CARE HOME ADULTS 18-65
78 Stubbington Lane Stubbington Hampshire PO14 2PE Lead Inspector
Liz Palmer Unannounced Inspection 8th May 2007 10:30 78 Stubbington Lane DS0000067609.V336195.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 78 Stubbington Lane DS0000067609.V336195.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. 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 78 Stubbington Lane Address Stubbington Hampshire PO14 2PE 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) 020 8544 8900 www.caremanagementgroup.com Care Management Group Limited Constance Sian Gardner Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st September 2006 Brief Description of the Service: 78 Stubbington Lane is registered to provide care and accommodation to five people between the ages of 18 and 65 who have learning disabilities. Each service user has a single bedroom, and shares the use of two bathrooms. Service users share the use of a lounge, dining room and kitchen. There is an enclosed garden to the rear of the home that service users are able to access. The fees at the home range from £1750 to £2200 per week, depending on the assessed needs of service users. 78 Stubbington Lane DS0000067609.V336195.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 carried which included a visit to the home which took 5 hours. The key standards were assessed by case tracking two people who live in the home. Time was also spent observing staff practice, talking to two staff and to people who live in the home. The registered manager (home manager) was present and assisted with the inspection. Some time was spent reviewing a random selection of documents and a partial tour of the premises was carried out. Other information used to make judgements about the home included an Annual Quality Assurance Assessment (AQAA) completed by the registered manager, incident reports and the most recent inspection reports on the home. Comment cards were received from two service users, one relative and three General Practitioners (GPs). Their comments have been reflected in this report. What the service does well:
People who live in the home say it’s a nice place to live and they are supported to pursue their hobbies and interests. People who live in the home say they have enough to do. Staff say they like working here and showed a good understanding of the needs of people who live here. People who live here can expect to be consulted about have their care plan and have it regularly reviewed. GPs involved in the home say people are well cared for and are responsive to the advice they give. Tablets and medicines are stored safely and records are accurate. This protects the people who need support with this. 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. 78 Stubbington Lane DS0000067609.V336195.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 78 Stubbington Lane DS0000067609.V336195.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place to ensure that prospective service users’ individual needs and aspirations can be met in the home. EVIDENCE: This standard was assessed at the last inspection and related to one new service user who had recently moved into the home. No new service users have been admitted since the last inspection. Care Management Group have an assessment and referral team who work with each home to find suitable prospective people to live in the home. The AQAA states these are deemed competent to assess prospective service users in collaboration with the home manager and care managers. 78 Stubbington Lane DS0000067609.V336195.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are in place and reviewed regularly to ensure people’s changing needs are met consistently. People who use the service are consulted and supported to make decisions, which affect their life. EVIDENCE: Two care plans were looked at. These showed evidence of the involvement of the people they were written for and the home has started work on person centred plans (PCPs). The dreams and ambitions of people are recorded and there was evidence of these being acted upon. For example, one person has requested a holiday to the Isle of Wight and this has been booked for later this year.
78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 10 Care plans detailed the personal care needs and preferences of individuals and their preferred morning and evening routines. Individual communication needs were detailed as were personal preferences, for example, likes and dislikes regarding food, music, books, domestic duties, transport, shops and activities. Activities observed during the inspection reflected the preferences recorded in care plans. People who use the service were observed being consulted about the activities they might engage in that day and about the arrangements for lunch for example. Care plans reflected that how people spend their time is decided after consultation with them and on an individual basis. Risk assessments are in place to support people to maintain their independence and increase their opportunities to take part in every day activities. For example, there are risk assessments for community access and using the laundry room. There are also guidelines in place to support people in their personal care, daily living skills and healthy eating. Care plans and risk assessments are reviewed formally every three months. Key workers review care plans with the people who use the service on a monthly basis. There was documented evidence that care plans are also reviewed and updated as and when changing needs occur. In particular for one person whose needs are diverse and subject to change at any point. 78 Stubbington Lane DS0000067609.V336195.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place which ensures people who use the service participate in educational, social and community activities. People who use the service have the opportunity to exercise their rights and responsibilities. Healthy and varied meals are provided with the involvement of service users. EVIDENCE: People who use the service are supported to access a range of leisure and educational activities. For example, shopping, cooking, college, cinema and lunches out. People are encouraged to pursue their hobbies and interests in the home and have their own televisions, DVD players, stereos and game consoles according to their personal choice. One person told the inspector
