CARE HOME ADULTS 18-65
West Street 4 West Street Biddulph Stoke-on-Trent Staffordshire ST8 6HL Lead Inspector
Wendy Jones Unannounced 18 May 2005 14:00 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. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service West Street Address 4 West Street 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) 01782 514141 westst@choicesha.co.uk Choices Housing Association Limited Ms Diane Deakin Care Home 4 Category(ies) of 4 LD registration, with number of places West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 29 September 2004 Brief Description of the Service: 4 West Street was registered in March 2002 to accommodate four younger adults with learning disabilities. It is a large detached bungalow, that has been extended to provide suitable accommodation, including 4 single bedrooms, a spacious bathroom and a walk in shower room. Communal space icludes a large lounge and a kitchen/dining room. The service also provides a laundry and large store room housing the food freezer and other household items. Externally there are good sized gardens and a patio area, all are accessible to service users. A large garage is used for storage purposes, the drive way provides ample parking space. The home is located in the village of Biddulph, within a short walk to the main shopping area, local pubs, church and other facilities. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on 18 May 2005. There were two service users in the home and one member of staff, deputy manager Rosemary Galley. Both service users freely discussed their lifestyles, aspirations, likes and dislikes during this visit and kindly provided a guided tour of the bungalow. Two other service users were out of the home on a day trip to a Safari Park. The service had addressed the majority of the requirements from the last inspection. What the service does well:
The service provides ordinary living for service users in a residential area of the village. Each of the service users had their own bedroom and are supported to take responsibility for it, all had their own bedroom keys and use them. A Statement of Purpose and Service User Guide was provided and records showed thorough pre admission assessments. Copies of contracts and licence agreement were in individual care files. The service demonstrated a good standard of assessment, care planning, and risk assessment with evidence of regular reviews. Arrangements were in place for meeting the health and personal care needs of individuals and details were recorded in care records. Agreed strategies for the management of challenging behaviour were effective. A regular programme of in house and external activities was in place for service users to participate in, records of also showed that service users were consulted about the type of activities they engaged in. Person centred planning ensured that service users wishes were respected and known to staff who supported them. Service users were provided with a choice of well-balanced and nutritious food that they were supported to choose, prepare and cook. Menu’s were planned weekly, recipes for main meals were recorded in the daily communication file used by staff. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 6 There was a complaints procedure in place, which service users asked were aware of. This was given to individuals on admission in the Service Users Guide and was also displayed in the home. Records showed that complaints were recorded. The environment was of a good standard, with adequate communal space, although a service user at the last inspection identified a wish for additional recreational space. All bedrooms were single, had adequate furnishings, fittings and all had bedroom door locks to which the individual occupant had a key. Service user views relating to day to day decisions were sought and acted upon and they were consulted regarding proposed changes. There was evidence of good relationships between service users and support workers and service users knew who their key support worker was. Systems for the management and administration of medication were good. The manager had been approved by the CSCI since the last inspection and is now registered as care manager. Health and safety systems were adequate with records indicating that daily and weekly audits of health and safety matters are undertaken. Risk assessments were in place and were subject to regular review. Fire safety checks were appropriately recorded. Fire drills had been carried out. What has improved since the last inspection? What they could do better:
Plan social outings for service users without impacting on the routines of others where possible. Ensure that all records of complaints included the action taken to address them. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 7 Matters arising from observation and discussion included a need for some redecoration of some areas of the home. The organisation should act upon the requests to redecorate the hallway, kitchen/dining room and service users bedrooms. Staffing levels were adequate, providing two throughout the waking day staff a recruitment drive was reported to have been successful, it was hoped that the home will be fully staffed soon. Matters arising included the need to ensure that all staff were involved in fire drills, including bank staff. Fire safety risk assessments should be reviewed at least annually. 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. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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 West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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) 1,2,5. The home’s Statement of Purpose and Service User Guide were good providing service users and prospective service users with details of the services the home provides enabling an informed decision about admission to be made. EVIDENCE: The Statement of Purpose had been reviewed since the last inspection to reflect changes in the management of the home. Care records showed detailed assessments in relation to physical, emotional and psycho social needs. Risk assessments, action and care plans were in place and had been reviewed regularly. A copy of the service users contract and licence was in the care file inspected; details were also included in the Service User Guide. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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) 6,7,8,9. The standard of care planning was good and reflective of the assessed needs of service users, providing staff with clear guidance and information to meet individual needs. Service users were supported to make day to day decisions relating to their daily life, enabling them to have some control about matters important to them. The systems for service user consultation in this home were good with a variety of evidence that indicated that service users’ views were both sought and acted upon. Risk assessments were of a high standard, with evidence of regular reviews and multi disciplinary consultation where the need arose, to ensure that the risks identified were kept to a minimum. EVIDENCE: The service has adopted the Person Centred Planning model. Meetings were being arranged with individual service users to establish who should be invited to inform the planning meeting.
