CARE HOME ADULTS 18-65
61/63 King Street Leonard Cheshire 61 and 63 King Street Sileby Leicestershire LE12 7LZ Lead Inspector
Kim Cowley Unannounced Inspection 6th July 2006 11:00 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 61/63 King Street Address Leonard Cheshire 61 and 63 King Street Sileby Leicestershire LE12 7LZ 01509 817750 01509 817751 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) Leonard Cheshire Mr Robert Edwards Care Home 17 Category(ies) of Physical disability (17) registration, with number of places 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13.11.05 Brief Description of the Service: King Street was purpose built in 2002. It has a total of 16 beds arranged in two eight-bedded units (which were, until 2005, registered as two separate homes). Each unit has 8 single bedrooms all with ensuite facilities (a toilet, shower and washbasin), two lounges, a dining room/kitchen, and a bathroom. There are secluded gardens at the rear of the home. There is a passenger lift. All areas of the home are designed to be wheelchair-accessible. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection that included a visit to the home and inspection planning. Prior to the home visit, the inspector spent half a day reviewing the last inspection report, and information relating to the home received since that inspection. During the course of the inspection, the inspector checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means that the inspector looked at the care provided to three residents living at the home by talking with the residents themselves; talking with the Team Leader and staff who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were inspected. Three other residents, three members of staff, and the Team Leader were also interviewed. The following areas were commended: care plans, the giving of personal care, the complaints procedure, the premises and their cleanliness, the staff team, the management. What the service does well:
King Street offers an excellent service to younger adults with physical disabilities. The premises are spacious and airy and the atmosphere in the home is lively and purposeful. One resident commented, ‘This home has changed my life. I feel I’m part of something here.’ Another said ‘I absolutely love it here.’ Staff are trained to treat residents with dignity and respect and to take account of their wishes at all times when delivering personal care. This is emphasised during in-house induction training, which is run every six weeks by Leonard Cheshire at various venues. During the inspection staff were seen caring for residents in a warm and sensitive manner. All residents interviewed made many positive comments about the home including: ‘I would grade this home as excellent.’ ‘It’s like being in your own home.’ ‘My way of life is less restricted here.’ ‘The philosophy of this home is fantastic – be as independent as possible.’ The home has a core of experienced staff who are able to provide residents with continuity of care. The Team Leader said, ‘I am pleased to say I have excellent staff. They have a good approach to care, work well as team, and I like way they relate to the residents.’ All residents interviewed praised the staff team and the following comments were made, ‘The staff are good. They’ve
61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 6 helped me come to terms with my disability’, ‘The staff understand about my condition. They explain things to me’, and ‘All the staff have time for us. They’re always willing to talk.’ The home is run along non-institutional lines with the emphasis being on resident choice. This reflects the ethos of the Owning Body. The result is a homely environment with residents who are confident about speaking out and determining their own care and lifestyles. One resident commented, ‘The Manager and the Team Leader have made me feel part of this home.’ 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. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ needs are assessed prior to admission to ensure the home is suitable for them. EVIDENCE: The Manager and Team leader assess new referrals in their own homes or in hospital using the Owning Body’s assessment procedure. They are then invited to visit the home to see if they like it. During this visit they are encouraged to meet with existing residents and to share a meal with them. Existing residents are given the opportunity to share they views about the new referrals with staff. Overnight stays are not permitted for insurance reasons, but new referrals can visit as often as they like to enable them to make a decision as to whether or not the home might be suitable for them. Social work assessments are taken into account during the admission procedure. Records relating to two new admissions were examined and found to be of a good standard. One resident commented, ‘I came and looked around a couple of times and staff answered all my questions. I wasn’t pressured and I was given time to make my mind up. But that didn’t take long and I’m really glad I chose to come here.’ 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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 excellent. This judgement has been made using available evidence including a visit to the service. Residents care needs are met. EVIDENCE: Care staff are responsible for writing care plans, overseen by the Manager and Team Leader. Care plans are viewed as ‘live’ documents, subject to continual improvement and review. Residents are always involved when their care plans are being written or reviewed, and are asked to contribute to them. Care plans were inspected and found to be well presented and user-friendly, with pictorial covers illustrating residents’ interests. Care needs are set out in residents’ own words. There is a section for cultural needs. Residents have free access to their care plans. One resident went to get theirs to show it to the inspector. The resident said, ‘This tells the staff how to look after me. I wrote some of it myself.’ Care plans are commended. Residents are encouraged to make choices about all aspects of their lives and these are recorded in their care plans.
