CARE HOME ADULTS 18-65
220 Preston Road 220 Preston Road Kingston upon Hull East Yorkshire HU9 5HF Lead Inspector
Simon Morley Unannounced 7 September 2005
th 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. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 220 Preston Road Address 220 Preston Road Kingston upon Hull HU9 5HF 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) 01482 706988 North British Housing Association Ltd Mrs Marjorie Mansfield Care Home 9 Category(ies) of LD Learning Disability (9) registration, with number of places 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: That registration is approved with the condition that a clear CRB disclosure for the Manager is received by the CSCI. Date of last inspection 3rd March 2005 Brief Description of the Service: 220 Preston Road is owned by New Leaf a subsidiary of North British Housing Association and is managed in partnership with Hull City Council. The councils social services department are responsible for the care and providing the care staff. New Leaf own the home, are responsible for its upkeep and provide ancilliary staff. The home is registered to provide care and accomodation for up to 9 adults between the ages of 18-65 who have a learning disability. The home is located to the east of Hull city centre and is purpose built. 220 Preston Road is a 2 storey building divided into 2 main units with a central ‘linked’ area that includes the reception area, office accommodation, the laundry room and the kitchen. Each unit has a lounge and dining room with kitchenette area. One unit has 5 bedrooms and one has 4, and a sleep-in room for staff. All bedrooms are singles. There are a number of bathrooms and toilets on each floor. Two bedrooms are downstairs. There is no chair or passenger lift. There is a car park area to the front and a pleasant garden to the rear and sides. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted for 6 hours and there had been no additional visits since the last inspection. The inspector spoke to the manager, 3 care staff, 3 residents and spent time observing residents and staff interacting. Care records were also examined. What the service does well: What has improved since the last inspection?
The manager and staff reported that morale had improved since the last inspection.
220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 6 The opportunities for residents to have meaningful activities is always being looked at for improvements so that residents can live out their own preferred lifestyle. 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. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.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 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.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, 4 and 5. There are good arrangements in place to make sure that prospective service users wishes and needs are assessed before moving into the home. This is supported by a good range of information about the service, which has been put into different formats to help people understand it. EVIDENCE: There is a good statement of purpose and brochure about the home, which described in detail the detail what the home has to offer. As well as this there is a guide for prospective service users and their relatives/carers, which is both written and presented in pictures to help people’s understanding. The manager reported that there had been no new admissions for quite some time. Two sets of case records were examined and both contained good evidence of assessment of individual needs and wishes. There was one vacancy at the time of inspection. From discussion with the manager it was clear that a full and detailed assessment would be completed for any prospective service user. This would be done in conjunction with other social and health care professionals. Anyone wishing to move in to 220 Preston Road would be supported to do so on a planned basis, starting off with short visits and slowly building these up. This will help them to become familiar with the other residents and staff. It
220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 9 would also give the existing residents an opportunity to express their views about some one new coming to live in their home. This good practice is supported by the home’s policies and procedures. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.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 and 9. There were very good arrangements to make sure that individuals needs are met and residents have plenty of opportunity to make decisions about their lives as far as possible. EVIDENCE: Residents spoken to who had some limited verbal communication said ‘I’m fine…I’m OK…I’m happy.’ Other residents were seen to be able to choose how and where they spent their time in the home. Staff were knowledgeable about their non-verbal communications and responded appropriately. Residents were seen to be comfortable with the staff that were supporting them. Two sets of care records were looked at that were of good quality. Individual plans of care were quite clearly centred on each person’s lifestyle, what is important to them and what actions staff would need to take to support them. These were called ‘Essential Lifestyle Plans’ and it was quite clear that the planning and provision of care for each person was what mattered most. These were reviewed regularly with the people important to each resident and if any part of the plan was not working efforts were made to try and discover why or look at alternatives. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 11 It was clear from observation, discussion and the care records that residents are given plenty of information and opportunity to make choices. ‘Communication Passports’ have been developed for each individual which tell people how that person communicates – verbally and non-verbally and how best to respond to them. This helps staff to support each person to make decisions. Sometimes, for example, when trying a new activity, it may not be obvious how a resident will respond. And there was a good approach to helping people try out new things to promote their independence and decision making whilst considering how best to limit any potential risks. One potential risk to a resident and staff was seen on the day. The manager and senior staff explained that the circumstances were very rare. It was recommended that they consider potential risks in the future, which they agreed to do. Staff also had ‘walky–talkies’ to use should they need to summon support. These were necessary due to the layout of the building. It was noted that care staff did not always carry them around. It was recommended that practice this be reviewed for staff safety in light of one resident’s behaviour management programme. The current manager has also made sure that each person has the opportunity to go on holiday. This is part of the service that is being developed with careful consideration, as some of the residents had not had this opportunity before. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.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, 13 and 15. There were good arrangements for supporting residents to follow their own preferred lifestyles. EVIDENCE: The ‘Essential Lifestyle Plans’ for each resident recorded in detail the preferred lifestyle for each individual and what staff need to do to support them. These included things such as their important relationships with family and friends, what they like to do, wear, eat, drink, health care, daily routines, what to avoid, and how to communicate. These have been used to develop a weekly programme for each individual. This included visits to and from family and friends, rides and walks out, gardening, cooking, going to college, shopping, using local leisure facilities and in-house activities such as games and using the homes sensory room. The manager and staff both reported that residents are supported to do more and more according to their wishes. Care records examined showed that the weekly programmes were followed and if not the reasons why - records showed that this was rare. The manager of the home monitors this. On the day of inspection the programmes were going ahead as planned.