West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 11 A sample of care plans seen, were appropriately maintained, addressed the identified assessed needs and were reviewed on regular basis. From discussion with a service user it was evident that she was aware of plans relating to her care, both service users knew who their key support worker was. There was evidence from observation and discussion that the views of service users were sought regarding day to day decision making, and that service users were supported and guided to make appropriate decisions. There was evidence of comfortable and positive relationships between service users and staff. Records of service user meetings were provided for inspection purposes, meetings were arranged approximately bi monthly. Additional weekly discussions were recorded, to plan menu’s and establish the activities and events for the following week. Individual risk assessments were in care files, general environmental and other risk assessments were stored separately. The records showed that they were reviewed at least annually and more frequently if necessary. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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, 14, 15, 16,17. Service users were supported to access a range of social, occupational and recreational activities that are located in the community and are socially valued. Dietary needs of service users were known and understood and efforts were being made to provide a balanced and varied selection of food to ensure a good nutritional intake. EVIDENCE: Each service user has an individual occupational, social and recreational plan, which is developed from the Person centred planning meetings, in consultation with the service user. Records indicated that service users were involved with local colleges, taking part in educational sessions appropriate to their identified needs and interests. Sessions at specialist day care facilities were also accessed, weekly outings to the library was included in the plan for 3 service users. Weekly swimming sessions were included in the plans of 3 service users, craft sessions were participated in by 2 service users. 2 service users had part time cleaning and office work at the organisation headquarters.
West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 13 Service users hobbies and interests were recorded, in each individual plan, the records of participation options indicated that service user were supported to pursue their interests. All service users were supported to decide on their preferred holiday and day trips though out the coming year. All service users had enjoyed one break, others were being organised. Two service users were out on a day trip during this visit. A service user who was not on the trip had had changes made to her usual routine, in that she could not go to work on that day due to transport difficulties. This had caused some concern and difficult behaviour. It was advised that service user routines, where possible should not be unnecessarily affected by arrangements for other service users. All service users engaged in household chores including cooking and cleaning and taking responsibility for their own bedrooms. Each of the bedrooms were fitted with door locks, the lock was of a type that could be secured by a key from the outside, and by a turn type handle from the inside, which could be overridden in the event of an emergency, both service users confirmed that they had their own key to their bedroom. Records and discussion with service users indicated that the local community facilities were accessed regularly and on the day of the inspection both service user were going into the village to do some personal shopping and for lunch. Service user confirmed that they had regular contact with family and friends, the service supported this contact by providing transport if necessary, regular telephone contact and correspondence. Weekly discussion facilitated by staff, planned the week ahead menu’s, with each service user choosing their preferred main meal. The information provided also suggested that service users would be encouraged to prepare and cook their chosen meal on the day. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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) 18,19,20,21. Staff had a very good understanding of the service users personal, emotional and physical support needs. This was evident from the positive relationships, which have been formed between the staff and service users and from the health records provided. The medication at this home was well managed promoting good health. Clear and comprehensive arrangements being in place to ensure service users medication needs are met. The records showed that the service had given consideration to the needs of service users relating to aging, illness and death, to ensure that known wishes and arrangements were communicated an in place and would be respected. EVIDENCE: Care records included Health Action Plans which had replaced the previously used OK health check. The HAP’s identified specific health issues and the action required to appropriately address the problem. There was evidence in individual files of regular health checks, including chiropody, ophthalmic, G.P, dental and specialist appointments. There was also multi disciplinary discussion and input from community learning disability services as required. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 15 Health records showed that daily checks were maintained on identified health needs and referral made to the appropriate health professional as required. All service users were referred to Consultant Psychiatrist, for chronic and acute health needs. Medication records included the signatures and initials of all staff responsible for the administration of medication. Information regarding the purpose and side effects of all medication prescribed for service users. Protocols for the administration of as required medication of pain relief, epilepsy and behaviour management were in place, since the last inspection the manager had approached the prescribing GP or consultant with requests for verification and signatures for each of the protocols. Medication administration records demonstrated that medication was appropriately signed for at the time of administration. Stock control measures were good. Staff responsible for medication administration received in house training and an assessment of competence. Evidence was provided following inspection that all staff administering medication have undergone a certificated medication course, or were booked to attend a course. Since the last inspection the organisation had introduced a document entitled “when I die”. The intention was for staff to discuss with service users, families and friends, their plans, preferences and arrangements in the event of death and serious illness. The records would include wishes relating to treatment, bequest and wishes relating funeral arrangements. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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. The home had a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. EVIDENCE: A complaints policy and procedure was displayed in the home and included in the Statement of Purpose, a more user friendly version was included in the Service User Guide. Discussion with a service user confirmed that she was aware of the procedure, and felt able to address any concerns she had with staff and the manager of the home. Records of complaints were maintained in the home, there were 3 complaints recorded since the last inspection. The records did not show what action had been taken to address the matters raised, this was discussed with Ms Galley and is a requirement of the report. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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) 24, 25,26,27,28,30. The home was suitable to meet the needs of service users, with adequate communal space, sufficient bathing and shower facilities and single occupancy bedrooms. EVIDENCE: The service is provided in a large detached bungalow set in it’s own landscaped gardens. The main entrance is accessed via a ramped pathway, the rear entrance is accessed via a paved patio area. Communal space is provided from a large lounge, with ample seating and a kitchen/dining room. Discussion at the last inspection included a request for the provision of an additional communal area for the benefit of service users. It was established from discussion during this visit, that this request should continue to be considered by the service. As the difficult to manage behaviour of service users was reported to have an impact on the lifestyles of others. At these times service users were reported to choose to retire to their bedrooms as a short term solution this arrangement could be supported, but for prolonged episodes was not the ideal solution, as service users could become isolated.
