CARE HOME ADULTS 18-65 30 Lower St Helens Road 30 Lower St Helens Road Hedge End Hampshire SO30 0LX
Lead Inspector Pat Hibberd Unannounced 5th April 2005 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. 30 Lower St Helens Road Version 1.10 Page 3 SERVICE INFORMATION
Name of service 30 Lower St Helens Road Address 30 Lower St Helens Road 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) 01489 787449 ILIACE Limited Mrs Sharon Walton CRH 4 Category(ies) of LD, 4 registration, with number of places 30 Lower St Helens Road Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th November 2004 Brief Description of the Service: The Home is one of a number of Homes owned by Iliace, a private organisation whose Head office is located in Alton, Hampshire. The Home opened in May 2004 and provides care and accommodation for four Service Users with a learning disability. The Home is a four bedded detached property situated within the village of Hedge End. There is a garden to the front and rear of the house which is secured by fencing and a gate. The Home has their own transport. All Service Users having their own bedroom . There is a large kitchen and a lounge /diner . If able Service Users can walk into the village of Hedge End which has a variety of shops . The city of Southampton with its range of shops/leisure facilities is only a short car journey away. 30 Lower St Helens Road Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours and was the first unannounced inspection of the 2005/2006 inspection programme. Fifteen of the forty three Standards relating to Younger Adults were assessed on this occasion. Seven areas of improvement were identified and required to be addressed by the manager. Details can be found at the end of this report. The inspection included a tour of the Home; including two residents bedrooms and the garden. Discussions were held with two residents, the two staff members on duty and the Home’s manager. Three resident’s files were viewed and care provided by the Home assessed and discussed with both the manager and staff. Throughout the report reference will be made to “residents” as, following discussions held on the day of inspection this was the term favoured and requested to be used by the two residents spoken to. What the service does well: What has improved since the last inspection? 30 Lower St Helens Road Version 1.10 Page 6 There were a number of areas identified at the last inspection that required improvement. These included medication administration, completion of risk assessments for residents ,health and safety and staff training. Staff have undertaken a range of training since the last inspection.Staff spoken to confirmed that they enjoyed the training and felt that it helped them in their support of residents. Medication records have improved and all were up to date. The manager is ensuring residents needs are discussed with health professionals although there are still areas requiring improvement . The manager has improved the health and safety of residents in the Home . One example being fire evacuation risk assessments completed for all residents. Residents spoken to had some understanding as to what to do in the event of a fire “I would get out of the house with staff”. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or
30 Lower St Helens Road Version 1.10 Page 7 by contacting your local CSCI office. 30 Lower St Helens Road Version 1.10 Page 8 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 30 Lower St Helens Road Version 1.10 Page 9 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) No Standards were assessed on this occasion. EVIDENCE: 30 Lower St Helens Road Version 1.10 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 and 9 The arrangements for care planning are not consistent for all residents to ensure their care needs are met and they are not placed at risk. EVIDENCE: Two residents were able to describe the care provided by staff which was consistent with their care plans viewed which detailed assessed needs and action required to meet those needs . However, at the last inspection a requirement was made in relation to care plans/risk assessments being completed and kept up to date. Whilst the Home has made some progress in this area when inspecting one resident’s file it was evident that it was not up to date. A review had not been undertaken but the manager indicated this was due to take place in the following week. Aspects of their health, personal and social care needs were not fully documented including guidance for staff in terms of the resident’s support needs . It was further evident that an assessment by a suitably trained professional has not taken place in relation to adaptations required to enable residents who have mobility difficulities to independently/safely access the garden.Currently residents are relying on staff to assist them.One resident advised that they consider this to be unsatisfactory .
