CARE HOME ADULTS 18-65
St Georges Road 281 283 285 287 281, 283, 285, & 287 St Georges Road Hull East Yorkshire HU3 3SW Lead Inspector
Christina Bettison Unannounced Inspection 13th September 2005 09:30 St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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 St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Georges Road 281 283 285 287 Address 281, 283, 285, & 287 St Georges Road Hull East Yorkshire HU3 3SW 01482 618096 01482 329337 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) Avocet Trust Position Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To retain one service user over 65 years of age. Date of last inspection 12th October 2004 Brief Description of the Service: The service at 281-287 St Georges Road is managed by Avocet Trust who rent the premises from Sanctuary Housing. It is one of a small number of similar services that Avocet provides. Avocet Trust is a registered charity. 281-287 St Georges Road consists of four separate units registered to provide care for 12 service users. The home is situated just off the Hessle Road shopping area to the west of the city. Two of the units are for 4 service users and two are for 2 service users, all accommodated in single rooms and each house has its own separate garden area. Three houses have a relaxation room and the house without has an additional lounge. Each house also has a communal lounge/dining area, kitchen, laundry and bathroom. One house has an additional bathroom. There are a variety of shops, pubs, GP surgeries and post office all within walking distance. Public transport to various parts of the city is easily accessible and in addition some of the service users have their own car arranged through their mobility benefits. There are parking facilities on-site. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours and was an unannounced inspection. A tour of the premises took place, staff files, care records, policies and procedures, staff lists and training records were all looked at. Two of the staff and the service manager were spoken to. Care practices and interactions were observed during the inspection. What the service does well: What has improved since the last inspection? The home has a new way of getting the opinions of service users and their families about the way the home is run. They hope that this will mean service users have say in how the home achieves its goals in the future. This new way of working is only at the beginning and needs to grow. The home has improved the ways in which they employ new staff. When new staff apply for a job at the home, the company now get references and check
St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 6 with the police that they are safe to work with service users thereby ensuring that service users are protected. The home is working with their landlord to make sure that when things break and need repairing or replacing this gets done quickly. Some bedrooms have been redecorated since the previous 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. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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 St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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: There had been no new service users (who would have had their needs assessed) come to stay at St.Georges Rd since the previous inspection; therefore none of these standards were assessed. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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): 6,7,8,9,10 Service users do not have a service user plan that reflects their full range of needs, choices etc thereby placing them at risk. Without this there is no assurance that their care needs will be met. EVIDENCE: Three service users care files were examined as part of the inspection process, all files contained an individual plan however for one service user this had not been updated to reflect the service users changing needs and there was no evidence of meetings and /or discussions held to agree how staff should meet the changing needs. Reviews were being held annually and the manager was advised that service users needs must be reviewed a minimum of 6 monthly. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 10 Risk assessments were in place for any areas that posed a risk to service users and measures put in place to minimise the risks, e.g. personal safety, access to the kitchen and leisure activities. All service users had a key worker. All service users were enabled to be as independent as possible within their capabilities this was confirmed by talking to staff. Information was observed to be securely kept and handled in accordance with the Data Protection Act. Lockable facilities were used. Staff were observed to knock on doors and to ask service users permissions to enter their bedrooms Where service users display behaviours that can be difficult to manage and specific techniques or methods of communication are required in order to minimise the risks this was found to be documented in the service user plan either in the form of a service user plan or behaviour management strategy. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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): EVIDENCE: None of these standards were assessed at this inspection. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 12 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): 19,20 The service users physical and emotional needs are met, by the provision of a wide range of healthcare professionals and outside agencies, however the inadequate record keeping and inadequate medication training provided to staff compromises this. EVIDENCE: Three service users care files were examined as part of the inspection process. In two of the files there was evidence that contact with GP, dentist, optician, audiologist, chiropody, community nurses and therapists and consultants was being facilitated on a routine basis for service users. The service manager explained to the inspector that one service user had been having some health problems and that the staff had been supporting her to access health provision, there were some decisions to be taken regarding her ongoing health care however there were no records in the care file to support and evidence this and the IPP/care plan had not been updated to reflect her changing needs and support required. The registered person must ensure that adequate records are kept to evidence that service users health is monitored and potential complications and
St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 13 problems are identified and dealt with at an early stage, including prompt referral to an appropriate specialist. The home has policies and procedures for the administration of medication however not all staff have received training for the administration of medication that includes a competency check or a workbook to complete at the end to ensure staff understand their responsibilities. From observations it was apparent that staff promoted service users dignity, privacy and respect. Staff were observed to behave in an appropriate manner towards service users. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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 Service users and/or their representatives are listened to and their views acted on by a wide range of methods. Avocet has a complaints procedure. The staff team are not fully aware of the Protection of Vulnerable Adults policies and procedures and their responsibility within these therefore strategies are not in place to ensure that service users are protected from abuse, neglect and harm EVIDENCE: Avocet had a complaints policy/procedure that included timescales. Minor issues were dealt with in the houses. There are regular parents meetings were issues can be raised and serious issues were taken up by the QA coordinator who responds to these areas of concern and/or complaint. There had been no complaints regarding the service at St Georges Rd since the previous inspection. From discussion with staff it was apparent that they were not fully informed about the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this. There was no evidence that all staff had received any training or briefings. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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): 24,25,26,27,28,29,30 The houses were well decorated and well maintained and the gardens well looked after with seating areas enabling service users to enjoy the outside space. EVIDENCE: 281-287 St Georges Road consists of four separate units registered to provide care for 12 service users. The home is situated just off the Hessle Road shopping area to the west of the city. Houses 285 and 287 are for 4 service users in each house and houses 281 and 283 are for 2 service users in each house, all service users have single rooms that are nicely personalised and each house has its own separate garden area. One of the gardens has recently been upgraded to provide a patio and barbecue area. Three houses have a relaxation room and the house without has an additional lounge. Each house also has a communal lounge/dining area, kitchen, laundry and bathroom. One house has an additional bathroom.
St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 16 The home has a refurbishment plan; in house 287 the bathroom is being retiled, 2 bedrooms have been redecorated since the previous inspection. In house 285 one bedroom has had new flooring and been redecorated and another bedroom was in the process of being redecorated, it is planned to replace the hallway flooring before Christmas. There are a variety of shops, pubs, GP surgeries and post office all within walking distance. The kitchens in all of the houses need refurbishment, however the inspector was informed that Avocet are working with sanctuary housing to ensure this happens within a reasonable timeframe. Public transport to various parts of the city is easily accessible and in addition some of the service users have their own car arranged through their mobility benefits. There are parking facilities on-site. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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): 31,32,34,35,36 Staffing in the home is of concern. There are a number of new staff that have not received appropriate induction, little supervision is taking place, lack of training both mandatory and service specific and all of this leads to service users needs not being adequately met. EVIDENCE: From examination of records, discussion with staff and observation it was evident that staff work to support the written aims and objectives of the home. It was also evident from discussion with staff that they knew how to meet the needs of service users and there was some evidence in care files of the involvement of other agencies with specific expertise. From examination of staff files it was evident that recuitment practices had improved, all staff files examined contained a satisfactory CRB disclosure, copies of application forms and references. One new member of staff interviewed stressed that in their experience Avocet are very good employers, the member of staff had been out of work for some time because of personal circumstances and said that they had been very well supported and that they felt valued within the organisation.
