CARE HOME ADULTS 18-65
41 Regent Road, Hanley Stoke-on-Trent Staffordshire ST1 3BT Lead Inspector
Ms Wendy Jones Unannounced Inspection 25 January 2006 11:00 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 41 Regent Road, Address Hanley Stoke-on-Trent Staffordshire ST1 3BT 01782 263720 01782 263720 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) Shelton Care Limited Mrs Yvonne Robertson Care Home 16 Category(ies) of Learning disability (16), Physical disability (3) registration, with number of places 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th July 2005 Brief Description of the Service: The home was formerly a factory site. The accommodation has been designed to provide single bedrooms in two units of eight beds, each with its own facilities. The accommodation has been refurbished and provides for a domestic scale environment. The service provides residential care for adults with learning disabilities including three who may have a physical disability. There is a day service owned by the proprietors on the same site, adjacent to the residential services. The residents of Regent Road are able to access inhouse and local community daytime provision. The accommodation is situated close to community facilities and services. The interior of the home is decorated and maintained to provide a domestic atmosphere, whereas the exterior of the home retains its industrial heritage. Plans are in place to develop the outward appearance of the building to improve the general look and impression. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out 25/01/06. Information for the inspection was provided from discussion with staff and service users; from inspection of the environment, care records, staff rotas, fire records, menus, records of service user meetings, the Statement of Purpose and observation of interactions. The inspection focused on the service users in the first floor flat. There were 4 service users in the flat during this visit. The service is registered to provide care and accommodation for up to 16 service users who have a learning disability. The dependency of service users varied - service users on the first floor were more self sufficient and independent generally, requiring less support with personal care matters than the service users on the ground floor. At the time of this inspection the home had one vacancy. The service has confirmed that all requirements of this report have been addressed within the agreed time scales. What the service does well:
A copy of the Service User guide was included in individual personal files. Care records and care plans were detailed, providing staff with sufficient information to enable them to effectively deliver care. There was evidence of regular reviews and that service users were included in planning and reviewing their care. Records of activities indicated that service users had access to a range of social, recreational and occupational opportunities. Records also showed how contact with families and friends was maintained. Personal and health care needs were documented with evidence of regular health checks and multi-agency involvement. Records showed that menus were planned with service users on a weekly basis and alternatives to the main meal choice were available on request. The environment was pleasant, comfortably furnished and clean and tidy. Service users had front door keys and keys to their own bedrooms. All bedrooms were for single occupancy, and the service provided sufficient bathing and toilet facilities. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 6 Staffing levels were satisfactory with no staff vacancies reported, staff training records showed that mandatory training was planned for all staff, and the numbers of NVQ trained staff exceeded the minimum recommended. The manager had completed her NVQ level 4 in care and the registered care manager’s award. General and individual risk assessments had been carried out and action taken to reduce the identified risk in most instances. Fire safety checks had been carried out and recorded and fire drills were undertaken very regularly. What has improved since the last inspection? What they could do better:
Ensure that risk assessments are in place for the risks identified for service users, including for the storage of cleaning solutions on the first floor, the action to take to reduce the risk to a service user identified during this visit. Reviews of risk assessment should be recorded in the mini-reviews. Amend the fire safety risk assessment to ensure that they accurately reflect the changes made to the locks on the external fire doors. The service must provide evidence that all staff have received vulnerable adults training, and that all staff have received mandatory training. Staff should receive at least 6 supervision sessions per year. Action should be taken to ensure that refrigerated food is stored at an appropriate temperature. Alternatives to the main meal choices should be recorded. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 7 Certificated medication training must be provided for all staff who have responsibility for the administration of medication. Mandatory training must be provided for all staff. Night staff must be involved in fire drills. Inventories of service users’ belongings should be up-to-date. 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. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 the following standard(s): 1 The home’s Service User Guide was 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 service user guide was included in the personal care file of each service user. It had been produced in a format that was reasonably user-friendly, and a review had taken place since the last inspection to include the costs of the service and the bedroom number. A sample showed that service users had signed to indicate that the contents of the service user guide had been discussed with them. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 the following standard(s): 6,9,10. There was a clear / consistent care planning system in place to provide staff with the information they need to satisfactorily meet service users’ needs. The systems for service user consultation in this home are good, with a variety of evidence that indicates that service users’ views are both sought and acted upon. EVIDENCE: A sample of care records showed that there was some very good information regarding the needs of service users. The 24-hour plan of care gave a detailed account of each service user’s preferred routine and the assistance they may require. Care and action plans were in place where a need had been identified and monthly “mini”-reviews were undertaken with each service user. Risk assessments were in place and the records showed that the last reviews had taken place in September 2003. The deputy manager stated that risk assessments were reviewed monthly as part of the “mini”-review and it was suggested that the records must reflect this. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 11 Service users confirmed that they were involved in care plan reviews and were aware that information in records was confidential to them. This had been discussed at a recent service user meeting. Records of meetings were discussed with service users during this visit. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 the following standard(s): 11, 13, 17. Service users were supported to live independent and fulfilled lives. Dietary needs of service users are well catered for, with a balanced and varied selection of food available that meets service users’ tastes and choices. EVIDENCE: The deputy manager and service users discussed plans to enable two service users to lead a more independent lifestyle. Referrals had been made to outside agencies and a multi-disciplinary approach adopted. Records showed (and service users confirmed) that they engaged in a range of social, leisure, recreational and occupational opportunities outside the home. Activities included involvement with Special Olympic activities, horse riding, college, library visits, pub outings and meals out. A number of service users had work placements. During this visit 3 service users were preparing to go independently to the town centre for lunch. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 13 On a weekly basis, service users plan the following week’s menu and shopping list. The menu for the week of the inspection showed a variety of meals available, but alternatives to the main meal were not recorded. Service users are supported to be involved with food shopping, preparation and cooking, and independently use the kitchen on the first floor. Daily fridge/freezer and hot food temperatures were recorded, the fridge appeared to be operating at a high temperature ( 10c) and had been consistently for a number of months. It was requested that action must be taken to ensure that the food is stored at the recommended temperatures (48c). 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 the following standard(s): 18,19,20 Personal support in this home is offered in such a way as to promote and protect service users’ privacy, dignity and independence. The health needs of service users are well met with evidence of good multidisciplinary working taking place on a regular basis. The medication at this home is adequately managed, promoting good health. EVIDENCE: Service users confirmed satisfaction with the care and support they received and they confirmed that key workers supported them to meet their personal care needs. Health records showed that service users were supported to access community based health services, such as the GP, the optician and dentist. Specialist health professional input was accessed as required - at the time of inspection Occupational Therapists, behavioural and psychology services were involved with service users. One service user was receiving independent support following bereavement and the service had accessed advocacy services for two service users. Guidance on relationships was being provided by a community nurse.
