CARE HOME ADULTS 18-65
West Park Road (63) 63 West Park Road Corsham Wiltshire SN13 9LW Lead Inspector
Mr Tim Goadby Key Unannounced Inspection 8th December 2006 10:00 West Park Road (63) DS0000028176.V307592.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 West Park Road (63) DS0000028176.V307592.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. West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service West Park Road (63) Address 63 West Park Road Corsham Wiltshire SN13 9LW 01249 712425 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) Mrs Jean Cottle Mrs Jean Cottle Care Home 1 Category(ies) of Learning disability (1) registration, with number of places West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: 63 West Park Road is a private domestic home, registered to provide care and accommodation for one service user. The registered provider and manager is Mrs Jean Cottle. She and her husband are the sole carers. The home is close to Corsham town centre and there are good transport links nearby. The service user has a bedroom on the first floor, with an adjacent toilet. There is a ground floor shower and toilet and a first floor bathroom. Communal space on the ground floor includes a sitting room and a large kitchen with table and chairs. The home also has areas of garden at both the front and back. Fees charged for care and accommodation are paid by the local authority which funds the placement. The service user also makes a weekly contribution from their own income. Information is available about the service. A brief Statement of Purpose has been compiled which explains the nature of the care provided. A copy of the most recent CSCI inspection report is also kept in the home. West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection took place in December 2006. Due to the nature of the service, it was carried out by one announced visit, which included meeting both the service user and the registered person. Relevant records were viewed, and a tour was made of those parts of the premises which the service user accesses. The inspection visit took two and a half hours. What the service does well: What has improved since the last inspection? What they could do better:
West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 6 The service needs to develop a suitable quality assurance system, proportionate to its size and the nature of the care it provides. The registered person was previously advised that this standard was not applicable to West Park Road, but this situation has now changed. The service will be required to produce a quality report which shows how it ensures that it continues to meet the needs of its service user. The Commission agreed to give further input and advice to the registered person on this topic in the near future. The service user is placed at risk by a failure to have full records and clear information regarding the support they receive with their financial affairs. Some withdrawals from the service user’s bank account are not linked to a clear audit trail which shows how and why the money was used. Information about the service user’s financial arrangements has been put in place since the previous inspection. But it does not explain these in sufficient detail. It is also out of date, because it does not cover the most recent increase in the service user’s weekly contribution for their care and accommodation. Care plans and risk assessments for the service user were all drawn up some time ago. There is some evidence of review, in the form of dates and signatures to indicate that the documents have been looked at again. But they have not been revised or updated, and it would now be appropriate to do so. In particular, a thorough assessment of the service user was carried out by a healthcare professional in late 2005. This report identified various recommendations. There should now be an update on what progress, if any, has been possible on these. Complaints information has also not been updated for some time, and the details for the regulatory authority still refer to the NCSC, which ceased to exist in April 2004. The procedure should be updated to show the correct current information. 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. West Park Road (63) DS0000028176.V307592.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 West Park Road (63) DS0000028176.V307592.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): Quality in this outcome area could not be assessed. Standards relating to admissions to the home were not applicable at this inspection. EVIDENCE: 63 West Park Road provides care for just one service user, who has lived within the registered person’s family home for over ten years. The service does not intend to take any further admissions. There have been discussions in the past about registering with the Adult Placement Scheme, as the relevant standards may be better suited to this service than those for care homes. However, the registered person has so far decided not to pursue this option. West Park Road (63) DS0000028176.V307592.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 adequate. This judgement has been made using available evidence including a visit to this service. The service user’s abilities, needs and goals are reflected in their individual plan. This could be enhanced by review and updating. The service user can make choices and decisions in daily life. The service user’s protection in management of their money needs to be ensured by clearer documentation for this area. The service user is supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: Records relating to the service user were viewed. These cover an appropriate range of topics, and set out the support provided by the service. There is clear information about issues which are particularly significant for the service user,
