CARE HOME ADULTS 18-65
21 FAIRFIELD CLOSE Worcester WR4 9TX Lead Inspector
Rachel McGorman Unannounced 22 July 2005 - 10:00 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. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 21 Fairfield Close Address Worcester WR4 9TX 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) 01905 616527 New Era Housing Association Limited Mrs Jeannette Mary McAllister CRH 5 Learning Disability 5 Category(ies) of LD registration, with number of places 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The following conditions of registration apply in addition to those detailed on the previous page: The home may also accommodate a maximum of two named people over 65 years of age with a learning disability. The home may also accommodate one named person under 65 years of age with an additional physical disability. The home may also accommodate one named person over 65 years of age with an additional physical disability. Date of last inspection 25 November 2004 Brief Description of the Service: 21, Fairfield Close is registered to provide residential care for up to five adults who experience a learning disability, who may have a physical disability, and whose needs are diverse. The premises is a large, detached bungalow, situated in a residential area on the outskirts of Worcester, approximately a mile from the City of Worcester, with easy access to public transport and a range of amenities and facilities. The home is owned and run by the New Era Housing Association Ltd., and is part of The New Dimensions Group, which, as the parent Company, provides strategic direction and a range of functional support services. The stated purpose of the organisation is, to work with people with learning difficulties, supporting them to make choices and to exercise control over their lives, and the main aim of the home is, to deliver a person-centred response to the needs and aspirations of the people we support. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this routine unannounced inspection was to follow up previous requirements and recommendations, and to monitor the care provision at 21, Fairfield Close, Worcester, in relation to the stated aims and objectives of the home. The inspection took approximately 3 hours, when some time was spent with service users, and also talking with staff, and a very favourable impression was gained about what it is like to work at 21, Fairfield Close. A tour of the building, which included the garden, was also undertaken. The care records of service users were inspected, and detailed discussions held with the manager and staff about the content, as service users were unable to communicate verbally. The records kept in respect of the maintenance of equipment, and safe working practices were also seen. What the service does well:
The organisational skills of the management are excellent, as evidenced in the comprehensive documentation maintained at the home. Good lines of communication ensure that everyone has the relevant information to enable appropriate decisions to be made. The initial impression gained is that the home is well maintained and cared for, and that it is comfortable and secure. The needs of service users are anticipated, and responded to appropriately. The individuality of each service user is recognised and the commitment of staff to their role in supporting and enabling service users is commendable. The detailed information available to service users is produced in an appropriate format. Health Action Plans have been developed for each service user, which are detailed and informative, and ensure a full understanding of their healthcare needs. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 6 What has improved since the last inspection? 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. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 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 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 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 Appropriate documentation is in place to enable prospective service users to make an informed decision about their future care needs. The admissions procedure is followed in detail, and all proposed admissions to the home are planned very thoroughly, over several weeks, to ensure an appropriate decision is made, both by the home and the service user. EVIDENCE: A Statement of Purpose has been produced, which together with the Service Users Guide, provides detailed information for residents and their families, on which to base decisions about their future care needs. The documentation is produced in an appropriate format if needed, and the Service Users Guide contains numerous photographs.
21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 9 The admission procedure includes extensive assessment by staff from the home, and a Community Care Assessment is undertaken by a social worker. A gradual introduction is made to the home following the initial referral, and a place is only offered if it seems likely that a suitable service can be provided for the prospective service user. Admission is agreed on a trial basis initially. There have been no recent admissions to the home, although consideration is being given currently to the possibility of a prospective service user being admitted in the near future. The positive interactions observed during the course of the inspection between staff and service users, confirmed that staff were competent in the delivery of appropriate care, and were able to meet the differing needs of service users, who also have limited verbal communication skills. A statement of the terms and conditions of residence is provided for each service user. The details of these documents are discussed with each individual, and their family, or representative, and a contract is provided for each service user by the placing authority. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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) 6,7,8,9 & 10 The service users plan of care is based on the initial assessment, which clearly identifies their assessed needs, and how these will be met. Service users living at the home are supported in making choices in all areas of their lives. Risk management strategies enable a responsible approach to the risks associated with the various activities of daily living. