CARE HOME ADULTS 18-65 34-36 Shaftesbury Road Southsea PO5 3JP Lead Inspector Lorraine Parton Unannounced 29 June 2005 9:00 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. 34-36 Shaftesbury Road Version 1.10 Page 3 SERVICE INFORMATION
Name of service 34-36 Shaftesbury Road Address Southsea PO5 3JR 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) 023 9229 4414 Southern Focus Trust Care Home 13 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia of places 34-36 Shaftesbury Road Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1 - Service users may be accommodated between 18-60 years of age. 2 - One service user over 65 may be accommodated until 1st December 2003. Date of last inspection 20/12/04 Brief Description of the Service: 34-36 Shaftesbury Avenue is a care home registered for thirteen service users within the category of mental health. One service user who has lived at the home for many years is over the age of 60. The home is managed by Southern Focus Trust and currently the home does not have a registered manager. The home provides single room accomodation and on the ground floors are kitchens, two lounges, and staff facilities. To the front of the property is car parking facilities and to the rear is a well maintained garden accessable from the ground floor. 34-36 Shaftesbury Road Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 3 hours and the inspector was assisted throughout the inspection by the homes staff and service users. The inspection assessed 19 of the 43 standards, the other necessary standards will be assessed at the next inspection. Some of the standards assessed involved both the home and 29 Shaftesbury Road, which is a similar service. Both homes share policies and procedures, quality monitoring systems and managing staff so therefore care plans and documentation are similar. The inspector spent most of the inspection obtaining the views of the service users about the service they received. The inspector had the opportunity to speak to some of the homes staff and audit the paper work associated with the care provided by the home. What the service does well:
The home provides twenty four hour cover and staffing levels are based on service user needs. The home accommodates service users with mental health needs and at times service users require the assistance of external agencies and professionals to maintain their health. The home has good links with these professional groups and as such service users have access to these when needed. The home has excellent care plans that evidence service user involvement. Identification of individual needs and aspirations for the future, have been completed for all service users and the home ensures these are met. The home supports service users living at the home to be as independent as possible and individual programmes of living skills have been addressed for each service user. The home has close links with 29 Shaftesbury Road, which is also managed by Southern Focus Trust. 29 Shaftesbury Road provides less staff support and service users living in the home, who are progressing and needing less support. Two service users advised the inspector that they are moving in the near future. The home provides access and support to service users to a range of activities, education and lifestyles of their choice. All service user choices are clearly documented in care plans. The home has supported and encouraged one service user to attend college for the access course to university. The service user stated that they would not have done it without the support of the staff team.
34-36 Shaftesbury Road Version 1.10 Page 6 The homes ethos is that of it is the service users home and as such service users are fully involved in the running of the home as they choose. Service users confirmed that they have good rapports with the homes staff and that the staff are an excellent support network should they require any assistance. What has improved since the last inspection? What they could do better:
The home has completed individual service user confidential questionnaires, about the service they receive. The home employed an advocacy group to obtain this information. On audit of the responses received by the home it was evident that service users are not happy with the service they received, both within the home and from external agencies. Questionnaires were also sent to outside agencies and relatives of service users living at the home. On speaking to service users the inspector was satisfied that service users although voicing these opinions felt safe within the home and were confident in the home to address the matters of concern. The homes staff advised the inspector that the comments received from service users are for discussion and action at the next house meeting. The home is planning a range of training for staff to ensure service user needs are being met and a way forward for the home. The home is required to address the consistent concerns of the service users brought to their attention in the questionnaires. One staff file was found not to contain evidence of a CRB check, although the staff advised the inspector this had been undertaken prior to employment. The home is required to ensure all staff information is available within the home. Service users advised the inspector that they would like access to a computer in the home. On speaking to the homes staff they confirmed that they had requested one, however, Southern Focus Trust had declined. The home is
34-36 Shaftesbury Road Version 1.10 Page 7 recommended to research alternative ways in which service users can access the use of computers. During the inspection it became evident that Southern Focus Trust whilst maintaining a good service for service users, the home does not a have a registered manager. This appears to be due partially to financial issues. The inspector requires a copy of the companies accounts. The home currently does not have a registered manager, this was discussed with Southern Focus Trust who advised the inspector that an advertisement had been placed and they were hoping to employ someone shortly. An agreement has been made that they will submit an application for registration on employment. The home is currently being managed daily by the area manager who knows the home well. 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 by contacting your local CSCI office. 34-36 Shaftesbury 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 34-36 Shaftesbury 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) 1,4,5 Service users are given information about the home. Service users are able to visit the home prior to agreeing to move in. All service users have a contract that clearly displays the terms and conditions of tenancy. EVIDENCE: The inspector had the opportunity to discuss the service users admission into the home. The service user confirmed that they had been able to visit the home prior to agreeing to move in and that they had been provided with information about the home. The service user stated they had been given a copy of the homes service user guide and complaints procedure and that if needed the staff would discuss any areas of the documentation if they were unsure. All service users have a contract of tenancy, which includes terms and conditions. Signed copies of contracts were noted in each service user file seen. Service users spoken to were aware of the contracts and stated that they have a copy, which they keep in their rooms. On speaking to a new service user it was evident that they had been issued with a contract and that staff had discussed the terms and conditions of tenancy.