41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 15 The medication storage facility was appropriate, daily checks of the storage temperature were recorded and action taken to maintain suitable temperatures as necessary. Medication is dispensed into blister packs with the month’s medication in one pack. There are separate packs for morning, lunch, evening and night-time medication. Since the last inspection the service had notified the Commission for Social Care Inspection of an administration error, this was discussed during the inspection. Appropriate action had been taken by staff and the management of the service to ensure the safety and wellbeing of the service user. It was required that all staff who had responsibility for the administration of medication receive a certificated medication course. Medication issues were discussed with 3 service users. None of the current service users self-medicate although risk assessments and care plans had been put in place for one service user who had expressed an interest in doing so. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 the following standard(s): 22 The home has a satisfactory complaints system, with some evidence that service users feel that their views are listened to and acted upon. EVIDENCE: A complaints procedure was displayed in the home and was included in the service user guide. A mix of symbols and text had been used to provide a more user-friendly document. Following discussion with service users, it was recommended that the procedure is revised again to ensure that it is accessible and understandable by all service users. One complaint had been received by the home. The deputy manager described how the issues had been resolved to the satisfaction of the complainant. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 the following standard(s): 24, 27, 28 and 30. The standard of the environment within this home is good, providing service users with an attractive and homely place to live. EVIDENCE: This inspection focussed on the first floor flat. The unit provided a spacious open plan lounge/dining room, which led to the kitchen. Another separate lounge was also available. Service users discussed the need for some redecoration in both lounges and mentioned that one of the sofas in the large lounge had a broken arm and needed replacing. The flat has a shower room, a bathroom and a separate WC. The environment was clean, warm and tidy throughout. The main COSSH store for the home was located on the ground floor. A small store for cleaning products was available in the kitchen of the first floor flat. This store wasn’t locked. The deputy manager stated that the risk to service users was low. It was suggested that a risk assessment is undertaken to demonstrate that the service has considered all potential risks. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 Staff morale is high, resulting in an enthusiastic workforce that works positively with service users to improve their whole quality of life. EVIDENCE: Staffing on the day of the visit included the manager and deputy. Both were supernumerary to the staff team. Care staff included: 3x 7.45am-3.15pm 1x 12noon-7pm 3x 3pm-10pm 1x 3pm-11pm, sleep over 1 waking night staff. A sample of the staff rotas provided evidence that the staffing levels on the day were consistent with those provided at other times. Information from the deputy manager indicated that the numbers of NVQ trained staff exceeded the minimum requirement of 50 of the workforce. Evidence was seen that mandatory training had been planned on a rolling programme, with manual handling and Vulnerable Adults training booked for February 2006. It was agreed that all staff must have received all mandatory training or updates by 30/04/06 as there were some gaps in the records seen.
41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 19 Senior staff have received training in staff supervision since the last inspection. The deputy reported that due to difficulties over the summer period, including staff sickness, some supervisions had not taken place as frequently as recommended. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42. The health and safety of service users was compromised by gaps in risk assessments. EVIDENCE: The manager reported that she had completed the NVQ level 4 in care and the Registered Care Managers Award, and she was asked to provide copies of certificates to the Commission for Social Care Inspection. Fire safety checks were appropriately recorded, fire drills were carried out very regularly and the names of staff and service users who attended were recorded. The records also detailed any issues that arose and how they were resolved. A fire safety risk assessment had been reviewed in August 2005. The need to review it further to include the changes made to the locks on the ground floor exterior doors was discussed. Risk assessments were in place for individuals. A risk assessment for one individual must be implemented to ensure that staff are aware of the action to take to ensure his safety out of the home.
41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 21 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 x ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 3 29 X 30 4 STAFFING Standard No Score 31 x 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 1 X 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 22 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 YA42 Regulation 23 Requirement Fire safety risk assessments must be revised to ensure that they accurately reflect the service. All staff must receive mandatory training. Risk assessments must be in place for every identified area of risk. The broken sofa in the first floor lounge must be replaced. All staff responsible for the administration of medication must receive certificated training. The responsible person must ensure that the service complies with Environmental Health regulations re the safe storage of food. Timescale for action 25/01/06 2. 3. 4. 5 YA32 YA42 YA24 YA20 13 13 16 13 25/04/06 25/01/06 25/04/06 25/04/06 6 YA17 16 01/02/06 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 23 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. 2. 3. 4 Refer to Standard YA17 YA10 YA36 YA24 Good Practice Recommendations A record of the alternatives to the main meal should be recorded. Service users’ inventories should be up to date Staff should receive a minimum of 6 supervision sessions per year. The lounge on the first floor should be re decorated. 41 Regent Road, DS0000008250.V280112.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Stafford Office 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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