61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 10 Residents are supported in taking responsible risks and comprehensive risk assessments are in place. While encouraging residents to be independent, staff also expect them to behave responsibly, for example by letting staff know if they are going out. Information about residents is kept securely and in accordance with the Data Protection Act. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are encouraged to lead full and active lives. EVIDENCE: Staff encourage residents to become more independent and to integrate into the local community. Residents use local shops, cafes and pubs. The home’s part-time Volunteer Co-ordinator has recruited a driver for residents, and a tutor to do cookery with them. Residents attend colleges, day centres and clubs. Residents have their own minibus that takes three wheelchair users, two staff, and the driver. Residents’ comments included: ‘We have holidays here and trips out.’ ‘We went to Rutland Water.’ ‘The staff take me to the pub.’ ‘We had a quiz night which I enjoyed.’
61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 12 Residents are supported in having appropriate personal relationships. There is a ‘Personal Relationships Policy’ and residents can have independent advocates if they wish. Care staff are responsible for shopping and cooking and residents are involved as much as they wish. Supplies are ordered ‘on line’ from a supermarket. Four weekly menus are planned, but these are flexible and alternatives are always available. Mealtimes are also flexible and organised to fit in with residents’ lifestyles. Some residents make their own snacks and drinks with staff support if they need it. The kitchen facilities are wheelchair accessible 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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 using available evidence including a visit to the service. The health and personal care needs of residents are met. EVIDENCE: Staff are trained to treat residents with dignity and respect and to take account of their wishes at all times when delivering personal care. This is emphasised during in-house induction training, which is run every six weeks by Leonard Cheshire at various venues. During the inspection staff were seen caring for residents in a warm and sensitive manner. This is commended. Two GP surgeries provide health services to the home and District Nurses visit when necessary. Services from private or NHS chiropodists are available. Dentists and opticians either visit or residents go to them in the local community. Physiotherapy services are contracted in. One resident commented, ‘This home is very hot on physical illness – they sort you out quickly if there’s anything wrong.’ The home’s pharmacist supplies medication and carries out inspections four times a year. Staff who administer medication attend an accredited course
61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 14 organised by the pharmacist. Medication is kept securely in both units. Residents who are able self-medicate supported by staff. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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 excellent. This judgement has been made using available evidence including a visit to the service. Residents feel able to talk to staff about any concerns they might have. EVIDENCE: The complaint procedure is displayed in the home and made available to all residents and their representatives. All residents interviewed said they were aware of this. All said they would speak to a member of staff if they had any concerns. One resident said, ‘The Manager is the last resort if there are problems. He told me “My door is always open”.’ Another commented, ‘If you have a problem it’s usually sorted out that day.’ Residents are reminded of the complaints procedure at meetings, and also encouraged by their key workers to voice any concerns they might have. The home keeps a ‘Service Complaints Record’ as part of its corporate complaints procedure. Records showed that complaints are taken seriously and investigated properly with residents and their representatives keep fully informed of all developments. Staff are commended for their open and supportive approach to residents who wish to complain. Policies and procedures are in place to protect resident from abuse. Staff receive induction and ongoing training in this area. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents live in an environment that is comfortable and well maintained. EVIDENCE: The home was purpose-built and designed to be easily accessible to wheelchair users. Corridors and doorways are wide and rooms are large and free of obstacles. There is a good range of equipment for residents with limited mobility. All bedrooms, ensuites, and communal bathrooms have ceiling hoists. A manual hoist is kept for use in emergencies. The home has two Parker-type baths and adapted kitchens with ‘rise and fall’ worksurfaces and sinks. Residents’ bedrooms are all single and large. They have ceiling hoists and their own ensuite toilets, showers, and washbasins. Four residents showed the inspector their bedrooms and all were homely and personalised. Ground floor bedrooms have French doors leading outside. The landscaped gardens are secluded.
