Inspection on 07/03/07 for 4 The Grove

This inspection was carried out on 7th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 The Grove 30/01/09

4 The Grove 25/10/05

4 The Grove 10/05/05

4 The Grove 23/11/04

4 The Grove 29/04/04

4 The Grove 02/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 4 The Grove Westoning Bedfordshire MK45 5JW Lead Inspector Don Traylen Unannounced Inspection 7 March 2007 10:30 th 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 The Grove Address Westoning Bedfordshire MK45 5JW 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) 01525 718025 www.macintyrecharity.org MacIntyre Care Margaret Banks Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2005 Brief Description of the Service: 4 The Grove is a purpose-built two storey home providing comfortable and accommodation to six service users with learning disabilities. The registered service provider is MacIntyre Care. The first floor of the home consists of service users bedrooms and two bathrooms with toilets. The ground floor had a staff room with en-suite facilities. There is a snoezelem, kitchen, dining room, lounge, and laundry all on the ground floor. The home is located in an enclosed courtyard with two other purpose-built homes belonging to MacIntyre Care. Parking for visitors’ cars and the homes mini-bus is within the courtyard. At the rear of the house there is an enclosed garden with a patio area. The home is in walking distance of the village shops and pubs. The service is commissioned by Local Authorities to provide care to service users with autistic spectrum disorders. Service users’ needs indicate high staffing ratios are needed and at specific times to reduce risks. At the time of inspection the fees charged by the home for the six service users living at the home ranged from £54,245 to £60,719 per year per service user. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted on 7th March starting at 10.30. The registered manager was present throughout the site visit that was conducted by one inspector. The inspection lasted 5 hours and consisted of a tour of the premises. 5 service users and four care staff met and spoke to the inspector. Service users were observed interacting with staff. One service user was present in the home for most of the inspection. What the service does well: What has improved since the last inspection? The home has continued to provide good quality care. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5, Quality in this outcome area is good. The service ensures prospective service user needs can be met by implementing a thorough admissions process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The same six service users were living at the home since the last inspection in October 2005. The homes Statement of Purpose gave an accurate representation of the service. Learning Disability Partnerships, of different counties, have carried out comprehensive assessments for each of the service users they have commissioned care for who live at the home. The range of fees they are paying for service users care is between £54,245 and £60,719 per year. The contracts that were read were of two types; those agreed between Local Authorities and MacIntyre Care and a ‘Service User Agreement’, made between MacIntyre Care and each individual service user. MacIntyre Care signed the agreements, but no representative had signed on behalf of service users and no reference was made to their capacity to sign and understand these agreements. The service users’ agreements indicate money is paid from DWP to MacIntyre to support service users and that this will pay for, amongst other things, the costs of the ‘house vehicle’. The costs of the vehicle 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 9 are shown on a separate form for each service user as an additional payment and were quoted as £86.60 per month (although the actual recorded amount paid is £80.00). An example of one agreement stated “ the total fees and DSS paid for … (Name of Service User)… for the financial year 2004/2005 is £ ……”. Aspects of the contracts were not clearly included in the agreement, such as the agreed arrangement for MacIntyre to act as an “appointee” and to receive service users’ DWP Benefits and any reference to their mental capacity or involvement of any advocate or representative. The agreements did not show a breakdown of the total actual fees paid, how frequently and by whom. The organisation could contact the Office of Fair Trading for their views on the fairness of these contracts. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is good. Service users are the centre of care planning where risks are balanced with potentially beneficial outcomes. Care Plans are comprehensive and very well developed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care Plans were informative and well developed documents that were personcentred records and contained care intentions and adequate and lengthy information about each service user’s complex emotional, social and health needs and their likes and dislikes. Extensive risk assessments underpinned the care planning as all service users have high risks indicated. Risk assessment are comprehensive and an essential aspect of the homes care planning and allow service users to takes measured risks. Reviews by the home and by the local authority had been carried out. Records of attendances at day centres were kept. Financial information about DLA amounts and adequate income are recorded. Evidence of the complex and behavioural needs support plans and aims and objectives were captured. The behavioural needs of each service user 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 11 were observe to be complex mixture of occasionally challenging demanding attention distractive and always intensive. Staff were knowledgeable and focused about service users different care needs, their routines and care patterns expected to be followed. Some service users have been risk assessed as needing the assistance of two care staff when in the community. The financial aspects of care plans did not state what benefit is actually paid by the DWP and by what authority MacIntyre were receiving service users’ DWP benefit payments. This may be an “appointeeship” as referred to in the Service User Agreements, but