78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 12 about being able to pursue their interest in gardening. An area had been fenced off to grow vegetables. Staff and people who live in the home felt that people who use the service had enough to do and there were usually enough staff to engage in one to one activities with people. People who use the service are supported to use local shops, pubs and public transport. Arrangements are in place for people to keep in touch with families and friends. Details of personal relationships are recorded and evidence of support being given was seen. For example, one person talked about telephoning their mother, another has a mobile telephone and is supported to contact their family. Records were seen of family contact and people said they could have visitors whenever they wanted. One relative’s survey said the home ‘usually’ helps their relative stay in touch. People who live in the home are encouraged to eat a healthy and balanced diet. Meal times are flexible and service users are involved in the shopping and cooking. People’s preferences for food and when and where to eat are recorded. Evidence of this being flexible was seen on the day. Any special dietary requirements are written in care plans and through observation it was evident that staff are aware of these. The inspector joined the people who live in the home for lunch, they said the food was always good and were seen enjoying their lunch on the day. 78 Stubbington Lane DS0000067609.V336195.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for supporting people who use the service to maintain their health and receive personal care in a way that meets their individual needs and preferences. People who use the service are protected by the home’s policies and procedures for storing, recording and administering medication. EVIDENCE: Individual needs and preferences regarding people’s personal care, emotional needs and health care are recorded in their care plans. Each service user is supported to maintain their health and well being by having their own GP. Support is given to keep GP’s appointments as well as dental, podiatry and optician appointments. Specific health issues are noted in care plans, for example, epilepsy and mental well-being. Specialist healthcare professionals are involved when necessary. Evidence of regular contact with consultants, psychiatrists and other relevant healthcare professionals was seen. The
78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 14 manager said the home is supported by the Community Learning Disability Team (CLDT) and that a good working relationship is maintained with them. Evidence of their involvement with one person in particular was seen. There is a care plan for the management of one person’s pain and a chart to show pain indicators. This person said they felt well looked after and could always tell someone if they felt unwell or in pain. Procedures for storing and administering medication were sampled and found to be secure and suitable. At the last inspection some omissions were found in the recording of medication and a requirement was made for this to be addressed. As a result of this the home now has a policy of two people signing for each administration. No errors or omissions were found during this inspection. Controlled drugs are suitably stored and recorded this involves them being double locked within a fixed cabinet, records are kept separately in a dated diary and are signed for by two staff and a running total is checked and recorded after each administration. Protocols are in place for any medication that is prescribed to be administered ‘as and when required’. An analysis of this is also undertaken and kept under regular review. Three surveys were completed and returned to the commission from GPs. All were positive overall, for example all three said the home ‘always seek advice and act upon it to manage and improve individuals’ health care needs’. All three also replied that the home has ‘always responded appropriately’ to any concerns about people’s care. One added a comment that they have ‘been very pleased with the caring nature shown, protocols etc… when in contact’. 78 Stubbington Lane DS0000067609.V336195.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to make complaints and procedures are in place to protect them from abuse. EVIDENCE: People who use the service and their relatives are provided with a complaints procedure in format that is accessible to them. When asked, one person said they would talk to their key worker if they had any concerns. People were observed making requests and airing their views during the inspection. This showed an openness in the home and was evidence that people can talk to staff about things they are unhappy with. The AQAA states that key workers discuss the complaints procedure with people at their monthly reviews to ensure they are aware they are able to make complaints. Both the surveys completed by people who live in the home said they ‘sometimes’ know how to make a complaint. The relative’s survey said they knew how to make a complaint and felt their relative in the home would tell them if they were unhappy about anything. A relative has made one complaint since the last inspection. This was recorded and is being dealt with by the manager. The
78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 16 requirement made at the last inspection regarding the recording of complaints has been met. Adult Protection was discussed with the manager in regard to some regulation 37 notices received by the commission relating to verbal aggression between people who use the service. The manager stated that all incident reports are copied to care managers. The manager understands her responsibilities about the reporting of incidents and keeping care managers informed. Staff have undertaken training in Adult Protection and those spoken to were aware of their responsibilities in this area thus ensuring service users are protected. The home looks after money on behalf of all service users. Monies held on their behalf were sampled. Three cash balances were checked and matched the recorded amounts that were seen to be stored securely. 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a clean, homely and safe environment. EVIDENCE: A partial tour of the home was undertaken. There was adequate communal space and these areas were clean and comfortable. Photographs and personal items around the home made it homely and service users clearly felt relaxed. Notices in the home promoted health and safety and emergency numbers and on call telephone numbers were seen in the office. Two requirements were made at the last inspection; the first regarding exposed light fittings and the second related to the emergency lights, which were not working at the time.