34-36 Shaftesbury Road Version 1.10 Page 10 34-36 Shaftesbury Road Version 1.10 Page 11 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) 6,7,8,9 All service users have a comprehensive care plan based on an assessment of needs and individual needs and aspirations. Service users make their own decisions about their lifestyles. Risk assessments have been completed, in agreement with service users. EVIDENCE: On the day of the inspection two service users care plans were audited. Service users and staff confirmed that they had been involved in the production of the service user plan. The plan is signed by the service user. The inspector had the opportunity to discuss with the service users about their chosen lifestyles, activities, work and leisure, choices and health and personal care. From these discussions the inspector on audit of the care plan, was able to identify that it reflected the service users views and needs. Care plans were found to be comprehensive and had been developed since the last inspection. Throughout the service user plan it was evident that the plan includes all relevant information and the home had involved relevant health care
34-36 Shaftesbury Road Version 1.10 Page 12 professions to assess any health care needs. This includes general practitioners and the mental health team. One service user plan was audited due to the service user experiencing issues with age. The home could evidence that the service user had been referred to the older persons team for review of placement and that the GP was involved with health related issues. The care plan reflected the changing needs of the service user and additional risk assessments completed for areas relevant to age. All service user plans had been reviewed since the last inspection and any changes or advice from relevant professionals incorporated into the service user plan and guidelines required for managing specific issues. The home had assessed service user risks with regards to participation within the home and for community access and these had been documented and incorporated into service user plans. Staff were seen to be encouraging service users to participate in their home and to make decisions regarding their lifestyles throughout the inspection. 34-36 Shaftesbury Road Version 1.10 Page 13 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) 11,12,13,14,15,16 Service users are able to choose their own lifestyles and friends. Service users access the community when they choose. Staff only support service users when requested. EVIDENCE: The inspector spent the majority of the inspection speaking to service users about their daily lives. It was evident from these discussions that service users choose their daily activities. Service users advised the inspector of the range of activities that they do and this included shopping, cooking, cleaning, going out with friends, watching tv, listening to music, walks, eating out and going to public houses. One service user attends college. Service users confirmed that staff support their choices and when necessary assist them accessing venues or leisure facilities. 34-36 Shaftesbury Road Version 1.10 Page 14 Any restrictions imposed are based on risk assessments and care planning reviews. Service users confirmed that staff support their choices in visitors and will support their decisions to refuse to have contact with family or friends. Service users participate within the home and this includes making the house rules in service user meetings, cooking either with assistance or alone and gardening. Southern Focus Trust provide each service user with a yearly fund which can be used for activities or holidays as service users wish to spend their fund. 34-36 Shaftesbury Road Version 1.10 Page 15 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) 20 Medication procedures are safe. Service users who are able manage their own medication. EVIDENCE: The home has a medication policy, which staff are aware of. The home operates a Nomad system of administration for those service users who are unable to manage their own medication. All staff receive training from the local pharmacist on the safe administration of medication. The home keeps clear records of administration, receipt and disposal of medication. The pharmacist visits the home and undertakes regular checks of the homes medication systems. Some service users manage their own medication and this has been clearly documented in the service user plan and risk assessed by the home. All individuals that self medicate are monitored by the home and this is kept under review should service users be experiencing any difficulties. Service users confirmed that they keep their medication in their rooms and the home has provided them with a lockable unit. 34-36 Shaftesbury 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) 22,23 Service users are aware of the homes complaints procedure. The home has implemented policies and procedures to protect service users. EVIDENCE: The home has a complaints procedure, which service users confirmed they were aware of. Service users confirmed that they could express their concerns to the staff and that they were confident that the staff would address their concerns. The inspector receives telephone calls from some of the service users if they are concerned about the service they receive. This displays to the inspector that some service users are aware of the complaints procedure. One visitor confirmed that they were aware of the homes complaints procedure and that if they had any concerns then they would speak to the homes staff who they found approachable and willing to resolve any issues they have. The home on a monthly basis holds a meeting with service users to discuss any issues they may be experiencing. These meetings are documented and appropriate action taken to resolve any issues raised within the meetings. The homes staff were aware of the adult protection procedures and whistle blowing policies adopted by the home. All staff receive training in adult protection issues. 34-36 Shaftesbury Road Version 1.10 Page 17 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 EVIDENCE: 34-36 Shaftesbury Road Version 1.10 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 Staff are experiencing difficulties in maintaining consistency in approach to care and undertaking their roles following sleep in duties. Staff files did not contain all relevant information for the protection of service users. EVIDENCE: The inspector had the opportunity to speak to several members of staff, who raised concerns about several aspects of the home. This included the employment of several new staff, undertaking sleep in duties and the cleaning of the home. Staff advised that whilst staff were now settling in and were very good they had experienced a unsettled period of time, that did not ensure a consistency of care was carried out. Staff spoken to also advised the inspector that when on sleep in duties they were being disturbed on a regular basis throughout the night and that whilst they expect this they then have to work several hours the following day with a lack of sleep, which they feel could lead to serious mistakes. This was
