CARE HOME ADULTS 18-65
5 Shetland Court Carisbrooke Road West Durrington Worthing West Sussex BN13 3RL Lead Inspector
Mrs J Aston Unannounced Inspection 18th July 2006 09:30 5 Shetland Court DS0000014316.V293943.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 5 Shetland Court DS0000014316.V293943.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. 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 5 Shetland Court Address Carisbrooke Road West Durrington Worthing West Sussex BN13 3RL 01903 691117 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) H4037@mencap.org.uk Royal Mencap Society Mrs Christine Davies Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: 5 Shetland Court is a Care Home registered to accommodate up to seven people in the Learning Disability Category aged between 18-65. The home is registered to provide personal care only. The accommodation consists of seven single rooms two of which are situated on the ground floor and five on the first floor. The property provides a lounge, dining room and kitchen and easy access to the garden at the rear of the property. The service provides personal care assistance and support to access day care services and appropriate leisure activities for adults with a profound learning difficulty and physical disability. The Royal Mencap Society owns the service. The Responsible Individual operating on behalf of the organisation is Ms Janine Tregelles. The Registered Manager is Mrs Christine Davies. 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection is the first inspection in the inspection year 2006-2007. This inspection is called a key inspection and will determine the frequency of inspection hereafter. The inspection was an unannounced inspection undertaken on Tuesday 18th July 2006 from 9.30am to 3pm. On arrival all six residents were in the home. The Inspector was unable to obtain the views of the residents during the inspection due to communication and comprehension difficulties. However some interactions between members of staff and residents were observed. Comment cards for relatives were sent to the home for distribution after the last inspection. Five comment cards have been received from relatives. Four were received from Professionals and two from G.P.’s. During this visit the Inspector looked around the home, spent time talking with members of staff and examined a sample of records. What the service does well: What has improved since the last inspection?
A requirement was made at the last inspection in relation to the development of the residents care plans and files to ensure that the information is condensed and provides evidence of how residents’ needs are to be met. It was noted at this inspection that this work is now complete. Garden furniture had been purchased, a new cooker has been installed and the boiler and central heating are now working in all parts of the home. 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 6 Improvements have been made in the frequency individual supervision off for members of staff. 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. 5 Shetland Court DS0000014316.V293943.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 5 Shetland Court DS0000014316.V293943.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, Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The organisation has comprehensive assessment and admission policies and procedures in place. EVIDENCE: Since the last inspection a service user has moved out of the home leaving one vacancy in the home. The Inspector is aware of the assessment and admission policies and procedures that are in place for Registered Managers and Service Managers to follow for any prospective service user. The policies and procedures require an assessment of the service users needs to be undertaken by the Registered Manager and must be supported by a Social Work assessment. The expectation is that a prospective service user is admitted to the home in a planned way. 5 Shetland Court DS0000014316.V293943.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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Improvements have been made to the format and information included in the service user individual plans. Service users are supported to make decisions and choices and any potential risks are considered and minimised as far as possible. EVIDENCE: Four out of the six records relating to service users were examined at this inspection. It was noted that all individual service user plans had been updated and compiled into a working file. This gives comprehensive information about service users behaviour, there needs, likes and dislikes. A photograph of the service user, a record of the last dentist, optician, chiropodist and other Health check ups and G.P. visits should also be contained in this working file. It was observed during the inspection that members of staff offered choices to service users.
5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 10 However due to the level of disability of some service user decisions have to be made in the best interests of service users but where their choice or wish is known this is recorded in their individual plan. There was evidence that potential risks for service users had been considered and actions taken to minimise the risk. A risk assessment recorded this information. Risk assessments were noted to be individual for each service user and covered areas in respect of bathing, travelling in vehicles etc. 5 Shetland Court DS0000014316.V293943.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. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels must be improved to ensure service users are able to participate in a range of activities. Activities for each individual must be reviewed. Service users are supported to maintain relationships. More flexibility could be introduced into meals and meal times. EVIDENCE: Individual service user plans indicated activities service users like to be involved in. The activities ranged from day care outside of the home, individual activities coming into the home from a professional such as a music therapist and aromatherapist and trips out of the home supported by members of staff such as swimming, shopping, and trips to local pubs and restaurants. From information gathered during the visit to the home and from observations made whilst in the home the Inspector has concerns about the level of staff available to support individuals with activities.