West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 10 such as their main healthcare needs. Risk assessments set out what the service user can do independently, and when some monitoring and support is required. The registered person has been caring for the service user for several years and has a good understanding of their key needs. The records would all benefit from review and updating, to ensure that they reflect the current position. In particular, it would be useful to give a progress report on the recommendations that were identified by an assessment carried out by a healthcare professional in late 2005. There have been difficulties in making progress on these, due to the lack of suitable resources in the local area. The service user’s eligibility for support is also limited because of the level of cognitive ability they have been assessed as having. Records relating to support of the service user with their financial affairs are in need of attention. In response to a recommendation of the previous inspection report, the registered person has produced some written information about the system in place. However, this does not go into sufficient detail to explain the current arrangements and the reason for them. It also needs updating, as the figure shown as being charged to the service user for care and accommodation is no longer correct. Of most concern was a failure to maintain clear and detailed records for all elements of the service user’s expenditure. Although they are capable of accessing and holding money independently, they are assessed as vulnerable because of not having a complete understanding of the value of money. Records relating to the weekly payments for care and accommodation are maintained. But examination of the service user’s bank account records, with their permission, identified a number of other withdrawals, for which the reasons were not completely clear. This included one with a note that the money had been paid back to the registered person. There was no clear audit trail in place to show why this money was owed. West Park Road (63) DS0000028176.V307592.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, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user has a range of activities and opportunities, offering full engagement with their local community. The service user can maintain and develop appropriate relationships with family and friends. The service user’s rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. The service user is offered healthy, nutritious and enjoyable meals, in line with their needs and preferences. EVIDENCE: West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 12 The service user often undertakes activities along with the registered person and her husband, as part of the family group. This includes going away on holiday with them. There are also other groups of friends and local contacts that are important to the service user. The individual has lived at West Park Road for over ten years, and has become a well recognised member of the local community. The service user has a job within Corsham, which involves them going out for a couple of hours twice a day. They are able to undertake this independently, and receive payment for it. The service user is also able to go shopping independently, and spoke about how they access public transport to travel into Bath or Chippenham. The service user maintains contact with various members of their family. This can be via phone calls, or visits to relatives who live locally. The service user also has an annual trip to stay with a relative overseas. The service user described how they are looking forward to the next such holiday, which was due to take place a few weeks after this inspection. The service user has unrestricted access to all parts of the home. They hold their own keys, and also have lockable storage space in their own room. The service user is supported in undertaking household tasks. Their level of participation will vary, depending on how they are feeling. The home has had input from a dietician to help in meeting the service user’s needs in this area. A record is kept of what the service user eats, which shows an appropriate variety of meals being offered. The service user is also helped to supplement their diet with prescribed vitamin tablets. West Park Road (63) DS0000028176.V307592.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 this service. The service user is supported to address their personal and health care needs effectively. The service user is protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The service user is independent in most areas of personal care, requiring only some prompting and reminding to attend to these. There are clear records relating to the service user’s healthcare needs. These show that information is shared with relevant healthcare professionals, and advice and treatment is obtained when necessary. Recently this has included referral to a specialist for one key area of need, and the service user is having various observations and tests to try and identify the most effective way to support them. West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 14 The service user is supported in the management of their medication. This is stored securely within the home, and records are kept about its administration. There is ongoing medical review of prescribed drugs, as work is continuing to try and help the service user to manage their main healthcare need effectively. There is input both from the service user’s local GP, and from a specialist consultant. Some drugs are prescribed to be given ‘as required’. There is a clear framework for deciding when to administer these. West Park Road (63) DS0000028176.V307592.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 good. This judgement has been made using available evidence including a visit to this service. The service user is safeguarded by the service’s policies and procedures for complaints and protection. EVIDENCE: Complaints information is in place, and has been provided to the service user and their relatives and representatives. No complaints have been received by the service. Contact details within the complaints procedure need updating, to show the correct current information for the CSCI. The service also has information about adult protection, including details of the local multi-agency procedures within Wiltshire. The registered person has received training on this topic via her other employment. West Park Road (63) DS0000028176.V307592.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 good. This judgement has been made using available evidence including a visit to this service. The service user lives in a clean, comfortable and safe environment, which is suitable to meet their needs. EVIDENCE: All parts of the home which are accessed by the service user were seen during the course of this inspection. These were seen to be homely, clean and tidy. The service user has their own bedroom, which is furnished and decorated to reflect their own tastes. The service user has a large collection of DVDs and CDs, and described how they like to spend time relaxing, watching or listening to these. There is a toilet next to the bedroom. The service user described how they use the downstairs shower room to wash. The service user can also access the ground floor living areas, which include a sitting room and the kitchen. There are also areas of garden at both the front and rear of the property.
