CARE HOME ADULTS 18-65
Abacus House Abacus Street 8 Princes Street Dunstable Bedfordshire LU6 3AX Lead Inspector
Leonorah Milton Unannounced Inspection 12th May 2006 10:45 Abacus House DS0000029303.V294010.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 Abacus House DS0000029303.V294010.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. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Abacus House Address Abacus Street 8 Princes Street Dunstable Bedfordshire LU6 3AX 01582 478998 01582 666667 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) Mr Chalvanayagam Menna Mr Sinnathamby Sivanesan Mrs Delia Williams Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1 adult aged 35 - 70 years Date of last inspection 14th December 2005 Brief Description of the Service: Abacus House was registered to provide for six adults with a mental disorder. The home had been owned by Mr Menna and Mr Sivanasan for a number of years. Mr Menna carried out the responsible person role on behalf of the partnership. Mrs Delia Williams had been the registered manager for two years The home was a detached property that had formerly been a private residence. It was located in a residential area of Dunstable within walking distance of the towns amenities. The premises had four storeys, the upper floor being reserved for administrative purposes. Bedrooms for single occupancy were located on the ground and first floor. A kitchen-diner was located on the ground floor as was an all weather conservatory that was used as a sitting room. There was a small front garden and a large back garden to the side of the building. The basement housed the laundry and a room that was occasionally used for activities and other storage areas. The garage that was accessed from the side garden had been converted into a gym for the use of the service users. Parking for two cars was available at the front of the building. There section on the statement of purpose relating to fees for accommodation had been left blank. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care (CSCI) since the last visit to and public report on, the home’s service provision in December 2005. Taken into account were reports submitted to the CSCI by the provider each month on the conduct of the home, reports from other statutory agencies and information gathered at the site visit to the home, which was carried out on 12th May 2006. The visit to the home included a review of the case files for two service users, and discussions with two members of staff and the manager. Sundry other records were assessed and a partial tour of the premises was carried out. What the service does well:
There were four service users in residence at the time of the visit to the home. Three of these were at home as the inspection commenced. The other service user returned home towards the end of the visit. Conversations, albeit brief in three instances, took place with all four service users. Each person seemed content with their lifestyles in the home, although one said that he would prefer to go out of the home more often but was unable to say where to. Members of staff on duty were observed to treat service users with kindness and respect. Prompts to remind service users about various aspects of daily life were given fairly and where necessary, for one person, firmly in accordance with the written assessment and plan for this person’s care. Service users described members of staff as good, ok and all right. Similar words were used to describe their experience of care in the home. The home had been well managed. It was evident that the manager was committed and well qualified to run Abacus House. She had ensured that the team had been thoroughly briefed about their responsibilities, so that a qualified and knowledgeable workforce in turn had cared for service users. Service users had diverse needs, which required some complex healthcare interventions and strategies to diffuse situations were service users became upset. Sufficient guidance had been sought from healthcare specialists and was detailed on written guidance to ensure that service users were properly cared for. Abacus House DS0000029303.V294010.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. Abacus House DS0000029303.V294010.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 Abacus House DS0000029303.V294010.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): 2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Satisfactory information about service users’ needs had been obtained before service users had moved into the home to ensure that the home had the ability to meet assessed needs. Contractual arrangements were incomplete, so that service users, or where appropriate their representatives, were not able to access information about charges for their accommodation. EVIDENCE: There had been no admissions to the home since the previous inspection that had assessed admission procedures as satisfactory. Service users had been given a contact in relation to the arrangements for their everyday lifestyles. There were no contacts in place with the funding authorities for the two service users whose documents were assessed at the site visit. It was reported to the inspector at this and the last inspection that the home had contacted the placing authorities about these arrangements. Given that both service users had lived in the home for more than as year this situation must be resolved. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 9 Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 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): 6,7,8 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Care planning documents were not sufficiently detailed, so that there was a risk that some needs would remain unmet. EVIDENCE: The assessments of need seen at the site were comprehensive. There was evidence to show that plans had been devised in consultation with appropriate health care specialists, particularly in relation to restrictions to usual liberty that were required to maintain the health and safety of service users. There was also evidence to show that service users and their families had been consulted about their plan of care. The plans, however, were not sufficiently detailed to show how service users would be supported with their social and recreational needs. It was explained that service users had been supported to access services for routine healthcare needs. However there was little detail in relation to this on care planning documents. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 11 Records of service user meetings and conversations with service users showed that they had been supported to make decisions about their lifestyles within the scope of their abilities. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users had mostly been encouraged to take part in activities of everyday living that were within their abilities. Access to leisure activities on a regular basis for one service user had been insufficient. Service users nutritional needs had been well met. EVIDENCE: Service users had been encouraged to take part in domestic duties on an agreed/signed rostered basis. They confirmed in conversation with the inspector that they had taken part in domestic cleaning duties. Records for one service user showed that he had only been supported to go out of the home on six occasions from 21.03.06 to 11.05.06. This situation
Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 13 seemed to be of a temporary basis. The record indicated that the service user had been previously been supported to go out of the home more frequently. The manager explained that service users’ abilities and behaviours had curtailed their contact with others in the community. One service user had been required to withdraw from a local college course and also from an employment opportunity. During conversations, service users were excited about the holiday planned for later in the year. Records indicated that service users had been consulted about the choice of holiday. One service user attended a local club for those with a similar disorder. Satisfactory arrangements were in place for the service user who had special dietary requirements, including detailed instructions for the management of diabetes. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 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 the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. There was insufficient evidence to show how routine healthcare needs had been met. Medication procedures were mostly satisfactory. There was a risk however to a service user’s welfare because one medicine had not been given as prescribed the day before the site visit. EVIDENCE: Records assessed in relation to two service users at the site visit showed that service users had been supported to consult with their General Practitioners and other specialist healthcare professionals. However they did not identity whether service users had been referred for routine treatments such as chiropody, dental and optical care. It was noted that one of these service users wore spectacles. Medications were stored securely. The inspector was informed that staff had undertaken a distance learning course to instruct them on the best practice for handling medications.
Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 15 The medication record for one service user showed that one prescription had been signed as given. However the medication concerned was still in situ in the monthly monitored dosage system. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home had systems in place to support service users to raise concerns. The home had not followed reporting procedures fully to ensure that all statutory authorities had been informed about a protection issue, however systems to protect service users from abuse had improved following a recent incident. EVIDENCE: The manager reported that there had been no complaints about the service since the last inspection and for sometime prior that inspection. Service users said that they would talk to staff and the manager if they were worried. There had been a recent theft of service users’ money held for safe keeping by the home. The inspector was shown a letter from the police to a service user explaining that they would not be pursuing an investigation of this matter. There had been no investigation by the local authority, as they had not been informed about the theft. The manager explained that she was under the impression that the police would make contact with the local authority. The home had reviewed its procedures to ensure limited access to the home’s security keys. The manager reported that the proprietor intended to reimburse service users with the missing monies. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 17 Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The building was mostly suitable to service users’ needs but the unregulated high temperature in the conservatory/lounge posed a risk of discomfort to service users and staff alike. Failure to ensure access to the garden had prevented service users from taking part in gardening activities. EVIDENCE: Redecoration and refurbishment of areas of the building had greatly improved the environment. Most of this had been at the proprietors’ expense. However, the efforts of the staff and service users should be recognised. It was reported that they had redecorated the hallway and staircase and music room. A service user stated that she and staff had cleared the section of garden that was accessible. Staff on duty were working in the other section of the garden as the inspection visit started. The area was significantly overgrown and will need a great deal of work to fetch it under order. It is not acceptable for staff
Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 19 to be gardening during times when they should be working directly with service users. The inspector had noted that service users had been supported to grow vegetables in previous years. The room temperature in the conservatory was taken at 13.00 hours when all of the windows and doors to the room had been left open. The reading was 33°C. The manager stated that quotes had been obtained in relation to the fitting of ceiling blinds to this room that was a requirement from the previous report. Whilst the compliance date was not until 31/05/06 it was evident at this site visit that this requirement must be actioned as a priority. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 20 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): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. There had been sufficient numbers of competent staff on duty to ensure that service users had been properly cared for. EVIDENCE: Duty rotas showed that sufficient staff had been rostered at all times with a ratio of 2 to 4 service users throughout the day. All but the 2 most recent employees had been designated as senior carers. It was reported that each held a National Vocational Qualification in care and had undertaken statutory training. A senior on duty confirmed her training experience. Assessment of files for 2 recent employees showed that recruitment procedures had been robust and had included checks on identity, previous employment and via the Criminal Records Bureau. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home had been well managed to the benefit of service users. EVIDENCE: The manager’s input into the home was commendable. At this and previous inspections, it was noted that she had continuously reviewed the home’s operational systems and documentation to improve the service. Recent updates had been had been made to the documentation to assess service users’ needs. The manager had also continued to update her professional knowledge and was currently working towards a diploma in health psychology. She had strived to develop the knowledge of the team by developing training programmes that were specific to the needs of service users with mental disorder.
Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 22 The previous inspection had noted that the home had met the standard in relation to a review of the quality of the service. This exercise was not due for review by the date of this inspection. The scoring for this standard is therefore carried forward. Safety arrangements were satisfactory. Staff had received statutory health and safety training. All but recent employees held first aid certificates. Environmental safety was subject to regular review by the manager and also by an authorised professional agent who carried out audits on the conduct of the service under Regulation 26. Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 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 1 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 4 x 3 x x x 3 Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 24 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 YA5 Regulation 12(1)(a) 4,5(3) Requirement The registered person must: Obtain an agreement for the arrangements for the accommodation for each service user from their placing authorities. Detail the home’s range of charges for accommodation in the home in the written guidance to the service. Care plans must contain more detail in relation to service users’ social, recreational, religious and routine health care needs. Service users must be taken out of the home to engage in recreational activities with a frequency that is in accordance with their abilities and wishes. Medicines must be given as prescribed. The registered person must ensure that allegations of abuse are reported to the Local Authority as well as the Police.
DS0000029303.V294010.R01.S.doc Timescale for action 31/08/06 2 YA6 12(1)(a) 15 31/08/06 3 YA14 12(1)(a) 16(2)(m) 10/06/06 4 5 YA20 YA23 12(1)(a) 13(2) 12(1)(a) 13(6) 10/06/06 10/06/06 Abacus House Version 5.1 Page 25 6 YA24 12(1)(a) 16(2)(c) The garden must be tidied up. A member of the care team must not carry this out as part of their rostered care hours. (Previous timescale of 31/03/06 had not been met.) Blinds must be fitted to the ceiling of the conservatory. (This requirement was issued at the previous inspection but was within the compliance date at this inspection) 30/06/06 7 YA24 12(1)(a) 16(2)(c) 31/05/06 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 Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Abacus House DS0000029303.V294010.R01.S.doc Version 5.1 Page 27 - 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!