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 11 EVIDENCE: An individual plan of care was produced for each service user, based on the initial assessment undertaken during the admission process. The plans seen are very comprehensive, detailing the specific needs of service users and how these are to be met. A key-worker is assigned to each service user, and has responsibility for ensuring that appropriate care is provided. On-going assessment is undertaken, changes are monitored over a period of time, and amendments made when necessary. The needs and individual preferences of every service user living at 21, Fairfield Close, are identified as far as possible, and their participation in the daily life of the home, is constantly encouraged. A Person Centred Approach is part of the philosophy of the care provision in homes run by New Era, and in addition it is the policy of the Organisation to consult service users on policy development and review. Risk assessments are completed, in relation to the premises, to the activities undertaken, and any restrictions imposed, and also in respect of every aspect of the life of each service user. A Confidentiality Code has been produced by the Organisation, which is clearly understood by staff, and reassures service users that information about them is handled appropriately. Training is also given to all staff. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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) 11,12,13,14 & 15 The opportunities made available to service users enable them to live as fulfilling a life as possible. Service users are involved in the daily arrangements at the home, as appropriate, and are the focus of the delivery of the high standard of person centred care that is provided. The involvement of each individual in planning their activities, both within and outside the home, means that they are able to choose what they wish to do, and that everything revolves around them. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 13 EVIDENCE: Service users living at the home are encouraged to follow an ‘ordinary’ life style as far as possible, by using the same facilities as other members of the community, and being involved in a range of leisure activities. Arrangements for holidays are made, as appropriate, and service users wishes not to go away on holiday, if this is their choice, are also considered. Links with family and friends are promoted, with a high degree of support provided by staff, to both the family, and to the service user. Limited communication skills preclude involvement in paid employment or educational opportunities, although one service user regularly attends a local cookery session, and another is involved with a choir, with the support of staff. Social activities are available, and these may be undertaken in-house or in the community, and they may be group or individual arrangements, but they are varied and flexible, and reflect the preferences of each service user. On the day of the inspection there was great excitement as three service users were preparing to go to a lunchtime BBQ. The opportunities made available to service users enable them to live as fulfilling a life as possible. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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) 18,19,20 &21 Support is provided to each service user, and encouragement given to promote independence as far as possible, in meeting the personal care needs of each individual. Advice and guidance is available from the primary healthcare teams, and associated specialists, to ensure that the health needs of service users are fully understood, and that appropriate responses are made. Arrangements for the safe administration of medication are in place at the home. Procedures are in place for managing the ageing process and possible illness and death of service users, to ensure that their dignity is maintained and their wishes respected. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 15 EVIDENCE: The personal and healthcare needs of service users are well documented, and there is evidence to show how staff understand and respond to them in an appropriate way. Personal care is provided in the privacy of the service users room or bathroom, as appropriate. The healthcare of service users is closely monitored, and additional specialist support and advice is sought from the primary health care team, and other health professionals, when necessary. Health Action Plans have been implemented for all service users living at the home. Medication arrangements are satisfactory, although the use of Tippex on the Medication Administration Records should be discouraged. Risk assessment is in place for the use of an oxygen cylinder by one service user. The issues relating to the ageing, illness and death of a service user, have been addressed by the management and staff at the home, following a fairly recent bereavement. Appropriate support was provided to service users and staff, during the deterioration and subsequent death of an older service user who was living at the home. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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 A satisfactory complaints procedure is followed at the home, and all interested parties are encouraged to express their views and opinions, which are taken seriously by staff, and responded to appropriately. The awareness of the management, together with the training provided for staff, ensures the protection of service users from all forms of abuse. EVIDENCE: A clear procedure for the investigation of complaints has been produced and any issues are dealt with immediately. The document has been produced in a format that is understandable to service users. Discussions have been held with service users and their families regarding the process, and all complaints are recorded. Since the last inspection, the records at the home indicate that 2 complaints have been made, which were dealt with appropriately. Several compliments have also been received. Staff are able to demonstrate a clear understanding of the issues relating to abuse, and also to their individual role as an advocate for service users. An appropriate procedure is in place relating to the many aspects of abuse and the protection of vulnerable adults. Training for all staff on the Protection of Vulnerable Adults (POVA) has been provided. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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) 24,25,27,28 & 30 The premises are very suitable for their purpose. They are comfortable and clean, and ensure as far as possible that the safety and wellbeing of service users is promoted. The standard of the accommodation is excellent. The décor and furnishings are in good condition, and provide service users with an attractive and homely place to live. The location of the house is convenient to local services and facilities, and the layout provides adequate communal space for the needs of service users. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 18 EVIDENCE: The premises at 21 Fairfield Close is a large detached, purpose built bungalow, which is maintained to a satisfactory standard, and is suitable for its purpose. The communal areas of the home are spacious and airy, nicely decorated and comfortably furnished. Sensory equipment is provided for the benefit of service users. There are two lounges, one with a door to enable access to the patio, and a kitchen/diner. There are five single occupancy bedrooms for service users, although only four are in use at the present time. Bedroom doors are fitted with locks that meet the agreed specification, i.e. they unlock with a single action. The rooms are furnished to reflect the personality of their occupants, and some have sensory equipment, specific to the needs of the individual service user. Adequate toilet and bathing facilities are available. There are three toilets, a large bathroom and a separate shower room. Appropriate aids and adaptations are provided for the use of service users. The home is clean and free from offensive odours. Procedures are in place in regard to the control of infection, and staff are trained in health and safety matters. There were no outstanding requirements following the last visit of the Environmental Health officer, approximately 3 months ago. The home has not received a recent visit from the Fire Safety Officer. The Fire Log Book was seen, and the appropriate checks have been undertaken with the required frequency. The gardens to the rear of the property are in need of extensive work, and professional advice should be sought with a view to making them accessible to service users, although this may not be possible, in which case they should be landscaped to provide an acceptable outlook. A small patio provides the opportunity for service users to spend time outside if this is their wish. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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) 31,32,33,35 & 36 The management support and supervision given to staff, enables a clear understanding of their roles and responsibilities, and ensures the promotion of the aims and objectives of the home. The home has an experienced and competent team of staff, who are able to ensure that the needs of service users living at the home can be effectively met. The extensive training programme available to staff ensures that they are competent in their work, and therefore able to provide appropriate care and support to service users. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 20 EVIDENCE: New Era provides relevant information for staff on joining the organisation, and also keeps them updated on new developments and any changes that take place. Each member of staff is given a Welcome Pack that contains details about the organisation, and its aims and objectives, an Employee Handbook that provides information about terms and conditions of employment and policies and procedures, and an Induction Checklist covering the first three months of employment. A training programme is in place at the home that includes Induction and Foundation training, the Learning Disability Award Framework (LDAF) accredited training, and the NVQ training. The training needs of staff are regularly reviewed, and care related courses are attended. A training record is maintained in respect of each member of staff. The rotas indicate that staffing is being maintained at a satisfactory level, and this enables many planned activities to be undertaken with service users. There have been some staff changes in recent months, and this has necessitated the use of agency staff, although they are usually known to the home and the service users, which provides some continuity of care. Supervision sessions are organised on a regular basis, approximately every 6 weeks, and an annual appraisal is undertaken with each member of staff. Staff meetings are held on a regular basis, usually every month. All staff are provided with the General Social Care Council’s Code of Conduct Practice. Comments from staff were all very positive about their experiences of working at the home, and also of being employed by New Era, and this will inevitably be of benefit to service users. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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) 37,38,39,42 & 43 The management arrangements at 21 Fairfield Close are satisfactory, and staff and service users benefit from the positive leadership, and the person centred approach to the care they receive. The health, safety and welfare of service users is promoted and protected in respect of all safe working practices. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 22 EVIDENCE: The Care Manager, Ms Jeanette McAllister has achieved the Registered Managers Award and the NVQ Level 4 qualification. She is also a NVQ Assessor. In addition she attends various care related training courses and ensures she is kept informed of the various developments relating to the care of people with a learning disability. The manager has many years experience working with this client group and has good communication skills, and a clear understanding of her role and responsibilities. The positive interactions observed between staff and service users were pleasing to observe. There is evidence of effective person centered care being delivered, and the home is being managed in an open and transparent manner. An annual development plan has been produced which involves the whole home. The team has identified where they are at, where they would want to be in 12months time, who they will need to help them to get there, the building bricks and the strengths needed, the first steps and who will do what, reviews of achievements will take place every 3 months, and the outcomes will be measured. A comprehensive health and safety policy has been produced and staff are trained in safe working practices. The care manager has a working knowledge of the relevant legislation and appropriate risk assessments are undertaken. Notifications are made to the Commission under Regulation 37, when necessary. A Business Plan is produced by the Organisation, which considers proposals for the next 5 years, and covers all aspects of the work of the New Dimensions Group. A copy of the Plan has been produced specifically for service users. Appropriate insurance cover is in place in respect of the business and the property. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.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 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 x 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
21 FAIRFIELD CLOSE Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 3 E52 S18652 (21) Fairfield Close V236710 220705.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 There are no requirements following this inspection 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 24 Good Practice Recommendations Urgent consideration should be given to the further development of the gardens in order to improve this facility for service users. 21 FAIRFIELD CLOSE E52 S18652 (21) Fairfield Close V236710 220705.doc Version 1.40 Page 25 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7W National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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