CARE HOME ADULTS 18-65
94 Whitstable Road 94 Whitstable Road Canterbury Kent CT2 8ED Lead Inspector
Lois Tozer Unannounced Inspection 17th January 2006 13:20 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 94 Whitstable Road Address 94 Whitstable Road Canterbury Kent CT2 8ED 01227 471980 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) whitstable@mcch.org.uk MCCH Society Limited Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. seven people with Learning Disabilities at any one time ( excluding persons registered or persons employed at the home or their relatives) The residents shall be 18 years of age and over 4th November 2005 Date of last inspection Brief Description of the Service: 94 Whitstable Road is registered to provide accommodation and personal care for up to seven adults who experience a learning disability (service users). In practice, the Home accommodates a maximum of six people because the one double room is used as a single. The premises are an older property that have been adapted for their present purpose. The accommodation is provided on the ground and the first floors. All of the service users have their own bedroom. There is dedicated parking for one vehicle, and the home has a large walled garden to the rear. The Home is operated by Maidstone Community Care Housing, which is a private company, with charitable aims. The Acting Manager is based in the Home and she is responsible for the supervision of its day-to-day operation. The home is situated within easy walking distance of local shops, pubs and a train station, it is also on a main public bus route. The City of Canterbury, with extensive shops and amenities is approximately 15 minutes walk. The home has access to one dedicated vehicle to support service users to get out and about. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place on 17th January 2006 between 13.20 and 16.10, and was assisted by the acting manager. All six people living at the home were in at some point, and several gave some input, although this was quite limited. The home and service users have experienced disruption over the last 12 months; the previously registered manager was seconded to another post and will remain there, and the previous acting manager is currently away on maternity leave. The current acting manager will also go on maternity leave in April 2006, opening up further change. The following methods were used to conduct this inspection; discussion with the 3 residents, discussion with 1 staff member and the acting manager, observation of the staff supporting residents; documents included – service user individual plans, medication administration records and storage; risk assessments, health and safety certificates, training records, staff rota and a tour of the premises. The people living at the home said or indicated that in the main they liked living at the home. One person said that they wanted to move on and live by the sea. Another smiled a lot when showing off their bedroom, looking proud. One service user was keen for the inspector to leave so staff could support getting online and looking at places to have a holiday. A service user said that they liked doing their jobs around the house and liked going out to visit their friends. What the service does well:
The service has staff who are well supported with statutory training and knowledge about the service user group. As the home is located well for access to town, people are able to access facilities easily. There is an atmosphere of teamwork, with staff and service users (who require less support) chipping in to make the day work well. Keeping in contact with friends and doing activities out of the house in community setting. The size of the home gives sufficient communal space for people to live with, but not on top of, other people. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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): 2 New service users have not been admitted for a considerable time, but needs assessments have not been conducted with existing service users that sufficiently respond to their changing needs. EVIDENCE: In conjunction with standard 6, the changing needs of individuals has been assessed and is well known to the staff team, however measures that are really effective in supporting these new needs are not evident. Staffing ratio is low, and a group assessment has not been conducted. People who have developed needs that are more challenging to the service, and therefore require additional support still rely on the basic staffing level. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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, 8, 9, The individual plan outlines changing needs, goals and aspiration, however, as in standard 2, action to meet these with appropriate staffing levels needs improvement. Service users are supported to make decisions and staff help people express their selves to make real changes in their lives. All service users are encouraged to participate in chores in the home. Risk assessments are in place and highlight action to reduce incident, however concerns in respect of pregnant staff being left to lone work and support service users was discussed. EVIDENCE: The individual plans are extensive and descriptive of each person’s support needs and requirements, however, where these highlight additional support is required, for example, where needs have changed, the staffing level or input has not been adjusted accordingly. The plans themselves meet the standard, but the outcome to the service users is that there is insufficient staffing to ensure people are supported to achieve when their needs change. The acting manager described how the organisation is supporting a person who stated they did not wish to live at the home. Many factors had been explored, and although peers changing needs (and therefore affect on constraints in the environment) were part of the bigger picture for the person, work with the area manager to look for alternatives was being conducted. Staff working in
94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 10 the home were inclusive and encouraged service users to be involved in domestic tasks. Risk assessments were written thoroughly, and in the main, workable, however environmental risks that had been identified (fire door held open), the risk assessment was absent, and action to improve the situation had not been conducted. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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, 15 Service users are encouraged to participate in occupational and educational activities, and some additional staff support is supplied for this purpose. Service users who have experienced difficulty in maintaining occupational placements have not been supported with an alternative within the home. Friendships and relationships are well supported. EVIDENCE: Several service users use day centres or other occupational / educational facilities, and the organisation run their own activities groups in community settings. An individual who has recently experienced a change of needs, and therefore has had a suspension of regular day service, was said to be at a loose end, waiting for review. Staffing ratios in the home are not sufficient to enable a person with higher needs to have an active, interesting life, and only allow the person to leave the home around 3 times per week. In discussion with a service user, relationships were advised to be well supported, and staff were kind and considerate, helping individuals to see their friends, relations, and offering support during difficult times. Regular friendship groups take place, and the home organises a monthly meeting group, based in a local community setting.