30 Lower St Helens Road Version 1.10 Page 11 Six significant events involving physical attacks between two residents had not been risk assessed or reported to the Commission. Discussions with the manager and staff confirmed that they are experiencing difficulty supporting residents when the incidents occur of which a further eighteen have taken place with staff being targeted. In discussion with staff they were aware of the risks but had only received verbal guidance from the manager. Written guidance for staff in relation to how they manage the behaviour had not been recorded or risk assessed. This approach is dependent on good communication and staff memory. Should this approach break down residents and staff are placed at further risk in respect of the situation previously described. Written guidelines must be completed by the manager alongside other relevant professionals if relevant, shared with staff and regularly reviewed . 30 Lower St Helens Road Version 1.10 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 17. Social activities are actively promoted based on residents interests . Menus were seen to be well balanced, creative and offering choice. EVIDENCE: Two residents were spoken to who described their interests and daily programmes which were produced in both a written and pictorial format. Both residents were going out during the morning and were aware of who was supporting them and where they were going. They were further able to confirm that they had choices in what they did and who supported them. Care plans were reflective of the activities arranged and the discussions held with residents. The Home has a communications coordinator who is responsible for all aspects of communication in the Home. The Organisation also have their own designated personnel who assess and provide an individual daily programme for all residents. However, to ensure needs can be met staffing must be reassessed in the Home to enable all residents to pursue their daily routines when there are specific incidents as previously described. With only two staff on duty during the day the manager confirmed that at times she had to cover duties to enable staff to
30 Lower St Helens Road Version 1.10 Page 13 support residents in their community activites. If cover is not provided activities have been cancelled on occasions. Residents spoken to commented on how much they enjoyed the food in the Home. All take part in purchasing the food from the local supermarket and in the preparation and cooking of meals. Menus were seen to be well balanced, offering three meals a day with meal arrangements flexible to accommodate the varied daily programme of residents. Dieticians are involved in residents care as required. 30 Lower St Helens Road Version 1.10 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) 19 and 20 There Home has clear practices to ensure the physical and health needs of residents are being met. There are systems in place for the safe administration of medication. EVIDENCE: Residents spoken to knew they had a GP and that they could have support from staff to attend appointments at the surgery. One resident has regular hospital appointments and in discussion with staff it was evident that there were clear guidelines in relation to the support required during those visits. The guidelines were documented in the resident’s care plan. Details in care plans viewed confirmed that residents have access to health professionals as required. Since the last inspection medication training has taken place for all staff . Medication administration records were up to date and reflective of information held in care plans. The practice of administering unprescribed medication is no longer taking place. There are no residents who self medicate. Support from the learning disability health team has been sought for one resident who is exhibiting behaviour which is placing themselves/residents and staff at risk.
30 Lower St Helens Road Version 1.10 Page 15 However, as detailed earlier in the report care plans must be up dated and clear guidelines produced for all staff which are regularly reviewed. 30 Lower St Helens Road Version 1.10 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The complaints policy and procedure is not accessible or in a suitable format for all residents accommodated. Arrangements for protecting residents are not satisfactory placing them at possible risk of harm. EVIDENCE: The Home has a detailed complaints policy and procedure which is held in the office. Residents spoken to advised that they would talk to the staff or Home’s manager if they were unhappy but did not know who else they could talk to. Residents did not have a copy of the procedure. The Home has not produced a complaints policy and procedure in a pictorial format despite all but one resident being unable to read. There had been no complaints made since the last inspection. Incident forms viewed confirmed that there have been twenty four incidents of physical assaults in the Home since the last inspection six of which involved assaults between two residents. The Commission have not received notification of the assaults and no discussion has taken place with Social Services under the Protection Of Vulnerable Adults policy and procedure. Both the manager and one staff member advised that managing the risks between the two residents was at times difficult and, that more staff were needed to ensure the safety of residents. The manager advised that additional staffing had been requested but this request had not been met by the Organisation. All staff have received adult protection training. In discussion with one staff member it was evident that they were aware of the need to report incidents
30 Lower St Helens Road Version 1.10 Page 17 and confirmed that incidents between the two residents as previously described were reported to the manager. Further training includes “SKIP” (restraint ) training although the manager advised that no incidents of restraint have taken place since the last inspection. Residents money is securely held in the office . Residents confirmed that they have access to their money at all times. Records viewed confirmed that systems in place are satisfactory. The Organisations Finance Manager undertakes an audit of all monies six monthly. 30 Lower St Helens Road Version 1.10 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 29 and 30. Residents live in a homely environment which is clean and hygienic. Measures need to be taken to ensure the safety of residents. EVIDENCE: The Home was clean, bright and hygienic with policies and procedures and systems in place including infection control /Control of hazardous substances ( COSHH )/food hygiene and moving and handling training for staff . The Home is well decorated with residents confirming that they are involved in the choice of décor in the communal areas and their individual bedrooms. Two bedrooms were viewed which were well furnished, had adequate storage facilities and residents personal affects. All bedroom doors are lockable but there are currently no residents who hold their own key because of their particular needs. This is documented in care plans with the manager confirming that there are plans for one resident to have a key once risk assessments have been completed. Routine maintenance is undertaken by the Organisation’s maintenance team. Since the last inspection risk assessments have been undertaken of residents use of the kitchen facilities .
