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Inspection on 05/01/06 for 51 Greedon Rise (Homefield College)

Also see our care home review for 51 Greedon Rise (Homefield College) for more information

This inspection was carried out on 5th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The following are areas identified as good working practices; 1) 2) 3) 4) Good medication processes for safe medication administration Good promotion of residents` choice Good day care provisions provided away from the home Well maintained, clean and hygienic home

What has improved since the last inspection?

The following areas were noted as improvements since the last inspection; 1) Residents` care plans and risk assessments are being reviewed

What the care home could do better:

The following are recommended areas for improvement; Give staff members access to operational records for inspection Issue residents with a contract of residence for legal protection Provide evidence of staff members` training including medication training Provide evidence of Regulation 26 (unannounced visits to the home) visits by the registered provider 5) Complete risk assessments of lone staff member working on night duties

CARE HOME ADULTS 18-65 51 Greedon Rise (Homefield College) 51 Greedon Rise Sileby Loughborough LE12 7TE Lead Inspector Mr Everton Osbourne Unannounced Inspection Thursday, 5th January 2006 16:30 51 Greedon Rise (Homefield College) DS0000001799.V275604.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 51 Greedon Rise (Homefield College) DS0000001799.V275604.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. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 51 Greedon Rise (Homefield College) Address 51 Greedon Rise Sileby Loughborough LE12 7TE 01509 816091 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) www.homefieldcollege.ac.uk Homefield College Limited Ms Wendy Cooke Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration apply. Date of last inspection 31st August 2005 Brief Description of the Service: 51 Greedon Rise is a four bedroom semi-detached property situated on a residential estate in the village of Sileby. This home is registered to care for four young people with learning disabilities. The town centre of Sileby is within close proximity to the home and residents have access to shops and other amenities. The home is easily accesible by public and private transport. The premise consists of two floors for residents use which is accessible by use of the stairs. The home has four single bedrooms without en-suite facilities. There are sufficient numbers of toilet and bathrooms in the home based on four people sharing the facilities. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took Three hours to complete. The outcome of this inspection was fair based on observations made, document reading and conversation held with two residents. Five Recommendations made at the last inspection remain unresolved. One Requirement was made regarding the home’s Statement of Purpose. Good systems are in place to ensure that residents are protected and that they receive good quality care. Observations made indicated that the premises are maintained to good standards creating a homely environment. One staff member on duty for the night was also spoken with as part of the inspection process. What the service does well: What has improved since the last inspection? 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. 1) 2) 3) 4) 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 6 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 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Acceptable admission procedures are carried out by the home so that prospective residents can receive the right care in the right environment. EVIDENCE: The Statement of Purpose was inspected. Insufficient information is provided about the home in accordance with written Regulations. The registered provider is required to review and update the home’s Statement of Purpose. One resident’s assessment was inspected. The document contained information which identified the resident’s care needs. Conversation held with this resident indicated that the assessment gives an accurate account of her required care needs. One resident’s admission record seen indicated that a contract of residence was not given to the resident. Conversation held with this resident indicated that she does not recall receiving a contract or Terms and Conditions of her residency. It is recommended that the registered provider issue a contract of residency to every resident residing in the home. Conversation held with two residents indicated that they had trial visits to the home before moving in. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 and 10 Residents’ care plans are good in ensuring that residents receive the care they need. EVIDENCE: One resident’s care plan seen showed that all aspects of her care needs are incorporated into the care plan. The information contained in the document gives staff members’ instructions on how to meet this resident’s care needs. Two residents spoken with indicated that they are satisfied with the care provided in the home. Conversation held with two residents and one resident’s risk assessment seen indicated that residents are supported to take reasonable risks as part of their daily living. Observations made and conversation held with one staff member indicated that residents’ documents are kept locked and secured. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 9 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): 14 Processes are in place to promote residents’ personal development so that they can pursue recreational and occupational activities. EVIDENCE: Observations made and conversation held with two residents indicated that they pursue occupational, educational and recreational activities as part of their daily living routine. One resident’s day care records seen confirmed the residents’ verbal statements. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 10 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): 20 and 21 The medication process is good in ensuring that residents receive their medication at the times prescribed. EVIDENCE: An examination of one resident’s Medication Administration Record showed that medication records are kept up to date with the medication also kept in order. There was no access to medication training records because they were locked away and the staff member on duty did not have access to those records. Conversation held with one staff member and the home’s policy seen indicated that suitable processes are in place in the event of the death of a resident. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 11 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): Not applicable EVIDENCE: Not applicable 0 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 12 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): 27 and 29 Residents’ surroundings are comfortable to meet their accommodation needs. EVIDENCE: Observations made and conversation held with two residents indicated that there are sufficient toilet and bathing facilities situated throughout the premise based on the number of residents accommodated in the home. Observations made indicated that there are sufficient equipment in the home for residents’ daily living needs for example kitchen equipment. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 13 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): 31, 33, 34 and 36 Staff members appear to be suitably trained to deliver good quality care but there were no written evidence to support this. EVIDENCE: Access to staff members’ records was not obtained because they were locked away and the staff member on duty did not have access to those records. There appear to be sufficient numbers of staff members on duty throughout the day. One staff member is on duty throughout the night. No risk assessment seen regarding staff members who work alone during night duties. It is recommended that the registered provider carry out a risk assessment for staff members who work alone during night duties. No evidence seen to indicate that the registered manager is carrying out regular supervision of staff members as required. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 14 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): 41, 37, 38, 40 and 43 The home appears to be managed to an acceptable level with priority placed on residents’ well-being. Staff members records were not available for inspection. EVIDENCE: Registration documents seen prior to this inspection regarding the registered manager indicated that she is suitably trained and experienced to manager this home. Two residents spoken with indicated that they are satisfied with the manager’s approach to managing the home. An inspection of the home’s policies indicated that the documents contain information for staff members’ guidance regarding care practices in the home. Observation made during the inspection indicated that the staff member on duty appeared to be adhering to safe work practices in accordance with the home’s written policies and guidance. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 15 Written records concerning staff members such as their recruitment, supervision and training records were not available for inspection because they were locked away. The staff member on duty indicated that she does not have access to those records. It is recommended that the registered provider give access to the staff team for the purposes of future inspections. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 16 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 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 3 28 x 29 3 30 x STAFFING Standard No Score 31 x 32 x 33 3 34 3 35 x 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 3 3 3 2 3 2 x 3 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 17 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 YA1 Regulation 4 Requirement The registered person shall compile in relation to the care home a statement as to the matters listed in Schedule 1. Timescale for action 19/01/06 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 YA5 YA36 Good Practice Recommendations The registered person should write a contract of residence in agreement with all residents and keep a copy in their care records. The registered person should carry out regular supervision of individuals within the staff team at least six times per year and provide written evidence for the purposes of inspection. The registered person should carry out a risk assessment for staff members who work alone on night duty and provide written evidence to show that lone working staff members are suitably supported. The registered person should carry out Regulation 26 (unannounced visits to the home) visits and submit a report once per month to the CSCI. The registered person should provide suitable access of DS0000001799.V275604.R01.S.doc Version 5.1 Page 18 3 YA36 4 5 YA39 YA41 51 Greedon Rise (Homefield College) staffing records to the staff team and have these records available for future inspections. 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 51 Greedon Rise (Homefield College) DS0000001799.V275604.R01.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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