CARE HOME ADULTS 18-65
72a Broad Street, House 1 Ash & Birch Units Clifton Shefford Beds, SG17 5RP Lead Inspector
Andrea James Announced 6 June 2005
th 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 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 Stationary 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. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service 72a Broad Street, House 1 Address Ash & Birch Units, Clifton, Shefford, Beds, SG17 5RP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01462 814196 01462 850689 0 Home Farm Trust Pauline Jarman Care Home 8 Category(ies) of LD Learning Disability 8 registration, with number of places 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20.12.04 Brief Description of the Service: 72A Broad Street (Ash and Birch) was a purpose built house owned by Home Farm Trust situated in a site recessed from the main street in the village of Clifton. On the same site was a second house provided by HFT for eight people with learning disabilities and the two houses shared a common paddock in addition to their individual gardens.
The house was divided into two units namely Ash and Birch, each with a lounge, dining room and kitchen. One unit catered for people with Prader-Willie syndrome and the other for people with complex communication needs. Each service user had a single bedroom. In each unit were two bathrooms and a shower room with a total of seven toilets between the two units. Staff were provided with a room with en-suite facilities, which was also used as the main office. This room was situated between the two units and formed the link on the first floor between both units. The ground floor link was the communal laundry. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out over a 5 hour period. The registered manager was present for the duration of the inspection. The inspection was carried out 6 months after the last unannounced inspection. The inspection followed a case tracking methodology where a sample of the service users files were viewed and those service users were spoken to. The report reflects the views of relatives, staff, and the management of the home. Some information was also gathered from the pre- inspection questionnaire provided by the home prior to the inspection. The home had 8 service users and 14 care staff. 28 of the care staff had achieved their NVQ level 2 in care. What the service does well:
The home provided satisfactory standards of care to the service users that promoted independence and community involvement. All service users had a structured timetable that showed that all service users attended college placements, day centres or other resources in the community. Service users were able to have choices in the daily running of the home. There was evidence to suggest service users were able to plan their weekly menu. The service users were also able to participate in the weekly food shopping. They recently chose their holiday destination to spain. One service user had recently started a part time job as a volunteer. The service users received annual reviews where their placements are reviewed and a plan of action identified. One service user said he liked the home “ it was really good”. One relative said it was a lovely environment and the service users always appeared happy. On observation the inspector was able to see non-verbal service users receiving positive interaction from the care staff. The inspector observed service users being escorted by the care staff to access various health care services and local shops. The home farm trust have ensured that all service users received a full preadmission assessment by a qualified social worker employed by home farm trust. The assessment was full and comprehensive. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
The care planning paper work had been implemented but the care plans had not yet been fully implemented. The home needed to ensure all service users care plans were completed. The home had one service user who was a diabetic and his insulin was being drawn up seven days before administering. The medication inspector had addressed the issue with the medical professionals but the procedures had not been changed. The home was in agreement to make changes but found the district nurses reluctant o change their procedures. The quality assurance systems in the home needed further development to ensure the views of the service users and relatives are sought and actions taken to reflect quality care in the home.
72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 7 The home needed to ensure that staff received adequate training in areas to meet the changing needs of the service users. One relative commented that staff did not demonstrate sufficient knowledge in the needs of the service users. The home needed to ensure all relatives are aware of the service provided by the home by providing a copy of the statement of purpose. The inspector would like to thank the service users, relatives, staff and manager for their co-operation in the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 8 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 Standards Statutory Requirements Identified During the Inspection 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 9 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 standard(s) 1,2,3,4 and5 The home ensured that the service users received sufficient information about the home and were given the opportunity to test drive the home before permanent residence was offered. The service users were able to make an informed choice about living in the home but relatives were not all aware of the services provided by the home. EVIDENCE: The service users were provided with a service user guide and those spoken to inform the inspector about the services they received from the care staff. One relative said he was not aware of the service user guide or the statement of purpose and was therefore unable to say what resources were offered to his relative in the home. The home assessed the needs of the service users by producing a person centred planning approach to all service users, which detailed individual service users goals and aspirations for the future. The home needed however to address the identified needs that required care intervention from the care staff. These included health care and personal needs. Perspective service users were able to visit the home on a trial basis before permanent residency was decided. Service users had 6 weekly review after admission to identify if the home was able to meet their needs. All service users had a signed contractual agreement with the home.
