashby Road, DS0000004912.V280152.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, 35 Some staff turnover and sickness disrupted consistency of care to service users and has affected staff morale. EVIDENCE: Staffing: 1x 7.30am-10pm, 1x 7.30am-3pm, 1x 7.30am-10pm. The records showed that the usual staffing numbers were for 3 staff to be on duty throughout the waking day. 2 staff were deployed at night. Following discussion with staff it appeared that staffing levels were of concern. Due to the dependency of service users it was quite difficult to provide leisure and recreational opportunities outside of the home with the current 3 staff per shift. There was discussion about the needs of service users; staff did not know if any 1:1 hours were provided in the staffing numbers, although it was understood that 2 service users required 1:1 staffing when out of the home. A requirement regarding suitable staffing levels was made, and discussion with the operational manager after the inspection determined that a review of staffing levels would be considered. Since the last inspection, 3 staff had left the service and 1 had been suspended; a deputy manager had been recruited but was off sick; this left a total of 12 staff.
204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 18 3 staff had achieved NVQ 3, 4 were working towards NVQ level 3, and 1 care staff had achieved NVQ level 2. The service was asked to confirm the percentage of staff trained to NVQ standard and to provide evidence that mandatory training is up-to-date. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 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 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): 42 The health and safety of service users were compromised due to poor attention to fire safety procedures. EVIDENCE: Fire safety records relating to servicing of equipment, weekly fire alarm tests, emergency lighting checks were appropriately maintained, certificates of inspection were dated 26th January 2005 and 30th November 2005. There were at least five fire evacuations/drills during 2005, and fire training had taken place in June 2005. Information from the records showed that 6 staff had not been involved in a fire drill or evacuation during 2005, and 5 staff had not received fire training. Risk assessments had been undertaken for individual service users - all were dated when they had been implemented but there was no evidence from the information provided that staff had read or reviewed them. The records of service users’ finances showed a running total and details of expenditure including receipts. From the records seen during this visit, it was
204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 20 evident that a number of transactions had not been countersigned by second member of the care team, as indicated in the service’s finance policy. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 x 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 3 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 1 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 1 x LIFESTYLES Standard No Score 11 X 12 X 13 1 14 1 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X X X X 1 x 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 22 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 2 3 4 Standard YA33 YA42 YA42 YA42 Regulation 18 23 23 23 Requirement The registered person must ensure that staffing levels are sufficient at all times. Fire doors must not be wedged open - appropriate door retainers must be provided. All staff must be involved in fire drills and receive fire training. The registered person must provide evidence that the fire officer has been consulted regarding the environmental changes made in the home. The risk assessments for service users must be followed as stated to ensure the safety and well being of service users. Agreed protocols for the administration of as-required medication must be in place. The registered person must ensure that individual service users are supported to engage in more varied activities both in and out of the home. The registered person must provide evidence that staff have received mandatory training. The registered person must provide suitable flooring and
DS0000004912.V280152.R01.S.doc Timescale for action 14/03/06 31/01/06 31/03/06 06/02/06 YA9YA42 5 5 YA20 YA14 7 13 15/02/06 13 16 31/03/06 30/04/06 8 9 YA35 YA25 18 16 10/03/06 31/03/06 204 Ashby Road, Version 5.1 Page 23 curtains in bedrooms. 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. Refer to Standard YA13 YA43 Good Practice Recommendations Up-to-date instruction regarding the purpose and effect of medication prescribed. All financial transactions on behalf of service users should be countersigned at the time the transaction is made. 204 Ashby Road, DS0000004912.V280152.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Stafford Office 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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