94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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 Staff safely manages medication on service user behalf, but some improvements are recommended. No service user has control of their own medication at present. EVIDENCE: Processes are in place to ensure all medication is accountable, however much of this is repetition, and it is recommended, especially in reflection of the low staffing levels, that the system be reviewed. All medication was up to date, and administration records were in good order. Discussion of medication with the acting manager highlighted the need for each person to have an ‘overview’ sheet, advising staff what each medication was for and its common side effects. Also recommended was a photo of the individual and their own homely remedy protocol be added. Many individuals are taking alternative remedies, but these are recorded as a group. It is recommended that all documentation be personal and contain only one individuals details, so, should they move on, they can easily access their personal records. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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): None of these standards were inspected on this occasion. EVIDENCE: 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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): 24, 25, 26, 27, 28, 30 Improvements to the premises, in communal areas, hygiene, and access to facilities are required. Individual bedrooms are very homely and are of sufficient size. There is an inadequate amount of bathrooms available. EVIDENCE: The home is a large building in a very good location, easily accessible to community facilities. Some areas of the home are in good order, the lounge, and the service users bedrooms (4 seen) were very homely and had been decorated as the individuals wished. The dining area is in need of urgent improvement, as a stale, unpleasant odour was evident, and was reported as an ongoing problem with the carpet and floorboards. The acting manager hopes the replacement will be a hard floor, which seems realistic, but care must be taken to the choice of hard floor, to prevent an un-homely look. There are two communal bathrooms and three toilets, but one bathroom and WC were out of action, and had been for at least 6 weeks. The functional bathroom had a WC within it, but the flooring had not been sealed where a utility had been removed, therefore floorboards were exposed, and a stale odour of urine was quite strong. The kitchen cupboards were in need of repair or replacement. Discussion revealed that improvements are planned, but as yet, no timescale for completion has been set. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 15 All hand wash areas involve the use of communal towels; this is poor practice in the control of infection, and advice from the East Kent Health Promotion Service should be sought for a manageable alternative. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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): 32, 33, 35 Service users have a competent and qualified staff team supporting them, however the numbers provided on a day-to-day basis do not give ordinary life opportunities to the individuals. Staff have received regular and relevant training opportunities. EVIDENCE: The staff team are experienced and have benefited from a wide range of health and safety and some service specific training. NVQ qualifications are supported by the organisation, and several staff hold the NVQ 4 level registered managers award. During the inspection, through observation and accounts by the staff, the number of staff available to support the 6 service users appeared insufficient. There was no service user group assessment in place, so a requirement that the residential forum assessment of minimum staffing levels is conducted was required, and copy of this sent to CSCI. If the outcome, based on meeting individual needs, highlights the need for more staff, then this must be discussed with the organisation. Currently a baseline of 2 staff are available during the day, with an additional 20 hours day support a week from the ‘visiting person team’. There is no additional support for domestic chores, such as cooking, cleaning, or gardening. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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, 42 There is no registered manager in post; the home has been managed for over 12 months by people in an ‘acting’ capacity. The promotion of health, safety, and welfare of both service users and staff needs improvement. EVIDENCE: The previous inspection (November 2005) highlighted that the electrical wiring certificate was out of date, the inspection dated being due 20/10/03. This inspection was still outstanding, and now forms an immediate requirement that must be met by 1st February 2006. Such shortfalls, and the ongoing problems with the fabric of the building, reflect that the permanent management of the home must now be a priority for the organisation. Whilst the acting manager is a competent individual, the expectation is that the majority of rota time is spent in direct care. Managerial duties are not given sufficient priority, as, rightly, the needs and demands of the service users have been put first. The current acting manager will go on maternity leave in April 2006. Risk assessments for staff that are pregnant have not taken into account being left in a lone worker position or the changes and challenges in behaviours of service users. This whole risk assessment process and needs urgent review to be more responsive and wary of the day-to-day hazards to pregnant staff.
94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 18 More positively, the home has had a recent replacement boiler. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 2 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 X 23 X ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 1 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 2 X X X X 1 X 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 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 YA2YA6 YA12YA33 Regulation 14 15 16 18 13 23 13 Requirement Assess the service users changing needs, seeking professional input as required, and provide staff in sufficient numbers to meet these needs. Fit suitable fire door retainer onto bedroom door wedged open With immediate effect, organise an inspection of electrical wiring that complies with the Electricity at Work Regulations 1989 and submit a copy of the certificate to CSCI. Inspection by 1/2/06 Submit an action plan for environmental improvements stating the timescale that work will take place. Seek hand drying and infection control advice from the East Kent Health Promotion Service and follow advice. Lone worker and pregnant staff risk assessment to take into account the changes and challenges of the service, and protect both staff and service users. Timescale for action 01/02/06 2 3 YA9YA42 YA42 01/02/06 01/02/06 4 YA24 YA27YA30 YA30 23 24/01/06 5 13 01/04/06 6 YA42 13 01/02/06 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 21 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 YA20 Good Practice Recommendations Individual recording sheets for alternative therapies. Each person has a ‘prescribed medication’ information sheet with the type of medication and common side effects. Assess the way in which medication is accounted at each shift versus the time spent away from service users. 94 Whitstable Road DS0000032234.V277059.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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