Inspection on 28/04/06 for 44 Monks Close

This inspection was carried out on 28th 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

44 Monks Close 27/03/09

44 Monks Close 06/12/07

44 Monks Close 31/01/07

44 Monks Close 27/10/05

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 44 Monks Close Bircham Newton Norfolk PE31 6RD Lead Inspector Mrs Lella Andrews Unannounced Inspection 28th April 2006 10.30a 44 Monks Close DS0000062976.V292796.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 44 Monks Close DS0000062976.V292796.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. 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 44 Monks Close Address Bircham Newton Norfolk PE31 6RD 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 576062 Mrs Yvonne Asbury Care Home 1 Category(ies) of Learning disability (1) registration, with number of places 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered for one named individual only. Date of last inspection 27th October 2005 Brief Description of the Service: Yvonne Asbury provides care and accommodation to an adult with a learning disability who has lived with the family for over fifteen years. It is likely that the service would be eligible to be registered as part of an Adult Placement Scheme but Norfolk does not have such a scheme and so the service is registered as a Care Home. 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Asbury (Provider) had been given four days notice that this Inspection was going to take place. It took place over two hours and the Inspector spoke to both the client and to Mrs Asbury. It would be more suitable for this service to be part of an Adult Placement Scheme but as there is no scheme available in Norfolk it must be registered as a Care Home and be inspected against the relevant regulations and standards. The Inspection has focused on the outcomes for the client living at the Home and the report reflects this. The requirements and recommendations made are those which the Inspector feels are most relevant and appropriate for this service rather than reflecting every instance that a regulation or standard has not been met. What the service does well: What has improved since the last inspection? The Provider and her daughter have both commenced NVQ training. An additional smoke detector has been situated within the Home 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 6 What they could do better: As the service user lives with the Proprietor as part of the family there has been an absence of written records kept relating to her care. Following the last Inspection the Proprietor kept some records for a short period of time but this has not been maintained. There is a real need for some records to be kept and maintained on a regular basis. These cover the following issues: activities healthcare issues and appointments financial transactions medication risk assessments. The Proprietor has explained the difficulties that she has in attending training due to her lack of transport and of alternative carers for the service user. However, there is a need for her to maintain and develop her knowledge and skills in specific areas: protection of vulnerable adults first aid food hygiene medication. There is a need for the service user to be supported to attend dental and optician appointments. The Proprietor and the service user live with in a local authority house which is situated in an isolated position with no local amenities. The Proprietors daughter also stays at the house on occasions. The size and location of the house do not meet the service users needs and there is a need for the Proprietor to discuss this with the purchasing authority. The Commission will also be passing on their concerns about this to the purchasing authority. 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. 44 Monks Close DS0000062976.V292796.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 44 Monks Close DS0000062976.V292796.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): The service is only registered for one named service user and so there is no need for the Proprietor to have an assessment process in place. EVIDENCE: N/A 44 Monks Close DS0000062976.V292796.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, 8 and 9 The service user does not have a care plan but as the Proprietor, and on occasions her daughter, are the only care providers this does not cause any obvious difficulties. There are no recorded risk assessments but the Proprietor does consider all risks prior to making decisions affecting the service user. The service user feels that she is involved in making decisions about issues that affect her. The Proprietor needs to keep records of the service users finances so as to provide evidence of expenditure. EVIDENCE: The service user has lived as a part of the Proprietors family for many years and do the Proprietor and her daughter know the service users needs well. This means that the absence of a care plan does not cause difficulties. However, during the previous Inspection a requirement was made for a weekly diary to be kept so that information, particularly with regard to health needs, 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 10 can be referred to in the future. The Inspector saw a diary that had been kept for a short time but had not been continued. The requirement is repeated within this report. The Proprietor gave examples of how she considers risks before making any decisions that affect the service user. During the previous Inspection a requirement was made for written risk assessments to be kept for situations affecting the service user. These have not been done and so the requirement is repeated within this report. The service user feels that she is part of the family and during conversations with her it is clear that her views are sought over issues affecting her. The Proprietor is responsible for looking after the service users finances and has recently opened a bank account in the service users name for her benefits to be paid into. The Proprietor showed the Inspector a selection of receipts that she has kept relating to expenditure on behalf of the service user. However, the previous requirement for records to be kept relating to expenditure and income has not been met and is repeated within this report. 