5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 12 The Inspector asked if service users were still going to the local private health & sports club where they had been given a special time to attend. The Inspector was made aware that some of the visits have had to be cancelled due to staffing levels. Whilst the Inspector was in the home there was no evidence of any meaningful activities being undertaken and service users were observed just wandering around the home. Improvements must be made in staffing levels to ensure service users are supported to participate in activities. A review of activities for each service user must be undertaken. The home have developed and maintained relationships with family. Five out of the six service users relatives responded to the inspection through comment cards. All relatives said that they were made welcome, they were kept informed of important matters affecting their relative and were consulted about their care. Due to the level of disability members of staff at times have to act in the best interests of residents however every attempt is made to ensure that a resident’s rights and choices is upheld as far as possible. A menu was supplied as part of the pre-inspection material. The menu is planned over a four week period and the main meal is eaten at lunch time. All meals are prepared and cooked by members of staff. It was an extremely hot day on the day of the inspection. The Inspector ate a meal of spagetti bolognese with the service users. It appeared that there was no opportunity to change the meal to something more in keeping with the weather or the time of the main meal. The Inspector discussed this with members of staff. The Inspector was informed that there is very little flexibility with the meals provided or with meal times such as when the main meal of the day was eaten. It is recommended therefore that more flexibility be introduced to meals provided and meal times. 5 Shetland Court DS0000014316.V293943.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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users personal care and health needs are met appropriately. The service operates effective and safe procedures in the administration of medication. EVIDENCE: From the sample of service user plans examined it was demonstrated that members of staff have comprehensive information about the personal care and health needs of each service user. However as previously stated the health care check ups should be recorded in the service user plan. Both G.P’s who responded through surveys confirmed that the home communicates clearly and work in partnership with them and staff demonstrate a clear understanding of the care needs of service users. It was noted that where necessary a service user’s weight and other health monitoring is recorded. Members of staff confirmed that appropriate training in how to move service users and to use lifting equipment is provided and updated regularly. They confirmed that they have the necessary equipment and it is in good working order.
5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 14 Due to the poor staffing levels found at this inspection the Inspector also has concerns about how much time staff have available to ensure that they are able to carry out their Key working reponsibilities. Medication was stored appropriately in the home. Records of medication given was in good order. Each service user has a pen picture in relation to what medication they are taking and what it is for and what to look for if there are any side effects. Both G.P.’s who responded to the inspection through surveys confirmed that service users’ medication is appropriately managed. 5 Shetland Court DS0000014316.V293943.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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Complaints are dealt with appropriately. The service has taken steps to protect service users. EVIDENCE: There have been no complaints made to the home or to the Commission for Social Care Inspection. A complaints policy and procedure is available for the service. Three out of the five relatives who responded to the inspection through comment cards were aware of the complaints procedure. It was noted that a copy of the complaints procedure is kept by the front door in the home. There have been no referrals made under adult protection procedures. The service work to the West Sussex Multi-disciplinary Adult Protection Procedures and it was noted that members of staff have received training in these procedures and in recognising signs of abuse. It was noted that some guidelines have been put in place in respect of working with service users with challenging behaviour and training in physical interventions has been provided to all staff in March/April 2006. This meets the requirement made at the last inspection. The organisations policies and procedures ensure that service users money is handled appropriately. The Registered Manager is the service users appointee.