61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 17 A number of improvements have been made to the premises since the last inspection including: • • • The smoking room has been completely refurbished (at present one resident in the home smokes) A further bedroom has been created. This was inspected and found to offer an excellent standard of accommodation. The downstairs corridors have been re-carpeted. A cleaner is employed to work for 15 hours per week in each unit. Care staff do the rest of the cleaning, sometimes helped by the residents. All areas inspected were clean, fresh and tidy. Radiators are covered and water temperatures are thermostatically controlled to reduce the risk of scalding Residents’ comments about the environment included: ‘I can make myself a drink in the kitchen’ (because of disabled access to kitchen facilities) ‘My room is very well laid out with the buzzer near my bed and my own hoist.’ ‘When I moved in I had shelves put up in my room and I’m having the internet installed.’ The premises and their cleanliness are commended. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 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): 32, 34, 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Friendly and professional staff meets residents’ needs. EVIDENCE: The home has a Manager, a Team Leader, carers, and ancillary staff. There is a core of experienced staff who are able to provide residents with continuity of care. The staff on duty were friendly, helpful, and enthusiastic about the work they do. Those interviewed said they were committed to enabling residents to live more independent lives. Staff were observed interacting with residents in warm and positive manner. The Team Leader said, ‘I am pleased to say I have excellent staff. They have a good approach to care, work well as team, and I like way they relate to the residents.’ All residents interviewed praised the staff team and the following comments were made: ‘The staff are good. They’ve helped me come to terms with my disability.’ ‘If you need staff they’re there.’ ‘The staff understand about my condition. They explain things to me.’ ‘All the staff have time for us. They’re always willing to talk.’ ‘From the day I moved in the staff made me welcome.’
61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 19 The staff team are commended. The Owning Body’s recruitment policies and practices are followed when new staff are recruited. Advice is provided by the Owning Body’s regional personnel office. All new staff must have two written references and satisfactory CRB checks. If staff start work before their CRB checks have been completed they work under supervision at all times. All new staff undertake the ‘Learning Journey’, a four-week induction provided by the Owning Body. This comprehensive introduction to working for Leonard Cheshire includes moving and handling, health and safety, infection control, protection of vulnerable adults, and an introduction to key working/care plans. Specialist training is provided to staff to assist them in working with residents with physical and learning disabilities. During their induction new members of staff are allocated a mentor from amongst the staff at the home where they will be working. Once their induction is completed staff have access to a wide range of further training opportunities including NVQs (over 50 of staff have NVQ Level 2 or above). These are dependent of each member of staff’s training needs (identified in supervision sessions). Courses attended by staff at King Street include ‘Challenging Behaviour’, ‘POVA Update’, and ‘Bereavement’. All staff have a ‘Personal Development Portfolio which they add to during their time at King Street. This is updated during supervision sessions, which take place six times a year, and feeds into their NVQ studies. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents live in a home that is safe and well managed. EVIDENCE: The Manager and the Team Leader, both experienced managers and carers, run the home along non-institutional lines with the emphasis being on resident choice. This reflects the ethos of the Owning Body. The result is a homely environment with residents who are confident about speaking out and determining their own care and lifestyles. Staff consult with residents on a one-to-one and group basis. Monthly monitoring visits give residents the opportunity to share their views about King Street with representatives of the Owning Body. Residents’ comments about the management of the home included: ‘The Team Leader’s fantastic. She’s an angel. She is a really special person and she always has time for me.’
61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 21 ‘The Manager and the Team Leader sorts things our for me.’ ‘The Manager and the Team Leader have made me feel part of this home.’ One resident praised the policy where a resident is on the interview panel when new staff are being appointed. ‘I like this idea. I agree that there should be a resident involved in interviewing new staff, but this is the only home I’ve been in where that happens.’ The management are commended for how well the home is run. The Owning Body carries out internal health and safety audits of the premises at least once a year to identify if any areas are in need of attention. The Manager oversees the maintenance of the home and carries out a weekly premises audit. Any jobs that need doing are recorded in the Maintenance Book for the home’s handyman (who is shared with another home) to attend to. The handyman has designated hours in which to check that the premises comply with Health and Safety legislation. Records showed the premises and equipment in the home are properly serviced and maintained. The problems with the home’s gas central heating system have been resolved. 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 22 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 4 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 4 34 X 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 4 X 4 X X 4 X 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 61/63 King Street DS0000061710.V303100.R01.S.doc Version 5.2 Page 24 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
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