220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 13 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.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 and 20. The arrangements for supporting residents with their personal and health care needs were good. EVIDENCE: Staff were seen to provide dignified care to the residents. The manager reported that anything less would be addressed in staff supervision. The residents were seen to be well dressed and groomed in their own individual style. There is a range of facilities, for example adapted shower rooms and toilets so that personal care can be tailored to each person’s needs. There is good advice for residents and staff, available from a wide range of community health services. Records examined contained good and detailed information from these services about the health care of each resident. The health of each resident is taken very seriously and if staff have any concerns the appropriate professionals are called upon to help out. This is reflected in the health care records that were kept on file. There were good and safe arrangements for the storage and administration of medication. This helps to ensure the good health of the residents. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 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 standard(s) 22 and 23. There were good arrangements to ensure that residents felt listened to and were kept free from harm. EVIDENCE: The person centred approach to care ensures that residents’ views often communicated non-verbally are acknowledged and responded to. This was evident through individual care plans and daily notes. There was also a simple and clear complaints procedure for recording complaints and action taken. The manager reported that there had been no complaints since the last inspection. On the contrary, she showed the inspector some written feedback from residents’ relatives praising the quality of care provided. There were good procedures in place for reporting any suspicions or allegations of abuse so that if necessary the appropriate action to safeguard the residents could be taken. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 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 standard(s) None of these outcomes were assessed on this occasion. EVIDENCE: 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33. There were good staffing levels in the home that met the recommended guidance. EVIDENCE: The number of care hours staff work on the rota met the recommended guidance which says what the staffing levels the home should have. There is always at least one member of care staff on each unit. In addition there is a senior care staff member for support. And the manager works office hours Monday to Friday and every third weekend. The rota is arranged to also provide extra staff on a flexible basis rather than working set shifts. Two more staff provide day care support during the week, which further enhances the care staff levels. Staff reported that at times some of the residents needed 2 staff to support them to have their needs met and when there is only one staff member in each unit there are potential risks. However in these cases the senior carer works in one of the units to cover. It was recommended the manager assess and records any potential risks and keeps this under review. The home also employs kitchen and domestic staff to support the efficient running of the home. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 18 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 and 39. Residents’ benefit from a well run home with good management and can be assured that their views, however communicated will be used to improve the service. EVIDENCE: The manager has achieved the required qualifications and has a vast amount of experience of working with people with a learning disability. She also undertakes other relevant training to help her be competent at her job. It was evident from speaking directly to some staff, reading feedback from relatives and looking at the results of satisfaction surveys that the manager was well liked and respected and the home was well run. The atmosphere in the home was warm, friendly and inviting. The manager has developed with staff a person centred approach to the residents and offers support and assistance to staff whenever asked. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 19 From discussion it was clear that the manager works as part of the team and there is good communication to help achieve a positive and inclusive atmosphere. Views about the service from residents, relatives, staff and other professionals are obtained using satisfaction surveys. For those residents who are unable to complete a satisfaction survey, staff were seen to respond appropriately to their non-verbal communication. Feedback is used to develop the service according to residents wishes. 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 20 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 x 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
220 Preston Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x x x 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 21 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. Refer to Standard 9 9 Good Practice Recommendations A risk assessment should be completed regarding the medication side effects on any residents mobility, when their medication causes them to be signifcantly drousy. If walky-talkies are necessary for staff safety and support then the manager and staff should consider using these again, especially when the use of them is detailed in a residents care programme. The manager should complete a risk assessment about the times there is only one care staff on each unit and keep this under review. 3. 33 220 Preston Road 20050907 220 Preston Road IR J54 v228553 s922 Stage 04.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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