72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 10 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 standard(s) 6,7,8 and 9 The care planning and assessment procedures in the home were poor and as a result the service users needs were not identified as being met. The service users were able to make decisions about their daily lives and were empowered to take risks in developing their independent living skills. The care plans were not all implemented because of the new systems as a result of this the changing needs of the service users were not positively reflected EVIDENCE: The care plans were being developed in a new format and were still in its early stages. As a result service users needs were not identified for the majority of the service users. The manager and staff assured the inspector that the present format was better and all care plans would be implemented in the near future. The assessment procedures also needed further development to ensure all the needs of the service users were identified. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 11 The home ensured that through person centred planning service users were able to make decisions about their future aspirations. One service user was able to have a part-time job while others were able to access community resources and day centres in order to develop their independence. There was evidence to suggest service users were consulted about the plans made about the activities in which they were to participate. One service user was bale to say that he was due to go on holiday to Spain and had on the day of the inspection received his passport. The service users were also able to choose their weekly menu and carry out the food shopping with the assistance of the staff team. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 12 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 standard(s) 11,12,14,15,16 and 17. The home provided opportunities to enable service users to live a fulfilled and balanced life. The activities and cultural settings were age appropriate and met with the needs of the service users. EVIDENCE: The service users spoken to said they were given the opportunity to develop. One service user spoke about his annual review and that he was able to lose weight by the activities he agreed to do in his review. Another service user said he was able to go to college which was a goal identified in his annual review. Service users were able to be involved in the community through various visits to social clubs, leisure centres, attending pubs, cinemas, theatres and other areas of interests. Relatives spoken to said they were made to feel welcome and were able to take their relative home whenever they chose. Service users also spoke of
72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 13 their contact with family members. Service users were also able to have appropriate relationships with their peers. Due to the needs of the service users, diet was a high priority in the home. The staff ensured that service users were consulted about what they would like to eat on a weekly and a daily basis. Service users were able to make choices and had satisfactory results in being able to enjoy their diet while loosing weight. The menu demonstrated that service users received a wholesome and nutritious diet. Their was however a need for consultation to be sought from the dietician for those service users with Prader –Willie. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 14 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 standard(s) 19 and 20 The home was able to meet the health care needs of the service users. The medication procedures were satisfactorily maintained with the exception of one service user that could result in the service user being abused due to bad management of medication. EVIDENCE: The home had regular contact with various external professionals that suggested they were being proactive in meeting the health care needs of some service users. The medication procedures were satisfactorily maintained but one service user had insulin drawn up 7 days prior to administration. This was a requirement from the last two inspection reports. The home feels unable to resolve the situation because it was the community nurse that insists of the current procedure. There was also a need to record all medications given to the service users such as paracetamols. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 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 standard(s) 22 The home had satisfactory complaints procedure in place that would ensure service users had a satisfactory outcome to any complaint made. Service users are aware of the complaints procedure and feel able to speak to a member of staff if they were not happy. EVIDENCE: Service users were aware of the complaints procedure and those spoken to said they were informed about the complaints procedure in their residents meetings. No complaints were received in the home since the last inspection. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 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 standard(s) 24,27,28 and 30 The home provided a safe and comfortable environment that met the needs of the service users. EVIDENCE: The home was decorated in bright and cheerful colours that created a warm sense of welcome and homeliness. Improvements were made to the environment since the last inspection including new furniture’s bought for communal areas. The bathroom and toileting facilities were sufficient in meeting the needs of the service users. The home had separate dining and lounge areas that created sufficient space for the service users. The home was clean and free from offensive odours. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36 The home had a stable staff team that created consistency and confidence for the service users to develop. The home ‘s recruitment procedures were satisfactory. The staff needed further training in some areas of service users changing needs. EVIDENCE: The home was adequately staffed and the inspector was informed that they had recently recruited 2 waking night staff. Their was however another 2 vacancies to fill and as a result agency staff were used to cover the staff shortage. The home’s recruitment procedures were satisfactorily maintained. The current staff team appeared competent and experienced in meeting the needs of the service users but the training records viewed suggested that further training was needed to ensure the staff were aware of how to meet the needs of service users with Prader- Willie, diabetes and other needs in the service users group. One relative spoken to felt that staff were not always aware of how to meet the needs of the service users in these areas. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 18 The staff spoken to said they received regular supervision in recent months and the manager said she was aiming to provide at least 6 per year. The staff said they had regular staff meetings and were able to speak to the manager whenever they needed to. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,42 and 43 The current management structure ensured that the home was well run and as a result the service users were confident in the managers leadership skills. EVIDENCE: The manager has recently resumed her position after being on long term sick. The acting manager has taken up the deputy manager’s position, which resulted in more time given for administrative duties, staff supervision and appraisals, which was lacking in previous inspections. The home had satisfactory health and safety procedures in place. Various risk assessments were seen for several aspects of the home. The inspector observed that various aspects of the home had improved with the input of the manager and the deputy manager. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 4 3 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x 3 3 x 3 Standard No 11 12 13 14 15
72a Broad Street, House 1 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 3
Version 1.20 Page 21 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x 3 3 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 22 yes 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 ya6 Regulation 15 (1) (b) (c ) Requirement Arrangements must be made to ensure all service users needs are identfied in the care plans with the plan of action. Timescale for action Original date;31.03 .04/31.08. 04/22.12/0 4 new date:30.08 .05 30.08.05 2. Ya6 14 (2) (b) 3. 4. Ya6 Ya6 15 (2) (c ) 15 (2) (b) 5. Ya20 13 (2) All service users must have an assessment that identifies the areas of need that the care staff needs to intervene with. where possible service users consultation must be sought for the care intervention intended. Service users care plans must be kept under review and changes made to reflect their current needs. Arrangements must be made for insulin syringes to be drawn up on a daily basis and not weekly. 30.08.05 30.08.05 6. Ya35 18 (1) (i) 7. ya39 24 91) (a) Arrangements must be made for all care staff to receive appropriate training in order to meet the needs of the service users. Arrangements must be made for Original dates;30.0 8.04/30.01 .05.new date:30.08 .05 30.08.05 original
Page 23 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 the quality assurance system to be implemented in the home to review quality monitoring. date : 30.02.05 new date : 30.08.05 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 ya1 Ya20 Good Practice Recommendations Arrangements should be made for all relatives to be given a copy of the homes statement of purpose. All medications given even for occasional use should be recorded on the medication administration record sheets. 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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 72a Broad Street, House 1 I51 S14884 72a Broad St Hse 1 V221771 060605 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