West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 18 The layout of the building was such that it could accommodate service users with physical disabilities, the hallway and corridor was wide enough to accommodate wheelchair users, bathing facilities were spacious enough to provide for specialist equipment if necessary. All bedrooms were for single use, had appropriate furnishings and fittings, and wash hand-basins, all exceeded the minimum standards for spatial requirements. The home offered a bathroom with island bath and wc, and a separate walk in shower room with wc. Both were tiled and well maintained, at the last inspection the intention was to create a more relaxing environment in the bathroom, this project has yet to be fully realised. The privacy lock to the shower room and wc was not working and in need of repair. The standards of cleanliness and hygiene are good throughout, staff and service user share responsibilities for household chores. The appearance of the home is let down by the marked walls in the hallway and kitchen/dining room. These areas are in need of repainting. A service user also identified that her bedroom needed redecorating she confirmed that she could choose a colour scheme and would be involved in the selection of curtain and bedding fabric. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 19 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) 32,33 Staffing levels were adequately maintained to ensure that service user needs were appropriately addressed. EVIDENCE: At the last inspection the service had recruited a full staff team, since that time some staffing changes had resulted in a return to the use of bank and agency staff to ensure that staffing levels are maintained to satisfactory levels. A recent recruitment drive was reported to have attracted a number of good candidates. Staffing levels on the day of this visit included 1x 7.30am-5pm, 1x 7.30am11am, 1x 10am-8pm, 1x 11am-11pm. A sample of staff rota’s indicated that staffing levels were usually two throughout the waking day with more if required. There was also evidence that on occasions 1 staff was deployed for periods of time usually in the evening after 7-8pm and from 7.30am-9-10am on weekend mornings. The service has a policy on lone working, that states “ Staff working the sleepover shift 10pm-7am alone, also when staff are left in the house whilst other staff are escorting clients to activities or appointments.” It is recommended that the policy is reviewed to reflect the staffing arrangements at West Street, it is accepted that the risk assessment identifies
West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 20 the control measure in place to minimise risk. It is required that the service evidences that all control measure are in place, for example Personal Safety Training. Each service user is allocated a key support worker West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 21 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) 42 The health and safety of services users was promoted and protected, through satisfactory fire safety checks, risk assessment, policy and procedure. EVIDENCE: The service had a Health and Safety policy and procedures for staff to follow. Health and Safety training is an integral part of the induction for new staff. Individual and general risk assessments were in place which included the control measures to reduce the risk and the action required to address risk areas. Records showed that risk assessments were subject to periodic review. Daily and weekly in house health and safety audits were carried out and recorded, including hot water temperature and fire safety checks. Records showed that weekly fire alarm checks were carried out, monthly emergency lighting and fire equipment checks were also undertaken. Fire drills were recorded for March and April, a requirement of this report was for all staff to be involved in fire drills including bank staff.
West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23
ENVIRONMENT Score x 2 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 3 3 3 3 3 x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 4 Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
West Street Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 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. Standard YA42/YA33 Regulation 13 Requirement A review of the homes policy on lone working must be undertaken (previous time scale 06/10/04) Repaint the hallway walls, replace the kitchen carpet, replace the hallway carpet( previous time scale 29/12/04). The registered person must demonstrate that all staff responsible for the administration of medication received certificated medication training. The registered person must ensure that records relating to complaints includes the action taken to address them. The registered person must ensure that all staff including bank staff are involved at least 2 fire drills per year. The registered person must ensure that Fire Safety Risk Assessments are reviwed annually. The privacy lock to the shower room must be repaired. Timescale for action 18/06/05. 2. YA30 16 18/08/05 3. YA20 13 18/07/05 4. YA22 20 18/08/05 5. YA42 13 18/08/05 6. YA42 13 18/06/05 7. YA27 16 25/05/05 West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 24 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 YA14 Good Practice Recommendations The service should ensure that service users lifestyles ad routines are not un necessarily affected by arrangements for other service users. West Street E51-E09 S29679 West Street V229788 180505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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