CARE HOME ADULTS 18-65
94 Eastern Road Portsmouth Hampshire PO3 5EW Lead Inspector
Lorraine Parton Unannounced Inspection 5th October 2005 09:00 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 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 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 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. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 94 Eastern Road Address Portsmouth Hampshire PO3 5EW 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) 023 9282 5182 Community Integrated Care Mrs Karen Lisa Lee Care Home 2 Category(ies) of Learning disability (2) registration, with number of places 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th April 2005 Brief Description of the Service: 94 Eastern Road is a detached house situated in Portsmouth. The home is close to some local shops, but is situated on the corner of a busy main road. The home provides two good sized bedrooms, which have ensuite facilities. The home also has a shared lounge/dining room and kitchen, which are situated on the ground floor. If a service user is unable to manage the stairs one of the bedrooms is downstairs. The home is staffed for 24 hours per day and has purchased a mini bus for the use of service users to access activities of their choice. Currently the home is undergoing some building works to provide another bedroom and is extending the lounge and dining room to ensure that more space is available in the shared areas. The home also has a garden, which surround the home and to the rear of the home there is space for parking. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The second inspection of the inspection year took place over 3.5 hours and the purpose was to ensure compliance with previous legal requirements brought to the homes attention at the first inspection in April 05 and to complete the inspection process for the year. The inspector audited 7 standards and reassessed 6 standards, in which the inspector had raised requirements at the last inspection. All key standards have now been assessed throughout the year. The inspection found that only one requirement had not been addressed by the home, which related to the alteration of the kitchen. This matter is being dealt with as part of the registration process as the home has submitted an application to admit one other service user. The inspection involved a walk around the home and an audit of some of the homes documentation. The inspector was assisted by the homes staff and one service user living at the home. The home was found to be homely with a friendly atmosphere. The majority of the inspection was spent talking to the service user who clearly displayed their involvement in the home. The service user spoken to advised the inspector that they enjoy living at the home and displayed this through the use of a range of verbal communication and photographs and pictures of the lifestyle that they participated in. What the service does well:
The home provides a homely environment that has been adapted to enable service users to live their lives independently. The service users rooms reflected their personality and the service user confirmed that they are able to have their room has they wish. Throughout the inspection it was evident that the homes staff promote and encourage service users to be independent. The service user was witnessed by the inspector to participate within the home and this included selection of the food, helping staff to clean their rooms, choosing staff to assist with personal care, activities and participation within the home and the use of the home facilities. From discussions with the service user and the staff it is evident that the home provides a service user led service that ensures service users chose and participate both within the home and outside as they wish. Throughout the inspection the service user was seen by the inspector to dictate their routine/activities and which member of staff they chose to support them.
94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 6 All care plans and risk assessments were found to be comprehensive and these clearly documented service users involvement in a range of activities and ensured a consistency of approach to managing issues experienced by service users. All staff confirmed that CIC and the homes manager ensure that the training they receive and can access are specific to the service they are providing. CIC provide a extensive range of training courses and are committed to ensuring the staff provided at the home are trained to a high level. What has improved since the last inspection? What they could do better:
The home has completed a range of risk assessments and implemented suitable controls, however, at the time of the inspection an issue occurred that identified that the home had not considered the potential risk whilst using the homes car. A requirement has been made for the home to consider this in their risk assessments. One service user’s money is held by CIC and staff are required to pre-plan if they wish to access money on behalf of the service user. This is unacceptable. All service users must have access to their money when they wish. Companies must not hold money for service users. The home has suitable medication procedures and policies in place, however, at the time of the inspection medication keys were not being kept safely to ensure the safety of medication being stored in the home. The home is required to implement suitable procedures for the safe keeping of medication. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 7 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. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 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 the following standard(s): 2, 5 The home has got an assessment procedure that ensures the needs and aspirations of prospective users are taken into account prior to admission into the home. All service users have a contract, which includes the terms and conditions of tenancy. EVIDENCE: The home currently is registered for two service users and has submitted an application to be able to admit another service user. The home has not admitted any other service users since registering and therefore the inspector is unable to fully assess the assessment process. The home has a procedure in place that enables a full assessment to take place, which will take into account the needs and aspirations of prospective service users. All service users now have a contract of tenancy, which includes the terms and conditions of the tenancy. Service users and/or their representatives have signed the contracts. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 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 the following standard(s): 6, 9 Both service users have an extensive care plan. Risk assessments had been completed for areas of risk identified and incorporated into service user plans. EVIDENCE: The inspector audited one service user plan with the assistance of the service user. The care plan was found to be extensive and covering all areas of need and lifestyle. The home had also undertaken risk assessments, which had been incorporated into the service user plan. The home had reviewed the care plans and risk assessments since the last inspection. The home had involved relevant health care professions to assess areas of identified need. This included an occupational therapist regarding moving and handling and the provision of suitable equipment to promote independence. These assessments had been incorporated into the service user plans. