CARE HOME ADULTS 18-65
3, Silverdale Street Kempston Bedfordshire MK42 8BE Lead Inspector
Mr Paul Worthy Unannounced Inspection 9th November 2005 02.40 3, Silverdale Street DS0000014969.V263888.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 3, Silverdale Street DS0000014969.V263888.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. 3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 3, Silverdale Street Address Kempston Bedfordshire MK42 8BE 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) 01234 302432 Royal Mencap (Housing & Support Services) Andrew Charles Reeves-Smith Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places 3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Mr Reeve-Smith must register, for and start work on gaining an NVQ 4 in care and management within six months of the date of this registration. 7th February 2005 Date of last inspection Brief Description of the Service: The service is provided by Mencap and the property owned and maintained except for bedrooms, by Jephson Housing Association. 3 Silverdale Street is an extended Victorian semi-detached house in a residential street in Kempston. On the ground floor there is one bedroom, bathroom and the communal space consisting of a lounge and a kitchen/diner. There is an office/meeting room. Seven further bedrooms are on the first floor. The home is in walking distance of a range of local amenities, including shops, pubs, places of worship, leisure facilities and a park. It is also close to the main bus routes between Kempston and Bedford. 3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 2.40 p.m. It took place over 6 hours. The case tracking approach to inspection was followed in respect of two people living at the home. The inspector looked at records and met with some of those living at the home. Those living at the home and staff were joined while they had their evening meal. The staff member on duty, a student nurse and the manager were also spoken to. There were several opportunities to observe the way those living at the home and the manager and staff interacted. What the service does well: What has improved since the last inspection? What they could do better:
The manager reported that there was ongoing work to improve the service users plans to ensure that they have all the information required to ensure
3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 6 they provide sufficient information as to how an identified need is to be met and linked to this to ensure that the practice of cross referencing to other relevant documents, such as risk assessments and the person centred planning documents, is made more extensive. 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. 3, Silverdale Street DS0000014969.V263888.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 3, Silverdale Street DS0000014969.V263888.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): 2, 3, 4, and 5 The aspirations and needs of those considering moving to the home would be assessed to ensure that they could be met. EVIDENCE: There were records relating to the most recent person to move to the home. These provided evidence that the correct procedures had been followed from the point of referral onwards to ensure that the persons needs could be met. In particular a record had been kept of all contact with the person prior to a final decision for him to move to the home. This person later confirmed that he was satisfied with the way he was introduced to the home and helped to make his decision about moving there. The Social Services Department had provided very good assessment information, which a comprehensive Mencap assessment form complemented. There was an excellent terms and conditions, which used pictures in part make it easier for those living at the home. 3, Silverdale Street DS0000014969.V263888.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 and 10 There were effective arrangements for identifying the needs and aspirations of those living at the home so that they would be helped to live as independently and fully as possible. EVIDENCE: The files contained comprehensive assessment and planning information. In particular those looked at had individual plans (called Person Plans), which were written in a user friendly way and gave a comprehensive picture of their needs and the plans to meet the needs of those living at the home. Person centred planning was being introduced and was playing an important part in involving those living at the home in planning their own lives. There was evidence that those living at the home were being given as much support as possible to live lives that were as full and independent as possible. This was being done in the context of risk assessments and appropriate training, for example in the case of someone who cycles. There was ongoing monthly reviewing of plans by with those living at the home and their key workers. Those living at the home who were spoken to confirmed that they were
3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 10 satisfied with their degree of involvement in planning for their own lives and involvement in decision making as a group through the weekly meetings they have. 3, Silverdale Street DS0000014969.V263888.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): 12, 13, 14, 15, 16 and 17 Those living at the home were provided with the support they needed to maintain appropriate and fulfilling life styles both in and outside the home. EVIDENCE: The assessment and planning information showed that those living at home were being supported to be involved in a wide range of activities, including employment. These provided the opportunity for individual development and access to the community. There were leisure activities including holidays. There was good contact with family and friends and staff supported this. The home was operated in a way that created a group living situation. This was observed to be the case, with those living at the home all sharing in daily domestic activities supported by staff. This was seen to help those living there to maintain as much independence as possible and develop independent living skills. There were weekly meetings of those living at the home, which involved them decisions relating to their daily lives, including meals. There were appropriate arrangements for meals, with staff supporting those living at the home to eat in a healthy way. Those people living at the home who were spoken to were all positive about the support they got in living their lives to the full.
3, Silverdale Street DS0000014969.V263888.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): 18, 19 and 20 The staff were providing appropriate care and support to those living at the home to ensure that they maintained as much independence and good health as possible. EVIDENCE: There was good assessment and planning information relating to care, support and health needs. The personal support and care provided was seen to be appropriate, although it was predominantly support that was required. The assessment and planning information provided detailed and up to date information on the medical needs of those living at the home. There were appropriate arrangements for managing medication, which included details of the medication being taken by each of those living at the home. Some of those living at the home took responsibility for their own medication, on a risk-assessed basis. This allowed for appropriate monitoring by staff. There had been a requirement at the last inspection to ensure that staff were appropriately trained to administer rectal diazepam, if it was possible they would be called upon to do so. In view of the low risk of epileptic seizures that require such emergency intervention in the home because of the effectiveness of medication regimes it had been decided that staff would always call the emergency services rather than administering the diazepam.
3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 13 This solution to the problem had not, however, included as part of the risk assessment the prescribing doctors agreement to these arrangements. 3, Silverdale Street DS0000014969.V263888.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 and 23 There were effective arrangements for dealing with the concerns and complaints of those living at the home and for ensuring that they were protected so that they felt listened to and safe. EVIDENCE: Mencap has good policies and procedures relating to complaints. Those living at the home that were spoken to understood what it was to make a complaint or express a concern and were clear how to do this. They all felt there were appropriate opportunities to do so, particularly through their weekly meetings, and that staff listened to them. There had been one complaint that had been made by a parent to Mencap rather than to the manager. This provided evidence that these arrangements were effective. The complaint was about observed failures in some domestic arrangements in the home. This had resulted in Mencap instigating its own enquiry. The complaint was upheld and new monitoring procedures were put in place to avoid a recurrence. Appropriate procedures were in place to ensure that incidents of abuse would be dealt with effectively and there was evidence that staff were aware of these, and that there was appropriate training. Staff confirmed that physical intervention was not required when working with those living at the home. It was observed throughout the inspection that the manager and staff had very positive and supportive relationships with those living at the home, which was reciprocated, and formed the basis for advising and guiding them in respect of appropriate behaviour, while treating them as adults. 3, Silverdale Street DS0000014969.V263888.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): None EVIDENCE: 3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 16 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): None EVIDENCE: 3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 17 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): None EVIDENCE: 3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 18 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 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
3, Silverdale Street Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x DS0000014969.V263888.R01.S.doc Version 5.0 Page 19 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 20 Regulation 13 Requirement If any service user is prescribed rectal diazepam then there must be appropriately trained staff to administer it or the prescribing doctor must agree in writing that, in the absence of appropriately trained staff, calling the emergency service is acceptable. If there are no appropriately trained staff then the prescribing doctor should arrange for staff to be appropriately trained by a community nurse and overseen by that nurse in respect of the specific individual. Timescale for action 20/12/05 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 3, Silverdale Street DS0000014969.V263888.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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