Inspection on 25/04/06 for 43 Freeman Street

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

43 Freeman Street 20/08/07

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 43 Freeman Street Wells-next-the-Sea Norfolk NR23 1BQ Lead Inspector Mr Roger Andrews Unannounced Inspection 25th April 2006 01:00 43 Freeman Street DS0000065466.V294358.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 43 Freeman Street DS0000065466.V294358.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. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 43 Freeman Street Address Wells-next-the-Sea Norfolk NR23 1BQ 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) 01485 542198 Miss Bridget Jane Marshall Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Not applicable Date of last inspection Not applicable Brief Description of the Service: 43 Freeman Street is a small domestic type environment offering support to three adults with learning difficulties. The residents share the house with the provider, Miss Bridget Marshall. The house is situated close to the centre of the seaside town of Wells-Next-The-Sea on the Norfolk coast. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Freeman Street is a small domestic care environment and ideally would be registered under an Adult Placement Scheme if this was available. However, such a scheme is not currently available in Norfolk. This is the first inspection at this address, though the residents have been together as a group for many years at a previous address. There are a number of matters that need attending to and these are described at the end of this summary and at the end of this report. Another inspection will take place to check that these matters are being attended to. What the service does well: What has improved since the last inspection? What they could do better: A regular record needs to be kept so that people reading the record can gain a picture of each resident’s lifestyle and care/health issues. The records including medication records need to be kept in a secure locked place when not in use. The medication needs to be kept in a secure fixed lockable cupboard to avoid misuse and risk assessments need to be put in place about each resident’s ability to manage their own medication. Arrangements to allow Miss Marshall personal time and time for attending relevant training courses including NVQ must be put into place. Hazards such as trailing cables must be made safe. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 6 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. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 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 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 No new admissions have taken place and none are planned. EVIDENCE: There have been no new admissions for some years. The three residents are settled and there are no foreseeable plans for any future admissions. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 9 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, 7, 9 & 10 Care plans are informative, but need to be backed up by a regular record reflecting the ongoing lifestyle of each resident. The care plans should focus a little more on the positive attributes of residents. Records containing information about residents must be stored securely and be locked away when not in use. The residents are involved in decision making on a day to day basis. EVIDENCE: Each of the residents has a written care plan and these were looked at during the inspection. These give a good overview of each resident including interests, health issues and the support residents need in personal care tasks. They describe, for example, areas where residents need encouragement or prompting such as going to bed. To some extent these overviews lean to the negative, i.e. what residents can’t do and greater emphasis could be placed on what they can do. See recommendation. There is a lack of ongoing written information describing the day to day lifestyle of each resident such as events and activities participated in, changes 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 10 in mood, health and important contacts such as with family and friends. These areas need to be commented on a regular basis so that someone reading the record can gain a true reflection of the lifestyle and ongoing issues pertinent to each resident. See requirement. The records on residents that are kept also need to be stored more securely, i.e. locked away when not in use. A suitable cupboard to which a lock could be fixed was identified with Miss Marshall during the inspection. See requirement. There was a good deal of informal evidence through discussion with the residents and Miss Marshall that the residents have a significant say in the things that affect them such as activities, work and other pastimes they want to be involved with and in the way they are supported. One resident wrote in his questionnaire that “we do not have meetings. We just sort things out by sitting down and talking with each other”; whilst another wrote “we do not have meetings. We talk every day”. One of the residents described how he handled his own money and another said that “I go to the post office or bank to get money out”. Risk assessments are in place. Topics covered in these assessments include being home alone, cycling, money handling and fishing. They are well set out, though see comments under standard 20 in relation to medication. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 11 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): 12, 13, 15, 16 & 17 Residents are able to participate in personal hobbies and indoor and outdoor activities. They also have daytime work centres during the week. Residents can have contact with friends and family when they want. The residents like the food and take part in shopping and deciding what to eat. EVIDENCE: The residents were chatted with as a group and individually. They described a flexible day to day routine where choices such as what to eat and where to go, e.g. at weekends, were decided between the Group and Miss Marshall. Each of the residents attends a day centre during the week, though Wednesday is a home day where they can catch up with domestic tasks and going out. The residents said they are able to go out on their own which they do occasionally and they were aware of local bus services to other towns as well as being just a brief walk from the centre of Wells. The residents described activities they enjoyed which included going to the cinema, having a picnic at Sheringham, (a local sea side town), and hiring 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 12 DVD’s. One resident wrote in his questionnaire that there is lots to do where he lives and he likes keeping his fish tank, (in his bedroom), and playing with his play station. All three residents said they could have friends to visit and one said their best friend had been for tea. The residents do not have keys to their rooms, though all said they didn’t really want one The residents said they all joined in with shopping trips to the supermarket and deciding the evening meal is a joint enterprise and there is no set menu. The residents said they made their own pack lunches for the following day if they are attending a daycentre. Otherwise mealtimes are entirely flexible and include meals out or takeaways. The residents help in the preparation of meals. The parents of one resident responded to the questionnaire sent to them by the Commission. They expressed the view that “we are more than satisfied with the quality of care and the experience XXXXX receives”. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 13 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 Residents can participate to the extent they are able in their personal care and have their healthcare needs attended to. Medicines are handled appropriately, but need to be stored more securely as do medication records. Risk assessments need to be in place in respect of the residents’ ability to self medicate. EVIDENCE: The residents are capable of looking after their personal care needs and generally require support, encouragement and prompting, (e.g. on an appropriate bedtime), from Miss Marshall. They are quite capable of choosing, for example, which clothes they wish to wear. The residents are registered with the local G.P. and dental services and care plans indicated appointments that had taken place. Special conditions are followed up and one of the residents is waiting to see the Consultant. Physiotherapy has been provided for one resident who also has a running machine in her room to help her exercise routine. Issues concerning their healthcare are discussed with each resident. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 14 The residents do not currently look after their own medication. However, a risk assessment is needed and this should be periodically reviewed. The medication needs to be stored in a more secure situation and a small, lockable cabinet secured to a wall would offer the best solution. See requirement. A record of medication given is kept and a record is kept of medications received. Previous records of medication need to be kept more securely. See requirement. Risk assessments need to be in place on each resident in respect of their capacity to manage their own medication. See requirement. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 15 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 & 23 The residents feel safe and know who to talk to if they have concerns. EVIDENCE: All three residents said they liked living in their new house and enjoy living with Miss Marshall. They said they felt safe where they lived and that if they were worried they could talk to Miss Marshall or to staff that they knew at the daycentres they attend. Miss Marshall is aware of the need to report any concerns and has been proactive in notifying the Commission and the Social Worker when any incidents have required to be notified. As with other training opportunities it would be beneficial for Miss Marshall to attend POVA and Adult Protection training. See comments in the section relating to staffing. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 16 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, 26, 27 & 30 The house has a homely feel to it and residents like their bedrooms which they can personalise. The extension cable in one of the bedrooms to the fish tank must be made safe as it presents a tripping hazard. EVIDENCE: Each of the residents has their own bedroom, one being on the ground floor and two being on the first floor. There are also two lounges on the ground floor which offer a choice of communal area. One of the lounges has a dining area and there is a kitchen which gives access to the back garden. Interior improvements have been taking place to the building since the residents and Miss Marshall moved in and the environment is looking comfortable and homely. Each of the residents is allowed access to their bedrooms which are personalised according to taste. One of the residents has just had her bedroom painted in the colour of her choice. There is a bathroom and toilet on the first floor and a separate toilet on the ground floor. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 17 The only obvious hazard noted was an extension cable which trails across one of the resident’s bedrooms to his fish tank. This needs to be rectified and was mentioned to Miss Marshall during the inspection. See Requirement. The home is clean and free of unpleasant odours. 43 Freeman Street DS0000065466.V294358.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): 35 Residents are supported, though Miss Marshall needs to build in time for personal time and training opportunities. EVIDENCE: All three residents are supported by Miss Marshall and no additional staff are currently employed. However, support staff is an area being considered and some discussion took place about the recruitment processes and the employment material and induction training that needs to be in place as well as identifying the additional range of policies and procedures that would need to be developed. Although the three residents enjoy good levels of independence and require encouragement rather than physical help with personal care and day to day matters, it is undoubtedly tiring for Miss Marshall to be the sole carer on a full time basis. The need for time off and relaxation is a necessary requirement for everyone and this needs to be addressed at some time in the foreseeable future. Arrangements also need to be in place that allow Miss Marshall to attend relevant training opportunities which is difficult in the current time slots available. See requirement. Nevertheless, it was apparent that the residents are being supported in an environment where they are treated as adults and are participating in decision making within their day to day routines. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 19 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): NVQ training needs to be embarked upon and a quality assurance process covering areas such as relevant training should be implemented. EVIDENCE: From observations it was very clear that the residents have a good rapport with each other and with Miss Marshall and the atmosphere during the inspection visit was relaxed and good humoured. However, Miss Marshall needs to make enquiries regarding undertaking relevant training such as NVQ in care and management in line with the comments already made about training opportunities. See requirement. A process of quality assurance is required. This can help identify relevant training, ensure appropriate policies are reviewed and that records such as care plans are also reviewed. See requirement. The residents described what they would do if there was a fire and were very clear about getting out of the building. There have been no significant accidents involving any of the residents. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 20 Each resident has a bank account for his or her personal money. 43 Freeman Street DS0000065466.V294358.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 X 2 3 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 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 2 X 2 X 2 X X 3 X 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 22 Not applicable 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 YA6 Regulation 16 Requirement A written record which demonstrates the involvement of residents in activities, contact with friends and family, healthcare appointments and general well being needs to be kept and updated on a reasonably regular basis. Timescale for action 30/06/06 2 YA10 12 Individual records containing 30/06/06 information about residents must be kept secure in a locked cabinet or cupboard when not in use. This includes records relating to medication. Medication needs to be stored in a locked cabinet or cupboard. Cables that present tripping hazards must be removed or made safe. Miss Marshall needs to create recreation time and time for pursuing relevant training, by recruiting support staff. A process for maintaining and improving the quality of care DS0000065466.V294358.R01.S.doc 3 4 YA20 YA24 13 13 30/06/06 30/06/06 5 YA35 9 31/10/06 6 YA39 24 31/10/06 43 Freeman Street Version 5.1 Page 23 such as identifying relevant training and ensuring quality of life indicators such as choice and independence are continuously promoted. 7 YA20 13 Risk assessments are required in respect of the capacity of each resident to manage their own medication. 30/06/06 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 YA6 Good Practice Recommendations Care plan comments should also be phrased in a manner that promotes the positive capabilities of residents. 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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 43 Freeman Street DS0000065466.V294358.R01.S.doc Version 5.1 Page 25 - 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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