CARE HOME ADULTS 18-65
King Street, 21a 21A King Street HEREFORD HR4 9BX Lead Inspector
Christina Lavelle Unannounced Inspection 2nd March 2006 02:00 King Street, 21a DS0000066942.V285508.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 King Street, 21a DS0000066942.V285508.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. King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service King Street, 21a Address 21A King Street HEREFORD HR4 9BX 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) 01432 269406 01432 344647 Aspire Living Mrs Elizabeth Linda Watkins Care Home 6 Category(ies) of Learning disability (6) registration, with number of places King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The provider’s proposal for the ongoing management of the service must be discussed and agreed with the Commission within three months of the home’s registration. Any remedial work identified as being necessary by other regulators will be completed within timescales agreed with the Commission and no later than 6 months from the date of registration. An electrical safety inspection will be carried out if the home does not have a current electrical safety installation certificate. Any remedial work indicated will be completed within 6 months or earlier as required to maintain electrical safety in the home. 19th December 2006 Date of last inspection Brief Description of the Service: 21A King Street was first set up as a care home in 1986. Until February this year the service provider was Stonham Housing Association. Aspire Living took over the home’s management at this time and so also became the registered provider. Aspire Living is a voluntary organisation and a registered charity, which now runs ten care homes in Herefordshire. The home provides accommodation with personal care for six adults (men and women) who must be aged less than sixty-five. Service users must need care primarily because of learning disabilities. Most of the current service users have lived at the home for many years and they are a very settled group. The property is a Grade II listed Georgian town house, which has three storeys. It is located right in the centre of the town and so is very convenient for access to the cities shops, services and facilities. It is leased by Aspire and there is a management agreement in place in respect of the upkeep of the premises. Each service user has their own bedroom on the first floor and there is a sitting room and separate dining room on the ground floor. The home has a cellar (also used as a games room), bathrooms and a small, enclosed garden at the rear for everyone to use. The accommodation also has a kitchen, laundry room an office/sleep-in staff room and a separate meeting room on the second floor. King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second routine, statutory inspection for 2005/06. The visit was arranged at short notice so that the home’s new manager could be present to discuss Aspire’s plans to run and develop the service. The inspection was carried out during three hours on a Thursday afternoon in the winter. The following ways were also used to assess the service and facilities provided. Time was spent with several service users who talked about their experience and views of living at the home. Various records relating to service users and their care, staffing and how the home is managed and kept safe were checked. Some areas of the accommodation and information relating to it were viewed. What the service does well: What has improved since the last inspection?
In view of the recent change of service provider it is understandable that the outgoing provider had kept the service running as it was, rather than effecting any changes or developing the service. Therefore, although it would be difficult to identify many particular improvements at this early stage it is very positive that Aspire and the new manager plan to totally review the current service and are putting systems in place, which will improve and develop many aspects of the home. This includes care planning, the accommodation, staff training and supervision, quality assurance and for the overall management of the service.
King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 6 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. King Street, 21a DS0000066942.V285508.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 King Street, 21a DS0000066942.V285508.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 are not assessed as there has not been any new service users admitted to the home for years, and in view of the recent change of provider. However Aspire did submit a suitable statement of purpose for the home as part of their application for registration. This document appropriately sets out the aims, objectives and philosophy for the service. It also gives details of the management and staffing arrangements and facilities provided by the home. The manager also confirmed Aspire provide a Terms & Conditions of Residence statement for service users. Staff had been through this with each service user to ensure they had understood it before agreeing and signing it. It is the manager’s intent to produce this document and a service users’ guide for the home in a format more suitable for people with learning disabilities. The guide has not been prioritised however because there are no vacancies at the home and so it is unlikely information about the home would be needed for prospective service users in the foreseeable future. King Street, 21a DS0000066942.V285508.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): 7&8 Service users are enabled to make choices and decisions in their daily lives and routines and are involved in the day-to-day running of the home. EVIDENCE: Some of these Standards are not fully assessed. However, it was found in the last inspection that each service user had a care plan drawn up, which detailed their needs and the support needed form staff to meet these needs. One service user’s care records were looked at during this inspection. In view of the management changes their plan had not been reviewed and updated for some time. Although daily records are being made by staff, which reflect their current needs and how one particular difficulty in their life was being managed. These records also provide helpful information about their mood, behaviour, health, activities etc and so of their progress. The manager confirmed that all the service users’ plans and risk assessments are to be reviewed and updated. Further, that a more “person centred” approach and care planning format would be introduced. This should help to ensure that service users are fully involved in drawing up their own care plans and that their goals and wishes are included in the plans.