could not be clarified. It was recorded in service users’ Care Plans that money representing Disability Living Allowance and Personal Allowances are regularly paid into their individual bank accounts by MacIntyre Care. It is not clear what is the amount received by MacIntyre from the DWP and if all of this is being paid into service users accounts. Service User Agreements included a standard phrases: “The total fees and DSS paid for ……(name of Service User) for the financial year 2004/05 is £…………”. The care plans need further explanation about the arrangements made for service users’ cash transactions, although there are instructions and guidance about the secure management and handling of these monies. One aspect of these transactions is the fact that some “extra” cash is held by a local office (in nearby Ampthill) and there was no record in the home, of the balance, or amounts of these monies held. However, there was a record of these deposits and withdrawals had been recorded by the home. This information about financial planning arrangements should be more transparent and available for inspection. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16,17, Quality in this outcome area is good. Service users are offered with an active and supported lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence showed that service users regularly participate in a variety of activities. There are records of service users day centre plans and their activities managed by the home and these are planned and partially based on developmental needs. On the day of inspection two staff accompanied one service user when he expressed a wish to go to the zoo. Some service users make their sandwiches for the work they do the following day and are encouraged to think of this themselves and are assisted in this task. One service user was encouraged to make himself a drink. Another service user showed the inspector the tool that he uses and where he keeps them safe. Some service user have limited speech and some are non-verbal. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 13 Staff were observed to use basic sign communications and an excellent understanding of how to intrepret body language and facial expressions and to communicate with service users. Service users who like to use picture references choose their menus and food. One service user stays with his parents in their house, most weekends. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, Quality in this outcome area is good. Service users health is satisfactorily promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care Plans included adequate record of the physical and emotional attention to be provided and the evidence was that some of this was given by good care and personal attention and through regular and routine health checks as well as monitoring by specialists and consultants associated with the Supporting People with Learning Disabilities, an NHS & Social Care Partnership. Regular dental and eyesight checks and treatment are planned and physical activities are designed to maintain basic fitness. Attention to dietary intake and weight is a feature of the home’s mealtime planning. All service users have been risk assessed for managing medication and none self medicate. The medication records were checked and found to be accurate and well recorded. The process of missed medication was discussed with staff that understood the process of contacting a GP in this event. It was discussed with the manager the process of accounting for medication if a service user is 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 15 staying with relatives or friends and their medication has been taken by a relative or friend and how this must be recorded and should be described on the reverse of the Medication Administration Record sheets. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, Quality in this outcome area is good. Staff were confident and able to respond appropriately and immediately to reporting a suspicion, or allegation of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and logbook to record complaints and a ‘whistle blowing’, Public Interest Disclosure Act policy. The complaints procedure was available within the home. Four care staff were asked for their response to a hypothetical allegation of abuse and responded positively and confidently and new where to locate the contact details of ‘key practitioners’ in Social Services/ PCTs and the Police, should they be expected to contact them. A file with details about Protecting Vulnerable Adults is kept and it was discussed with the manager how this could be developed into a larger resource. All staff have had training in the prevention of abuse. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30, Quality in this outcome area is good. The home is comfortable and suited to service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment is well maintained and clean and suitable for service users routines and privacy. Bedrooms are individualised and service user are provided with extra safe area to keep some of their possessions. Communal areas are comfortably furnished and ordinary and homely. The quality of furnishing is good and the communal areas are equipped to accommodate all service users, should they be all together at any one time. The exterior of the building is in good repair and the garden was neat and on a cold day was tidy and inviting. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36, Quality in this outcome area is good. Staff are motivated to bring positive outcome to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A positive aspect of the staff team in this home is they are consistent and familiar to the service users. 11 staff are employed by the home. A ratio of two care staff has been identified in risk assessments of three service users when they are in the community. This may become a staffing issue at weekends and especially in the summer time when more service user may wish to be out. The manger stated that extra staff could be called in when this has been planned and that working as a cluster of care homes other staff can help in an emergency. The numbers of staff shown on the staffing roster would not always be able to accommodate a service user’s impromptu request to go out if the request had not been anticipated. This may be a restriction upon service users, particularly at weekends, although there was no evidence to show this occurring. However, the registered person should review their staffing arrangements in light of this need. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 19 Two staff files showed that satisfactory CRB checks and references had been obtained. There was no letter confirming a start date in the files. Supervision is regular, is recorded and staff stated they were supported in this process and valued their supervision. Regular weekly team meeting are held and staff reported they felt valued members of staff and respected the manager’s style and leadership. Care staff are trained in Working with People with Learning Disabilities that has replaced the LDAF training previously undertaken. Staff are expected to achieve a six months competency level before working alone or being able to be trained in medication. Training is provided annually for protecting vulnerable adults. Training included treating people as individuals, intensive interaction, Autism spectrum disorders, Fire safety and food hygiene. MacIntyre Care provides most of this training. Only two staff have not undertaken an NVQ award. Two support staff have NVQ level 3 awards and the manager is completing an NVQ level 4 in management. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42, Quality in this outcome area is good. The home is run in the best interest of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has established a regular method of working and has set an example of attentive and risk assessed care. The manager and inspector discussed the future of inspection and that email contact and Internet access was expected from services and would be an important aspect of future communication with the CSCI. Policies read included that supported the management of the service included Medication, Service Users Money and Protecting Vulnerable Adults. The 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 21 medication policy did not refer to recording service users medication when staying with relatives or others not employed by the service. There are policy instructions and guidance about the secure management and handling of service users’ money. The policy for Managing service users’ money did not make any reference to the position of the home as a “receiver”, or “appointee” for service users and should be reviewed to clarify their position. One aspect of the records of service users money is the fact that the local office holds some “extra” cash, yet there was no record, in the home, of the amounts of the money maintained at this other office. However, a record of these deposits and withdrawals for each service users had been recorded and are maintained by the home. The information and records used to manage service users’ money should be more transparent and easily available for inspection. The policy for Protecting Vulnerable Adults from Abuse did not refer to the organisations position in regard to Bedfordshire County Council published guidance. There was no written policy for transport or vehicles. The home did not have a training policy, although there was reference to training but it was not a developed policy statement or intent, that should reflect the home’s Statement of Purpose. Weekly fire testing is carried out and monthly fire drills include all service users when a complete drill is acted out. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 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. 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 Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 2 X X 3 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA40 Regulation 17(1)(a) & Schedule 3 Requirement The registered manager must ensure the home has a medications policy that includes the process to record when service user are staying with relatives, or others, and their medication has been entrusted to the relative. Timescale for action 01/05/07 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 YA5 Good Practice Recommendations Information should be made available in service users contracts (agreements) about the amount and breakdown of their fees and who pays or contributes towards these fees. The organisation is recommended to contact the Office of Fair Trading for their views on the fairness of these contracts. Care Plans should record the overall and specific financial arrangements or plan, that has been made for each service user in relation to their financial needs. The plans should indicate service user’s level of mental capacity, who is acting or advocating and responding to their known DS0000014907.V331142.R01.S.doc Version 5.2 Page 24 2 YA6 4 The Grove 3 YA23 4 YA38 5 YA40 6 7 YA40 YA40 8 9 YA40 YA40 needs, what are their responsibilities and what authority or agreement has decided this. Staff induction training should include protecting vulnerable adults awareness training and is arranged for the first day of a person’s employment, to ensure staff are aware of the overarching care need to ensure the safety of vulnerable adults. It is recommended that internet access is available in the service to enable staff to access current legislation, relevant guidance and vital information from a range of different sources. The policy for Protecting Vulnerable Adults from Abuse should be reviewed in regard to the organisations position to Bedfordshire County Council guidance, the reporting procedures including specific contact points where referrals can be made. The policy for Managing service users’ money did not make any reference to the position of the home as a receiver, or “appointee” for service users and should be reviewed. The registered manager should ensure there are sufficient staff at all times especially with particular attention to weekends and should review their staffing policy arrangements in light of this need. The registered manager should ensure the home has a written policy for transportation or vehicles. The registered manager should ensure the home has a written policy for training staff. 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 4 The Grove DS0000014907.V331142.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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