St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 18 However eight new staff had been appointed since the previous inspection, there was no evidence of LDAF induction having been carried out. The registered person must ensure that all new staff receive induction training that meets LDAF standards The manager reported that within Avocet Trust there is a Human Resources section responsible for organising training. The CSCI are aware that Avocet are working towards a solution to ensuring that staff receive appropriate training and that staff are working towards their NVQ level 2. There was some evidence of training and this was linked to the needs of service users, e.g. moving and handling, epilepsy, use of stesolid, basic food hygiene and first aid, however from examination of records and discussion with the manager and staff it was apparent that not all staff were up to date with their mandatory training and although working towards it not all had received appropriate medication training. Staff spoken to were not clear about their responsibilities with regard to the Protection of Vulnerable adults and had not received any training. There are 27 staff at St Georges Rd split up between the four houses, for management purposes there is a full time senior in 2 of the houses, a part time senior in one of the other houses and a “c” grade in the other house. Out of 27 staff only 2 staff have NVQ level 2 and there are 3 registered and working towards it. The registered person must ensure that 50 of staff are qualified to NVQ level 2. The supervision records of three staff were examined as part of the inspection process, these were found to be inadequate, one member of staff had received 3 sessions in 18 months, another member of staff 2 sessions in one year and the other had received one session in October 2004. This is clearly not providing staff with support and direction that they need, this was discussed with staff and the manager and the inspector was informed that there had been some difficulties with staff shift patterns and working hours. The registered person must address these problems and ensure that all staff receive formal recorded supervision at least 6 times per year. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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): 37,39,40,42 Service users are encouraged on an informal basis to contribute to how the home is run. A formal approach has been devised but not yet fully implemented. EVIDENCE: The Service Manager and staff presented themselves as helpful,friendly and approachable throughout the inspection, they had a clear sense of direction and aims for the home, however he home has been without a registered manager for some considerable time and this does not provide ongoing stabilty and development of the home. A manager has been appointed for the home and was visiting the home on the day of inspection. The registered person must ensure that the manager is put forward to be registered by the CSCI. The Service Manager has been covering at the home on a temporary basis.
St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 20 She reported that budgets are set by the provider and she has responsibility for managing a range of budgets e.g. staffing, food, petty cash,and training. There was suitable insurance cover in place. Avocet have developed a quality assurance system however this has not yet been fully implemented within the home, this means that service users and their families views are not yet utilised to help shape the way the service is provided in the future. As part of the inspection the maintenance records were examined and those seen were in order. It was evident throughout the inspection that the service is centred around the service users. The Service Manager supported staff to ensure this was the case. Policies and procedures were examined as part of the inspection process, the CSCI are aware that the QA manager has been working hard to update the policies and procedures some of which dated back to 1995/98. The registered person must ensure that Avocet,s policies and procedures are reviewed and amended in line with changes in legislation and best practice guidance. St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 2 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Georges Road 281 283 285 287 Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 2 x 3 x DS0000000916.V250082.R01.S.doc Version 5.0 Page 22 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 YA6 Regulation 15 Requirement The registered person must ensure that all service users have an individual plan that covers all aspects of personal, social and health needs. The registered person must ensure that individual plans are reviewed at least 6 monthly and amended in light of changing needs. The registered person must ensure that service users health needs are met and that detailed records are kept in respect of this. Service users must be offered annual checks and health action plans must be prepared for service users. The registered person must ensure that all staff responsible for administering medication have received training and have their competency assessed. The registered person must ensure that all staff receive training in the protection of vulnerable adults. The registered person must ensure that at least 50 of staff are qualified to NVQ level 2
DS0000000916.V250082.R01.S.doc Timescale for action 13/09/05 2 YA6 15 13/09/05 3 YA19 13 (1a and b) 13/09/05 4 YA20 18 (ci) 31/12/05 5 YA23 13 (6) 31/12/05 6 YA32 18 31/03/06 St Georges Road 281 283 285 287 Version 5.0 Page 23 7 YA35 18 8 YA35 18 9 10 YA35 YA35 18 18 11 YA36 18 12 13 YA37 YA40 8 24 The registered person must ensure that all staff are up to date with mandatory training and this must include infection control. The registered person must ensure that a training audit is undertaken and a training plan developed for the staff team in the home. The registered person must ensure that all staff have an individual training profile The registered person must ensure that all new staff receive induction training that meets LDAF standards. The registered person must ensure that all staff receive formal supervision at least 6 times per year. The registered person must ensure that the manager of the home is registered with the CSCI The registered person must ensure that Avocets policies and procedures are updated and amended in line with legislation and best practice guidance. 31/12/05 31/12/05 31/12/05 13/09/05 31/03/06 31/12/05 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Georges Road 281 283 285 287 DS0000000916.V250082.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 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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