44 Monks Close DS0000062976.V292796.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, 14, 15, 16 and 17 The service user is supported by the Proprietor to take part in social activities within the community, however, this is limited by the lack of public transport. The service user is supported to maintain contact with family and friends. The service users rights are respected. The service user says that she enjoys her meals. EVIDENCE: The location of the Home is in a rural area which has little public transport and the Proprietor does not have a car. The Proprietors daughter provides transport to enable the Proprietor and the service user to access the facilities in the local town/villages. The Proprietor and the service user on occasions stay with another daughter in Norwich which enables them to access facilities in the city. 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 12 The service user told the Inspector about her regular holidays abroad and the friends that she meets there. She clearly enjoys these trips. The service user also enjoys shopping and having meals/coffee in cafes and restaurants. The diary that had been kept for a short time included details of the activities that the service user had taken part in. The Proprietor and the service user return to the county that they moved from at least once per year for the service user to maintain contact with her relatives. It is increasingly difficult for the Proprietor to enable the service user to access leisure/educational activities and there have been difficulties for the Proprietor in obtaining support from social services to assist in this process. The service user told the Inspector what kind of food she likes and said that she always has “nice food”. The diary that had been kept included the meals that the service user had. 44 Monks Close DS0000062976.V292796.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 and 20 The service user receives support in the way that she prefers. There is a need to ensure that the service user receives healthcare services such as dental and optician. There is a need to improve the security of storage of medication and the records of its administration. EVIDENCE: The Proprietor and, on occasion, her daughter are the only ones that provide care to the service user and they both know her very well. The service user spoke highly of the Proprietor and her daughter and considers that she is part of the family. The service user is registered with the local GP and the comment card from the GP did not highlight any concerns. There is a need for the service user to visit the dentist and a requirement is made with regard to this. It is also recommended that the service user is supported to visit the optician as the Proprietor said that she did used to wear glasses. A requirement has already been made in this report about the need to maintain records relating to the service users health needs. 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 14 The Proprietor is responsible for the storage, administration and recording of medication. The previous requirement for secure storage and the maintenance of records of administration has not been met and so is repeated in this report. The Inspector gave the Proprietor information about forthcoming medication training but the Proprietor said that she has difficulties attending training due to transport difficulties and difficulties in providing alternative care for the service user. 44 Monks Close DS0000062976.V292796.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 and 23 The service user feels that her views are listened to. There is a need for the Proprietor to undertake training with regard to the protection of vulnerable adults. EVIDENCE: The Home does not have a formal complaints procedure and the service user would find this difficult to use. The service user feels that she is part of the family and said that “mum” sorts things out for her. The service user has little, if any, contact with anyone other than the family and so may find it difficult to raise any complaints that she may have about the service provided. The Proprietor feels that the service user is part of her family and that, as such, she provides protection to her. The Proprietor has a good understanding of the vulnerability of the service user and the risks attached to her lack of understanding of certain situations. The previous requirement for the Proprietor to attend training with regard to the protection of vulnerable adults has not been met and so it repeated within this report. The Proprietor said that she has difficulties attending training due to transport difficulties and difficulties in providing alternative care for the service user. The previous report contained a requirement for a Criminal Records Bureau disclosure to be obtained for the Proprietor daughter who provides care to the service user. This requirement has not been met and so is repeated within this report. 44 Monks Close DS0000062976.V292796.