5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 16 Each service user has an individual building society account and members of staff assist service users with the management of this account. Two signatories are required to withdraw any money from this account. All transactions are recorded and receipts obtained. Service users files contain a record of money spent and hold the receipts. The accounts for each service user are checked regularly by the manager and as part of the regulation 26 visits. 5 Shetland Court DS0000014316.V293943.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, 30. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The standard of accommodation provided for service users is good and provides a safe environment. EVIDENCE: A tour of the premises was undertaken. The property is of a high standard and provides a comfortable and homely environment. Service user rooms looked individually decorated and furnished and suitable for the needs of the service users. The home looked clean throughout and well maintained. A new cooker has been purchased. Garden furniture had been purchased and used however the chairs are falling apart and have to be returned. The Inspector discussed the storage of a hoist and wheelchair in the recess by the stairs and perhaps that an alternative storage place could be found. Records examined demonstrated that safety checks on the property and utilities are regularly undertaken and comply with safety legislation. 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 18 The garden is accessible to service users and reasonably well kept however this does need continual attention. Members of staff are responsible for gardening. Considering the poor staffing levels found in the home at this inspection members of staff do not have time to do gardening, therefore the Registered Manager must ensure that this is addressed in a different way. 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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, 35. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Currently staffing levels are inadequate to meet the needs of service users. Training is appropriate and NVQ now undertaken. There are good recruitment procedures and individual supervision of staff is now regularly undertaken. EVIDENCE: A sample of training records demonstrated that all staff had undertaken a wide range of training from induction through to National Vocational Qualifications level 2 & 3. The pre-inspection questionnaire confirmed that ten members of staff have undertaken training at NVQ level 2 and above. Training in Health & Safety topics had been undertaken at induction and updated as required. Specific training in topics relevant to the needs of the service users had also been undertaken. Members of staff confirmed that this training had been provided and that updates in Health & Safety topics are being updated again this year. It was noted that all staff had received training in using physical interventions. Currently there are four vacancies for support workers in the home. The Inspector was informed that there has been a difficulty in recruiting new staff. On the day of the visit to the home two members of staff were on duty.
5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 20 One member of staff had specific needs that required extra support. Both members of staff had been working alone assisting service users to get up, washed and dressed. One service user requires assistance with moving using a hoist. A member of staff confirmed that only one member of staff supported this service user whilst using the hoist. One member of staff then left the home to drive service users to day centres. It was noted that the driver also took other service users in the car. The Inspector was informed that they are advised that if one member of staff was working in the home alone then the service users with challenging behaviour would be taken out with the driver. This clearly puts the driver and other service users at risk if one of these service users became agitated. The current and planned rotas for the next three weeks were examined. It was evident that most shifts are covered by two members of staff only. It was also identified that there were at least five shifts were the member of staff with specific needs was on duty with only one other person. It was also noted that there were seven shifts where a permanent member of staff worked with an agency member of staff. Agency staff are not allowed to give medication, drive or be left in the home alone. Therefore when there are only two members of staff on a shift and one is an agency member of staff more responsibility is put onto the regular member of staff and unless all service users go out at the same time trips out of the home have to be cancelled. There are currently only two support workers who are able to drive the homes vehicles. When a support worker is on duty who is a driver a lot of their time is taken up driving service users to day care facilities. Due to the fact that members of staff are responsbile for cooking, cleaning, driving, gardening, laundry, medication, answering the phone when the Manager or Deputy are not in the office, and supporting service users the staffing levels of two members of staff on each shift is very inadequate. A review of the staffing structure and expectations of staff responsiblities should be undertaken. Staffing levels must be increased as a matter of priority. Four members of staff records were examined during the inspection that included one new member of staff. The records demonstrated that the organisation follows a robust recruitment procedure and all staff had Criminal Record Checks undertaken. Records demonstrated that those members of staff have received regular supervision. There was no evidence of annual appraisals/personal development reviews. Members of staff spoken with confirmed that they receive regular supervision and staff meetings are usually held regularly. 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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, 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is well maintained and safe for service users. The safety of service users and members of staff is considered and risks minimised as far as possible. EVIDENCE: A quality assurance system is in place and provides an organisation service review every 2-3 years. The Manager had undertaken a quality assurance exercise last year that obtained views of the service from relatives and professionals who know the service. A quality assurance exercise should be undertaken for this year. 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 22 Records demonstrated and members of staff spoken with confirmed that training in the Health & Safety topics: Moving & Handling, First Aid, Food Hygiene, Fire and Health & safety is undertaken as part of their induction programme and then updated as required. Currently the food hygiene training is being updated. Records seen on the day of the inspection demonstrate that annual safety inspections are undertaken on equipment and utility supplies and maintenance systems are in place to ensure the safety of residents. The Inspector is aware from previous inspections that risk assessments are undertaken in respect of potential risks to staff or service users when using kitchen equipment for example and other hazards within the home. There is a current liability insurance certificate for the home . 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 23 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 X 33 1 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x X X 3 X X 3 x 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA33 Regulation 18 (1) (a) Requirement The Registered Person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The Registered Person shall make arrangements to enable service users to engage in local, social, and community activities and to provide a programme of activities. Timescale for action 31/07/06 2 YA13 16 (2) (n) 04/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 5 Shetland Court DS0000014316.V293943.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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