West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 17 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): 33 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user is supported by suitable numbers of staff. Standards relating to staff recruitment and training are not applicable to this service. EVIDENCE: The registered person and her husband are the sole staff team for the service user. This is their own home and one of them is available at all times when the service user is present. Support is also provided outside the home whenever necessary For instance, the service user prefers to be accompanied when attending appointments with healthcare professionals, to be helped to understand and remember any advice they are given. West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 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): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is suitably qualified, competent and experienced to provide care appropriate to the service user’s needs. The service needs to devise and implement a suitable quality assurance system to help ensure it develops in line with the service user’s needs and preferences. The service user’s health and safety are protected by the systems in place. EVIDENCE: The registered person is Mrs Jean Cottle. She has a job working in another care setting which provides for older people, as well as her role in providing care for the service user at 63 West Park Road.
West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 19 Mrs Cottle has completed various training as part of her other post. This has included a number of courses and updates during 2006. Topics include moving and handling, first aid, infection control and basic food hygiene. She has also successfully achieved a National Vocational Qualification in care at Level 2, and is due to begin studying for the Level 3 award in January 2007. The standard relating to quality assurance was previously judged to be not applicable to this service. However, at this key inspection it was discussed and agreed with the registered person that this could no longer be the case. Linked to changes in the minimum frequency of inspection, there is a new regulatory requirement on care homes to produce a quality report and provide a copy to the Commission. The registered person will need to identify a suitable means of complying with this arrangement, which is proportionate to the service she is providing. It was agreed to discuss this issue further when more information on suggested quality report formats becomes available. This is expected to happen during the early part of 2007. Information about the specific needs of the service user was gained through an assessment by a healthcare professional in late 2005. This reached the conclusion that the service user was unfortunately not eligible to receive input from the local specialist team of health and social care professionals which works with people with learning disability. However, the exercise did provide some useful information and recommendations about ways in which to support the service user, which the home continues to try and work towards. The service user has consistently made clear their own positive views about the service provided, and their strong belief that it meets their needs well. The same views were restated by the service user during this key inspection visit. Suitable arrangements are in place to uphold health and safety. Risk assessments recognise relevant factors for the service user, and set out why measures such as observing them in particular activities are necessary. There are safety data sheets for cleaning products in use in the home. Water temperatures are checked regularly. The registered person has written a fire safety procedure and the service user is involved in practices in the home. Smoke alarm checks are recorded. West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 20 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 N/A 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 N/A 33 3 34 N/A 35 N/A 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 21 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 YA7 Regulation 17-2 Sch4-8,9 Requirement The registered person must keep a record of all money received from or returned to the service user. Where applicable, the record must show the purpose for which the money was used. The registered person must establish and maintain a system for evaluating the quality of the services provided. COMMENT: The registered person was previously advised that this standard was not applicable. This situation has now changed. The Commission agreed to give further advice and input on this topic when more information becomes available. Timescale for action 08/12/06 2 YA39 24 31/03/07 West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 22 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 YA6 YA7 Good Practice Recommendations All elements of the service user’s care plan should be reviewed and updated. Information about the arrangements for supporting the service user in managing their money should be updated and contain greater detail about the overall approach. The home’s complaints information should be updated to include the correct contact details for the CSCI. 3 YA22 West Park Road (63) DS0000028176.V307592.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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