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 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): 17 Service users enjoy a wide range of meals. EVIDENCE: The home has only two service users and as such service users are able to choose their meals and participate in all aspects of meal preparation including shopping and cooking. Staff advised the inspector that they ask the service users what they want for their meals and are aware of their likes and dislikes. The service user spoken to advised the inspector that they are involved in the menu planning, shopping for the food and preparation of meals. This was also witnessed during the inspection, as the service user picked what they had for breakfast. One service user has a range of food choices in a file that contains photographs, that enable the service user to make choices of meals. Service users are able to eat their meals when they wish and both service users go out for meals to venues of their choice. Healthy options were available in the home. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Medication practices are safe, however, the home does not keep the medication keys safe. EVIDENCE: The home has adequate procedures in place to ensure medication storage and administered to service users are safe. Previous inspections indicate that the home meets this standard. At the time of the inspection the staff kept the medication cabinet keys on the top of the cabinet. Staff advised the inspector that usually the office door is locked, but at the time of the inspection it remained open. This could lead to staff becoming complacent and this is unacceptable. The home is required to implement suitable procedures to ensure medication and service users are kept safe. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 13 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): 23 Service user do not have direct control over their personal finances. EVIDENCE: One service user manages with the assistance of family their own money. On audit of the other service users financial arrangements the inspector was informed that CIC hold the monies for them in two bank accounts. Furthermore the homes manager then needs to order the money on behalf of the service user and this can take three days. Organisations and registered managers must not manage the personal finances of service users in this way. The home is required to make suitable financial arrangements that enable service users to access their money as they wish. The home is to consult with the service users care manager and family to ensure the rights of the service user are upheld. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 14 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): 28, 29 Service users healthcare needs are met, following an assessment by a relevant healthcare professionals, however, the moving and handling equipment is inadequate. Service users are able to be independent in their home, but one service user is restricted due to access to the kitchen. EVIDENCE: The home had obtained a moving and handling assessment from an occupational therapist and equipment was provided to meet assessed needs. Following an accident involving the service user, the home involved the occupational therapist who made recommendations for new equipment. At the time of the inspection this equipment had not been provided and the home was managing with equipment that was not suitable to meet the service user needs. This was discussed with the service users care manager and an agreement was sought that the equipment would be ordered. The home has completed a satisfactory risk assessment and has appeared to have implemented suitable controls until the equipment is received. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 15 The home has completed all the building works to extend the home and this was found to provide a homely appearance. The service user confirmed that they had been involved in the selection of furniture and decoration of their home. The home has not altered the kitchen to permit access to all service users without the assistance of staff. This is the responsibility of the landlord and out of control of the home. This remains outstanding from the last inspection. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 16 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): None EVIDENCE: Not inspected on this occasion. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 17 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 Service users live in a well run home that promotes independence and encourages self expression. Service users views are listened to. The home provides a safe environment for service users to live, and this is supported by documentation, however, the home needs to consider the risks to staff and service users whilst in the car. EVIDENCE: The service user spoken to confirmed that they like living at the home and that they are involved in the running of the home. The home holds monthly meeting’s with each service user to discuss any difficulties they may be experiencing. These individual meetings are documented, which was audited by the inspector. No concerns had been raised. One service user experiences difficulties with communication. The home has involved a speech therapist and 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 18 a communication system has been adapted to meet the needs of the service user. Staff confirmed that the manager is approachable and that she promotes good relationships with service users, other professionals and visitors to the home. Staff also stated that the manager promotes and encourages staff in their personal development. The home has undertaken risk assessments and has documented policies and procedures, which were found to be satisfactory. At the time of the inspection, one service user was at college and needed to be brought home by the staff. Another member of staff needed to be called in to assist the staff in the car. On audit of the risk assessments this had not been considered. The staff advised the inspector that this was unusual and therefore had not been considered. The home is required to undertake a risk assessment and implement suitable controls for any identified risks. The home ensures that all certificates and insurances are in place to protect the welfare of the service users living at the home. These were audited at the last inspection. 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score N/A 3 N/A N/A 3 Standard No 22 23 Score N/A 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 N/A N/A 3 N/A Standard No 24 25 26 27 28 29 30
STAFFING Score N/A N/A N/A N/A 3 3 N/A LIFESTYLES Standard No Score 11 N/A 12 N/A 13 N/A 14 N/A 15 N/A 16 N/A 17 Standard No 31 32 33 34 35 36 Score N/A N/A N/A N/A N/A N/A CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
94 Eastern Road Score N/A N/A 2 N/A Standard No 37 38 39 40 41 42 43 Score 3 N/A 3 N/A N/A 3 N/A DS0000061646.V255333.R01.S.doc Version 5.0 Page 20 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 YA24 Regulation 23(2) Requirement Review the layout of the kitchen to ensure all service users have independent access. This remains outstanding from the last inspection. Undertake a suitable risk assessment for the use of the car, when service users are displaying issues with behaviour. All service users must have their own bank accounts . Companies must not hold service users monies on their behalf. Implement suitable procedures to ensure medication is stored safely and that service users do not have access to medication that may harm. Timescale for action 31/03/06 2 YA42 13 31/12/05 3 YA23 20 31/12/05 4 YA20 13(2) 07/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 94 Eastern Road DS0000061646.V255333.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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