King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 10 Service users are clearly very self-determining and confirmed they choose their daily routines and life styles to a great extent. They also take responsibility for many of the household tasks and cooking. Informal meetings are held weekly with service users when they choose their weekly meals and discuss general issues about the home. The manager plans to arrange a more formal meeting on a regular basis, which will be minuted and increase their participation in how the home is run and developed. King Street, 21a DS0000066942.V285508.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): 12, 13, 14 & 17 Service users are encouraged to lead full, active and interesting lives and have been enabled to integrate within the wider community. Staff ensure service users receive a suitably healthy diet. Meals are part of the social life of the home and service users take responsibility for their provision. EVIDENCE: The manager and service users discussed how service users continued to lead busy lives, in accordance with their interests and wishes. Most of them attend day services, workshops and/or have work placements during weekdays. Those without specific activities spent their time out with friends or in town. They are all able to go out without staff support and enjoy a variety of leisure activities such as social clubs for people with learning disabilities, involvement with the Church and other mainstream activities within the local community. Records of food provided are appropriately kept for the main meal of the day and showed a variety of nutritious meals. Service users help themselves to breakfast and either have lunch out, make themselves snacks or take a packed
King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 12 lunch. The food stocks seen today (and service users) confirmed that plenty of wholesome food is available for them to choose and they eat what they want. Service users are fully involved in the preparation, cooking and clearing up of meals. They choose weekly menus for the main meal, and staff just oversee them cooking. Some help with food shopping, and it is good that all the meat and fresh food/vegetables are freshly purchased locally as needed. Service users discussed how much they enjoy all sitting together with staff for meals. The need for one person’s special diet was fully understand by them and staff. Appropriate food is provided and their intake and health is closely monitored. King Street, 21a DS0000066942.V285508.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): 18, 19 & 20 Appropriate arrangements were in place to meet the personal and health care needs of service users and to manage medicines safely in the home. EVIDENCE: Service users are mostly independent in respect of their personal care and hygiene, although staff assist and give guidance to each person as is needed. It was evident from the last inspection, and was confirmed by the manager, that service users’ health is closely monitored and their good health promoted. Their health care needs were being re-assessed and additional and appropriate input sought from relevant health care professionals, such as for continence management, communication and speech therapy. There were individual procedures in place for service users with specific health issues (i.e. epilepsy and diabetes,) with records kept by staff and service users themselves. Health care appointments for regular check ups are also arranged. In relation to the management of medicines there are policies and procedures available, as well as relevant guidance from the Royal Pharmaceutical Society. Assessments had been carried out for all service users who self medicate and suitable lockable storage is provided for them. Records relating to medicines kept and administered in the home were being maintained appropriately.
King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 14 The manager was not sure about the type of training staff who had continued to work at the home since the change had undertaken in respect of managing medicines. It was confirmed however that Aspire would ensure that they all complete the safe handling of medicines course, as is expected. As all the current service users are relatively young and physically able an assessment of the way the home would handle the ageing, illness and death of service users was not applicable at this time. Although the home would be expected to have procedures in place should a service user develop an illness and also how to deal with the sudden death of a service user. King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: These Standards are not fully assessed. However Aspire provide a suitable written complaints procedure for the service users. There are also policies and procedures in place relating to abuse and the protection of vulnerable adults, including whistle blowing. The manager expressed an intent to arrange a training session for the staff team taken by the Herefordshire Adult Protection co-ordinator. This is good as it will ensure that staff are clear about their responsibility and also know how to refer any suspicion or incidence of abuse or neglect of service users. There have not been any complaints or vulnerable adults concerns raised with the home or the Commission about the service or any of the service users. King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 16 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 & 29 The home provides suitable accommodation for the service users. Appropriate arrangements are in place to maintain the condition and safety of the premises EVIDENCE: 21A King Street is in a convenient place in the middle of Hereford city. Service users appreciate this because of its close proximity to shops and other services and facilities; especially as they are able to go out without staff support and are physically able. So there is no need for any aids, adaptations or equipment Being a townhouse some of the windows look out onto the walls and roofs of other houses and there is a pedestrian walkway right outside the dining room window. Some bedrooms are also smaller than is now specified in the National Minimum Standards and there is limited space for these service users’ personal possessions and furniture. However current service users who are very settled there have accepted these less positive aspects. The size of bedrooms would however have to be taken into consideration and the Commission be consulted before any new service users were admitted to them. The premises have been maintained to a reasonable standard and the house is comfortable and was found to be warm, clean and tidy. As the property is leased there is a management arrangement in place relating to the ongoing