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, 25 and 30 The parts of the Home seen by the Inspector are homely, comfortable and clean. The Home does not meet the needs of the service user due to the size and location. EVIDENCE: The Home is a two bedroom local authority house located on a housing estate in a very rural location with little public transport. There are no shops or other amenities within walking distance. As previously mentioned in this report this causes difficulties for the service user in accessing leisure and educational facilities. The Home only has two bedrooms and the Proprietors daughter also lives there. The service user said that the Proprietor sleeps in her bedroom when the daughter is also at home. This was confirmed by the Proprietor. This is an unacceptable situation as the service user should have her own bedroom. It is recommended that the Proprietor speak to the service users social worker about the housing situation. 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 17 The Inspector saw the lounge, bathroom and the service users bedroom. These are adequately decorated and furnished and are homely. The Proprietor has two dogs and the service user has two budgerigars. The service user said that she enjoys having the animals and appeared to be comfortable with them. 44 Monks Close DS0000062976.V292796.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): The Home does not employ any staff EVIDENCE: The Proprietor is the main carer for the service user but said that, on occasions, her daughter does provide care for short periods of time. As previously mentioned in this report there is a need for the Proprietor to obtain a CRB disclosures for her daughter. The Proprietor said that her daughter has recently started to undertake NVQ Level 2. 44 Monks Close DS0000062976.V292796.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): 37, 39 and 42 The Proprietor has provided care for the service user for over sixteen years and is capable of doing so. The home does not have a formal quality assurance process but the service user feels that her views are listened to. The Proprietor has taken steps to protect the health and safety of the service user. EVIDENCE: The service user has lived with the Proprietor and her family for sixteen years, since she was a child. The Proprietor does not have any formal qualifications but has recently registered to start undertaking NVQ level 3. Requirements were made during the last Inspection for the Proprietor to undertake training with regard to Food Hygiene and First Aid. This has not taken place and so the requirement is repeated in this report. 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 20 The Home does not have a formal quality assurance process but the service user is involved in discussions affecting her and the rest of the household. The Proprietor has taken steps to protect the health and safety of the service user. For example, there are smoke detectors around the Home, including one at the top of the stairs which has been fitted following a previous recommendation. The service user does not require any specialist equipment but does find the handrails on the stairs useful. 44 Monks Close DS0000062976.V292796.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 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 2 ENVIRONMENT Standard No Score 24 2 25 1 26 X 27 X 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 1 2 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 X 1 X X 2 X 44 Monks Close DS0000062976.V292796.R01.S.doc Version 5.1 Page 22 yes 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 15 Requirement The registered person must keep a weekly diary for the service user, particularly recording issues relating to her health and activities. Previous date of 30/11/05 not met The registered person must keep records relating to the receipt and expenditure of the service users money Previous date of 30/11/05 not met The registered person must keep written risk assessments for issues that pose a risk to the service user. Previous date of 31/12/05 not met The registered person must keep medication in a secure place The registered person must keep records relating to the receipt and administration of medication Previous date of 30/11/05 not met The registered person must attend training with regard to the protection of vulnerable adults DS0000062976.V292796.R01.S.doc Timescale for action 01/06/06 2. YA7 17(2) 01/06/06 3. YA9 13(4) 30/06/06 4. 4. YA20 YA20 13 (3) 13(2) 01/06/06 01/06/06 5. YA23 13(6) 31/08/06 44 Monks Close Version 5.1 Page 23 6. YA37 10(2) 7. YA23 19 8. YA19 12 The previous date of 31/01/06 not met The registered person must attend training with regard to Food Hygiene and First Aid Previous date of 31/01/06 not met The registered person must obtain a CRB disclosure for all people providing care to the client Previous date of 31/01/06 not met The registered person must enable the service user to visit the dentist 31/08/06 30/06/06 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. 2. Refer to Standard YA19 YA24 Good Practice Recommendations It is recommended that the registered enables the service user to have regular checks with the optician It is recommended that the registered person contacts the service users social worker to arrange a review which should include discussions about the suitability of the house It is recommended that the Proprietor attends training with regard to the safe administration of medication 3. YA20 44 Monks Close DS0000062976.V292796.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 44 Monks Close DS0000062976.V292796.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!