CARE HOME ADULTS 18-65
Grosvenor Crescent (5) Dorchester Dorset DT1 2BA Lead Inspector
Marion Hurley Unannounced Inspection 7th December 2005 10:30 Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 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 Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 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. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Grosvenor Crescent (5) Address Dorchester Dorset DT1 2BA 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) 01305 262046 01305 250138 Leonard Cheshire Mrs Glynis Elizabeth Baker Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Mrs Baker to undertake an adult protection managers course (agreed suitable by the Commission) by September 2005. 23rd June 2005 Date of last inspection Brief Description of the Service: 5 Grosvenor Crescent is a registered care home that can accommodate up to three adults who have a learning disability, and additional physical disability. The home is one of seven similar services in Dorchester that are owned by the Leonard Cheshire Foundation, a not for profit organisation providing services to people with disabilities. The house is a dormer bungalow, located on a residential estate, within walking distance of Dorchester town centre and the local facilities. It is a family style home with domestic furniture and fittings. There is a large back garden, with summerhouse. The downstairs bedroom has been adapted and equipped for a wheelchair user. Residents living at Grosvenor Crescent are supported by staff on a 24-hour basis. The service provided includes the provision of accommodation, day services, personal care, meals and laundry services. Residents are expected to pay for personal items, such as clothing and toiletries, and also make contributions to certain activities that are provided outside of the day service programme. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act, 2000. Grosvenor Crescent was assessed according to the Care Home for Adults (18-65) National Minimum Standards. The overall time spent to complete the inspection process was a total of five hours; one and half were spent at the home. In the course of this inspection one member of the staff team was available and the Registered Manager was later seen in the Cheshire Home’s Main Office for further verification and discussion. Unfortunately all the residents were out at the time of this unannounced visit. What the service does well: What has improved since the last inspection?
Since the last inspection members of the staff team and the Registered Manager have spent considerable time in developing and changing the written format of the Individual Service Plans. The new style reflects a Person Centred Approach to these documents and the reader gets a real feel of the person in addition to good practical information. Requirements and good practice recommendations have been met with reference to the safe handling and administration and storage of medicines. A comprehensive programme of staff training events has given staff opportunities to attend statutory training courses. Two members of staff are currently completing the Team Leader course in management. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 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 Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 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 • Service Users would only be admitted based on an assessment of their needs ensuring the home would be able to meet the service user’s identified needs and have the appropriate staffing levels and facilities. EVIDENCE: Since the last inspection no new services users have been considered for Grosvenor Crescent. The group of people living at this small family style home are settled with the last person joining nearly twelve months ago and no changes in the family group are anticipated. In view of this the inspector discussed the principles of a prospective service user being considered for a placement with the Registered Manager. It was clear from these discussions that their knowledge and understanding of good working practices would ensure any prospective service user’s needs would be fully identified through assessments. Many of the prospective service users considered for the Cheshire Home Service have complex needs and very individual methods of communicating and in reality it might take months to complete a full assessment of the persons needs, preferences and wishes. Records relating to the resident’s needs indicated the staff’s ability to seek advice and work as part of a multi agency network obtaining specialist assessments where appropriate. It is anticipated any prospective service user would benefit from this comprehensive approach. Prospective service users would always be involved and the admission process would be based on the individual’s ability to cope with the transition of moving into a new situation. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 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): 7 • Residents make decisions about life in their own home. This encourages each person in their own way to gain a degree of independence in his/her own life. EVIDENCE: Evidence of how residents’ independence and participation is encouraged was noted by discussions with the member of staff on duty at the time of this inspection. Residents are given choices about the food they want to eat and the drinks they like to have, what clothes they want to wear, and how they spend their time enjoying activities. On occasions it is difficult for the residents to distinguish what they may like to choose and then the staff make the “best guess possible based on their knowledge and the resident’s previous decisions”. Staff will present choices to the resident which encourages and helps the resident to make a decision for example at breakfast time a choice of cereal is available for each to select from. Resident’s indicate their decisions through a series of sounds, gestures and other distinctive behaviours. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 10 Please note a good practice recommendation from the previous report has been fully actioned and the records of one service use reflected the change in style of formulating the resident’s individual Plans which now are Person Centred and more holistic providing the reader with a real feel of the person’s wishes, abilities and needs. The new style service plan is divided into two files one detailing the resident’s care and social needs and the other their health needs. Each file contained clear practical instructions for staff, which identified how that resident likes and needs to be supported to manage daily living tasks. Good use of symbols and words had been used and one informative sheet had the photograph of the resident in the centre and then all their likes and dislikes spreading out from them. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 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): 15, 16 & 17. • Considerable focus is given in supporting residents to maintain contact with their family and in developing appropriate relationships. • Residents’ rights are respected and independence and choice promoted in the home. • Meals are healthy and mealtimes flexible to suit the resident’s lives. EVIDENCE: The residents all have different levels of contact with their family members. One person has little contact whilst another has regular “sleep overs” with their family and another family phone regularly. Whilst, in this case the resident can’t speak to their family the use of the telephone is encouraged so the resident can at least hear and listen to their family members speaking. Contact with family members is recorded in each resident’s own diary. Staff described how one resident is just beginning to accept the company of others though at this stage still does not react and therefore it is difficult for staff to ascertain if this contact is a good experience for the resident or not however s/he appears quite relaxed in the company of others when pursuing activities i.e. swimming, walking. Residents are friends with other service
Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 12 users supported though the Cheshire Home Services and one resident also benefits from regularly meeting with their peers at the Social and Education Centre. Both the Registered Manager and member of staff emphasized the importance of consistently treating the residents with respect and ensuring their dignity at all times irrespective of the resident’s non-verbal behaviour and extreme gestures at times. The menu is planned a month in advance and whilst it does not show specific choices there is always an alternative available. Staff know the resident’s likes and dislikes and adjust the menu accordingly. Staff are keen to encourage healthy living and the menu was balanced and showed plenty of variety. No special diets are required. However, one resident reacts if the food is too spicy and staff are conscious of the reactions which may be caused by drinks with too many additives or caffeine. Decaffeinated tea/coffee is introduced from time to time. None of the residents can voice their opinions concerning the menu. However, staff are confident they would be able to interpret the residents’ likes/dislikes through their behaviour and other gestures and sounds. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 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): 19 • The home’s system for assessing & reviewing and monitoring residents healthcare needs is well managed and allows for individual needs to be continually met as and when they change. EVIDENCE: Discussions with staff confirmed that personal care and support is provided according to each resident’s individual needs and preferences. One resident’s health care records were read and this documentation clearly stated the needs of the resident and the most appropriate way to manage them. It is difficult for the resident’s to voice their opinion concerning their own health and even how they are feeling so staff have to be very alert to interpret any changes in each person’s behaviour and non verbal communication. The records demonstrated there was regular input from other professionals and all appointments and outcomes were recorded. All residents have regular health checks including appointments with the dentist, opticians and the audiologist. One person has been identified as requiring additional supplements to improve general well being and help stabilise their weight. The member of staff spoken with during the inspection demonstrated a good understanding of the personal and healthcare needs of residents living in the home.
Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 14 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): 23 • • Adult Protection is appropriately and well addressed in staff training. There are both policies and good practice in place to help safe guard service users from potential abuse and harm. EVIDENCE: Cheshire Homes, Dorchester, has clear policies and procedures and a working understanding of the issues concerning the Protection of Vulnerable adults and this information is appropriately cascaded to the staff throughout the network of their small homes in and around Dorchester. Staff are provided with information in their induction programme about the key issues surrounding Adult Protection, and Whistle blowing. Staff are currently being nominated for a series of POVA training events. The Registered Manager and member of staff spoken with during the course of this inspection demonstrated a good understanding of the issues and are very alert to ensure the residents are safeguarded at all times from potential abuse and harm. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 15 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): The key standards were assessed at the last inspection. EVIDENCE: Please refer to the summary for general information concerning the environment. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 16 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 & 34 • The employment procedures and the staff training programme, is comprehensive and covers all elements of the statutory training, ensures residents are safely protected and supported by staff trained to undertake their duties and accept their responsibilities. EVIDENCE: The Registered Manager and member of the staff team each talked confidently about the needs and preferences and wishes of the different residents. Both had clear insight into the different styles of communicating each resident use. No residents were present during this unannounced inspection visit and therefore no observation of staff & residents interaction could be recorded to provide further evidence. All staff files are retained at Cheshire Homes main Dorchester Office and three files were checked when visiting these administrative offices. Each file contained the required statutory checks and references. Both POVA first and an Enhanced CRB check had been received plus two references. Identification and a photograph was found in each file along with completed interview notes, “letter of offer of employment”, terms and conditions/contract. A useful checklist was at the front of each file and had been completed in each case. An induction/training checklist was found completed in two out of the
Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 17 three files and those completed confirmed which policies and procedures had been provided to the new recruit. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 18 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): 42 • Health & safety checks are adequate and these contribute to safe working practices to protect residents and staff living and working at the home. EVIDENCE: The responsibility for checking the health and safety equipment and servicing records is with the maintenance employee who is based at the Cheshire Homes Administrative Offices, Dorchester. Each home has a generic work base file containing risk assessment and these are reviewed. Other documents relating to individual staff fire prevention training are collated at the Administrative offices and kept with other training records in individual training files. The “responsible individual” representative for Cheshire Homes completes the monthly monitoring visits, Regulation 26 and these reports are comprehensive and extremely useful and practical in providing on going information. Please note NMS39 was not reassessed but remains a requirement from the previous inspection. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 19 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 x 3 x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 3 x x x Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Grosvenor Crescent (5) Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x DS0000026751.V266745.R01.S.doc Version 5.0 Page 20 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 YA39 Regulation 24 Requirement The home must establish and maintain a system for reviewing and monitoring the quality of care provided by the home and where possible involving residents or their representatives. Please note NMS39 was not reassessed but remains a requirement from the previous inspection Timescale for action 31/03/06 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 YA9 Good Practice Recommendations Risk assessments should be reviewed regularly and provide details of who has been involved /consulted with during the assessment process. Risk assessments must reflect the individual residents abilities/needs and the hazards applicable to them and the plan of actions to minimize the hazards and risks. Grosvenor Crescent (5) DS0000026751.V266745.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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