34-36 Shaftesbury Road Version 1.10 Page 19 discussed with the homes staff. The home is required to review staffing levels at night in line with service user needs. All staff spoken to, and some service users stated they were unhappy with the required cleaning that was needed. Staff confirmed that cleaning the home is part of their role, however, it was felt that whilst they are cleaning this time should be spent on supporting service users. The home provides a cleaner for a short period each week and this has recently changed to less hours. The home is required to review its cleaning staff hours to ensure it can meet the needs of the home and this does not infringe on service user care and support hours. Three staff files, were audited by the inspector and two files were found to include all relevant information. One new staff file did not include confirmation that a CRB and POVA first check had been undertaken by the home. The homes staff confirmed that this had been undertaken by head office prior to employment. The home is required to obtain and ensure all staff files contain the relevant and required information. 34-36 Shaftesbury Road Version 1.10 Page 20 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) 39 The home has sought the views of service users and other stake holders of the home about the service it provides. EVIDENCE: The home has started to implement a quality monitoring system that takes into account the views of the service users and other stakeholders of the home. The home has devised and employed the services of an advocacy service to seek the views of people through the use of a questionnaire. The inspector was able to audit the returned confidential questionnaires from service users, visitors and outside agencies. The home had received a good response. Whilst some service users were happy with the service they received, many of the questionnaires identified serious concerns. This included not being given enough information about the care they receive, not being involved in the home, not being comfortable making a complaint and that they did not feel that they are being listened to. Service users further commented 34-36 Shaftesbury Road Version 1.10 Page 21 that they did not feel supported and did not always have access to care coordinators. On audit of other stakeholders questionnaires it was evident that the general opinion was that there is a lack of consistency within the home. All these matters were discussed with the one of the homes staff, who advised the inspector that these matters are to be discussed at the next staff meeting and that Southern Focus Trust training and development unit is looking at staff training needs and a way forward for the home to act on the concerns raised. The inspector discussed some of the matters raised as part of the inspection, which included making complaints, involvement in the home and awareness about their care plans. Eight service users that were spoken to during the inspection clearly advised the inspector of how to make a complaint and to whom. Service users stated that they are happy talking to the homes staff and were confident that they would be listen to and their concerns addressed. Service users also stated that they would discuss concerns with the mental health team and families if necessary. All service users advised the inspector that they are involved in the running of the home and can attend house meetings if they wish. Some service users stated they would like to be more involved in the home and some stated they were not asked their opinions about the running of the home. The home is required to address the views of the service users and incorporate these into the management of the home. All service users were aware of their care plan and advised the inspector that they sit with their key worker monthly to discuss any changes. Two service users advised the inspector that they do not have a care manager and one service user confirmed that he had not had a review for over a year with a care manager. This was discussed with the homes staff who confirmed that some service users if experiencing issues have to go through a duty social worker. This is unacceptable. The home is required to try to obtain care managers for service users who do not have access to this service. 34-36 Shaftesbury Road Version 1.10 Page 22 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 3 x x 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 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 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x 2 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x 34-36 Shaftesbury Road Version 1.10 Page 23 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. 2. Standard 34 39 Regulation 7,9,19 Schedule 2 35 Requirement Timescale for action 31/9/05 Ensure all the required information is held in staff files and is kept in the home. Ensure the views of service users 31/9/05 regarding the service being provided are addressed and incorporated into the management of the home. Review staffing levels in accordance with service user needs. This must include during the night Provide the CSCI with a copy of the companys accounts. Submit an application for a suitable registered manager. 31/9/05 3. 33 18 4 5 43 37 25(2) 8 31/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations 34-36 Shaftesbury Road Version 1.10 Page 24 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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