78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 18 Both these requirements have been met and action taken to prevent the risk of this happening in the future. For example working in a proactive way with the person who dismantles the lights and also replacing the lights with a type that cannot be so easily dismantled. This is supportive to the person responsible and improves the safety of the other people who live in the home. The manager stated a new maintenance person had been employed and this had improved the time within which repairs got done. A log of repairs needed is kept, however it was noted that some repairs are done more promptly than others and there is room for improvement in this area. 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are protected by the recruitment procedures and are supported by well trained staff in sufficient numbers to meet their needs. However, staff need show their competency at all times . EVIDENCE: A rota was seen that clearly identified which staff were on duty and this corresponded with the staff on duty at the time of the visit. The two members of staff spoken to during the inspection were confident and competent. They said they enjoyed their work and showed a sound knowledge of the individual needs of service users. They said they usually had enough staff to work with service users who all need a one to one when out in the community. Two of the GP surveys stated they felt more staff were sometimes needed in the home. The manager said the only explanation she could think of for this was
78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 20 that sometimes when staff are making appointments they say they can’t make certain times because of staffing levels. They spoke about service users in a sensitive and positive manner and were seen interacting in this way too. Service users said spoken to say they liked the staff and a natural rapport was noticed between the staff and service users. Staff were seen interacting in a positive and respectful manner with service users. This is with the exception of one member of staff who was heard speaking to a service user in a disrespectful manner on more than one occasion. This was addressed with the home manager who said she had also noticed it on one occasion that day but that it was totally out of character and that this member of staff was very popular with people who live in the home and well respected by her colleagues. The manager spoke to the member of staff concerned who said she recognised what she had done, was regretful and agreed to address and resolve the matter. There is a corporate training programme in place, which enables staff to have the mandatory training as well as the opportunity to do National Vocational Qualifications (NVQs). One new member of staff said his induction had included medication, both an in house course and a pharmacy one. He had also been trained in epilepsy, behaviour management and adult protection. Another member of staff spoken to has been with the company for 5 years (prior to it being taken over by Care Management Group last year) and has achieved NVQ levels 2 and 3. She has also trained in all the mandatory courses, epilepsy and autism. The Care Management Group induction programme was sampled and was seen to be comprehensive and suitable. The home follows the corporate recruitment procedure, which was found to be robust, and being followed by the home. Three staff files were looked at and all contained an application form, two written references and a Protection of Vulnerable Adults check. Two had a Criminal Record Bureau (CRB) check and one was waiting for this to be returned. This person was undergoing their induction and shadowing other staff. 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and the views of people who use the service are acted upon. Improvements since the last inspection ensure the safety of people who live in the home. EVIDENCE: The manager has completed an NVQ level 4 and the Registered Manager’s Award and has been registered with the commission in October 2006. The manager is also a qualified NVQ assessor. Staff spoken to say they had confidence in the manager and thought the home was well run. They said the
78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 22 manager was approachable and that all the staff were helpful, professional and worked well as a team. Care Management Group has a corporate quality assurance system. This includes a survey of service users, a survey of relatives, relatives meetings, and a monthly surgery for relatives with the Regional Operations Manager and service user meetings that are held in the home. Examples of how requests from service users have influenced the running of the home were provided in the AQAA and seen during the inspection. For example the development of the vegetable patch. A service user also talked about getting a new barbeque and garden furniture. This was noted as an action in the AQAA. Regulation 26 monitoring visits take place by senior managers in the company and actions are drawn up for the managers to improve the service. Assessments are completed for chemicals used in the home, which were seen to be stored in a locked cupboard. The repairing of the light fittings and emergency lights as previously mentioned improves the safety of people living in the home. The AQAA states that safety checks are undertaken including testing of portable electric items, the testing of fire equipment and that regular health and safety audits are undertaken to ensure that people live in a safe and hygienic home at all times. 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 3 3 3 X 3 X 3 X X 3 X 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 1. Refer to Standard YA22 Good Practice Recommendations The registered person should provide details of the home’s complaints procedure to all service users’ representatives. 78 Stubbington Lane DS0000067609.V336195.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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