King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 17 maintenance and upgrading of the premises. Most responsibility for this does not actually lie with Aspire and as part of the transfer process a survey was carried out and a programme drawn up for work needed. There is also a work list for ongoing repairs and areas of the home were soon to be redecorated. There were two conditions of registration agreed between the Commission and Aspire in respect of the premises; one involving other regulators. Since then an Environmental Health Officer (EHO) has inspected the home and made some requirements in respect of food hygiene and general health & safety matters. These were discussed with the manager who confirmed some had already been addressed and action was planned to meet those remaining. The provider must ensure therefore that any timescales laid down by the EHO are met and that the Commission are kept informed about this. In relation to the other condition relating to electrical safety, a satisfactory installation certificate was seen and so this condition will be removed in due course. Although infection control was not fully assessed the manager confirmed that the home’s policies and procedures are in need of further development and that training for staff would be arranged. King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 18 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): 33 & 35 Suitable staffing levels are being maintained to meet service user’ needs. The provider is to ensure staff receive the training each needs to help them to meet service users’ needs properly and to keep them and the home safe. This should improve further when a supervision system is in place to support staff. EVIDENCE: Some of these Standards are not fully assessed. However staffing levels and deployment continued as was agreed as sufficient to meet service users’ needs A few of the former staff team had been re-employed by Aspire and two Aspire staff had transferred from other homes. Two more part time support staff are being recruited, because one staff member has a temporary contract and it is considered another person is needed to fully cover the home and staff leave. The manager also intends to allocate more hours just for administration and management. This should further improve the effectiveness of the staff team. A review is to be carried out of staff training so a programme can be drawn up by Aspire to address any shortfalls identified and to update all the mandatory health & safety topics and ensure staff achieve an NVQ qualification in care. There is also currently not a formal supervision and appraisal system in place to monitor the performance and to support the development of individual staff and Aspire’s system is to be implemented by the manager in due course.
King Street, 21a DS0000066942.V285508.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): 39 & 42 It will ensure the service develops as service users wish when a formal Quality Monitoring and Assurance system is implemented in the home. There are appropriate arrangements in place to promote safety in the home and to ensure the protection and welfare of service users. EVIDENCE: Most of these Standards are not fully assessed due to the recent management changes. However the following information was obtained. The new manager (Mrs Liz Watkins) was already a registered manager and has been seconded to manage 21A King Street from another of Aspire’s care homes for six months. Hence the condition of registration made stating the Commission should be informed about (and agree) to the provider’s proposals for the future management of the home within three months of registration. Mrs Watkins is suitably experienced and qualified. She was first registered as a care home manager in October 2002 in respect of a service which also
King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 20 accommodates people with learning disabilities. She has an NVQ 4 qualification in care & management and is an NVQ assessor. She has undertaken all the mandatory health & safety training and attended various training sessions on topics relevant to people with learning disabilities, such as epilepsy and for the positive management of challenging behaviour. The requirement for all care services to operate a formal Quality Assurance & Monitoring system was discussed with the manager. Aspire have implemented an appropriate system in their other care homes, which will be introduced to 21A King Street. This process will involve regular audits of all aspects of the service and obtaining views of the home from service users and relevant other people. This should result in a plan to continually develop/improve the service and result in periodic reports; copies of which must be sent to the Commission and made available to service users and all other interested parties. In respect of the policies and procedures that care homes should have in place to inform their practice, these were all being reviewed by the manager to ensure they are in line with current guidelines and are endorsed by Aspire. It was planned that all staff would have to go through them and sign a checklist to confirm they have done so and have understood and will follow them. Although it was confirmed that all staff had undertaken the mandatory health & safety training topics Aspire will be reviewing their individual training needs to ensure their training is appropriate and necessary “refreshers” are arranged. Regarding health & safety in the home the relevant legislation is available and/or displayed. Aspire plan to implement their own policies and procedures following an audit to be undertaken by their Health & Safety officer. Other evidence showing that safety is promoted in the home are as follows: • COSHH data sheets are available. • Portable Electrical appliance (PAT) tests had been carried out. • Fridge temperatures are now being checked and recorded. • Accident records are available and there is information on RIDDOR. There were also no safety hazards noted during this inspection. King Street, 21a DS0000066942.V285508.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 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 N/A 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 N/A X X 1 X X 3 X King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 YA39 Regulation 24 Requirement The Provider must ensure there is an effective quality assurance and quality monitoring system. Timescale for action 31/07/06 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 YA32 Good Practice Recommendations Staff should achieve an NVQ qualification in care. This recommendation was not reviewed in this inspection and so is carried forward. King Street, 21a DS0000066942.V285508.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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