30 Lower St Helens Road Version 1.10 Page 19 Infection control guidelines are in place for all staff. An occupational therapist has undertaken an assessment and produced guidelines for the use of bed rails and a bath seat as required for two residents. Hot water temperatures are monitored and adaptions made to the showers in the Home to ensure residents safety. Residents who have mobility difficulities have use of a wheelchair enabling them to access the community with staff support. However,they cannot access the garden independently due to there being insufficient adaptions made to ensure their safe access. Currently residents are relying on staff to assist them.One resident advised that they consider this to be unsatisfactory . One resident enjoys looking out of their bedroom window which has a radiator immediately below. An assessment has been undertaken which highlights a risk from the radiator when hot but the radiator remains uncovered. This must be covered to eliminate the risk . 30 Lower St Helens Road Version 1.10 Page 20 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) 33,35 and 36. The Home benefits from a well trained and supervised staff team to support their residents. Staff levels are not sufficient to meet the current needs of residents accommodated. EVIDENCE: The Home has a rota which clearly indicates staff on duty. There are always two staff on duty during the day and one waking staff member at night. Since the last inspection staff have received a range of training including food hygiene, infection control, moving and handling and autism. All undertake a thorough induction which is currently being refreshed utilising the Learning disability Award framework. Staff advised that they feel that the training meets their current needs and can ask for any additional training as identified with their manager. The Organisation has their own Training Manager who organises all training of which staff attend as a minimum of three weekly. One staff member advised that they receive supervision informally on a daily basis with formal supervision taking place at least two monthly and appraisals yearly. Staff felt well supported by the manager and advised that they would not change anything about their daily practice other than the recruitment of an
30 Lower St Helens Road Version 1.10 Page 21 additional staff member for one resident who challenges the service which can result in other residents activities being compromised or cancelled. However, as previously detailed staffing must be reassessed and sufficient staff on duty to ensure not only the safety of residents but, to prevent activities being cancelled . Agency staff are used in the Home with the manager confirming that they would be familiar with the Home and residents. 30 Lower St Helens Road Version 1.10 Page 22 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) No Standards were assessed on this occasion. EVIDENCE: 30 Lower St Helens Road Version 1.10 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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
ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score x x 2 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x 30 Lower St Helens Road Version 1.10 Page 24 yes Are there any outstanding requirements from the last inspection? 30 Lower St Helens Road Version 1.10 Page 25 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 6 Regulation 15 Requirement The Registered Providers must ensure Service User plans are sufficient in detail to provide clear guidance to staff on the actions to meet their health and welfare needs.Service User plans must be kept under review. The Registered Providers must ensure the Commission are notified of any event in the Home which adversely affects the well-being or safety of any Service User.(Previous timescale of 22/11/2004 not met). The Registered Providers must produce a complaints procedure in a format suitable for the Service Users accommodated. The Registered Providers must ensure Service Users are protected from abuse and , that consultation takes place with Social Services under the POVA policy and procedures following an incident of abuse. The Registered Providers must ensure an assessment of Service Users with mobility difficulties accessing the garden is undertaken by a suitably trained professional. Any adaptions identified must be addressed . The Registered Providers must ensure a radiator cover is fitted in the bedroom of one Service User who has been identified as being at risk of burn. The Registered Providers must there are sufficient staff1.10 duty Version on at at all times to meet the needs of Service Users accommodated. Timescale for action 19/4/2005 2. 23 37 5/4/2005 3. 22 22 26/4/2005 4. 23 12 5/4/2005 5. 24 23 5/5/2005 6. 24 23 26/4/2005 7. 33 18 12/4/2005
Page 26 30 Lower St Helens Road 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 30 Lower St Helens Road Version 1.10 Page 27 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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