CARE HOME ADULTS 18-65
Abacus House Abacus Street 8 Princes Street Dunstable Bedfordshire LU6 3AX Lead Inspector
Katrina Derbyshire Unannounced Inspection 30th April 2007 11:00 Abacus House DS0000029303.V339418.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 Abacus House DS0000029303.V339418.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. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 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 Manager post vacant Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1 adult aged 35 - 70 years Date of last inspection 12th May 2006 Brief Description of the Service: The home is a detached property that had formerly been a private residence. It is located in a residential area of Dunstable within walking distance of the towns amenities. The house has four storeys, the upper floor being reserved for administrative purposes. Bedrooms for single occupancy are located on the ground and first floor. A kitchen-diner is located on the ground floor as is an all weather conservatory that is used as a sitting room. There is a small front garden and a large back garden to the side and rear of the building. The basement houses the laundry and a room that is occasionally used for activities and other storage areas. Parking for two cars is available at the front of the building. No copies of the homes statement of purpose and service user guide were on display neither were copies of the most recent inspection report. The owner and staff at the home say that they make these available to prospective people who may wish to move into the home. The owner gave the following information on charges on 30th April 2007. The fees for this home vary from £650.00 per week, to £970.00 plus per week, depending on the funding source and assessed need of the person. Additional charges are made for hairdressing, barber services outings and holidays. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 30th April 2007. During the inspection several areas of the home were visited and the inspector spent time with people who live at the home in the communal areas. The care of two people was examined by looking at their records and interviewing them and staff who look after them. The views of people living at the home were also received through 4 returned comment cards and their feedback has been used alongside information from the home, through written evidence in the form of a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
People living at this home feel that they are able to do the things that they enjoy. One person has a pet that they care for and staff support them to do so they said, “l love my cat, l have this room because it opens up into the garden so she can get in and out”. People spoke of enjoying the use of fitness equipment at the home; there is a separate area outside that has an exercise bike and treadmill alongside other equipment. This means people feel that they are supported to meet their social interests and have opportunities to follow and maintain their hobbies. Staff are good at writing about the care that people need, these documents are known as care plans. The care plans are used by staff to let them know how they should support the person and to make clear the individual needs of the person. People are involved in developing their care plan, so they are able to voice their views and express how they feel they should be supported. Once the care plan has been written both staff and the person living at the home sign to say that they agree with its content. This makes sure that people are involved in planning the care that they receive. The way that staff order, looks after and give out medication is good. There is one member of staff who is responsible for ordering medication that people
Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 6 need and checking that the correct stock is at the home at all times. Records that show the type of medication and when it has been given are also maintained. So people living at the home know that they will always have their medication when they need it and safely. What has improved since the last inspection? What they could do better:
There is a conservatory that is used as the sitting room in the home. When we last visited we said that the owner must fit blinds to the ceiling, as the room especially in the summer months becomes very hot and there is limited protection from the glare of the sun. This still has not been done. This means that when people are sitting watching television for example it is to hot and it is not comfortable to be in. One person living at the home said, “its always hot in here, its to hot in fact”. Written information about the home needs to be readily available for the people living there and displayed for people who may wish to move into the home. The information is called a statement of purpose and service user guide. These are documents that should let the people at the home know all about the manager, accommodation and staff for example. The owner did find copies eventually, but they were out of date and still said that a manager was employed at the home, but they didn’t work there anymore. This needs to be updated so a purposeful guide is available on the services at the home, for people who wish to and who already live at the home. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 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 Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 People who use this service experience Adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Pre admission information on the home is not sufficient to ensure people have accurate information to make an informed choice as to whether to move into the home or not. EVIDENCE: It was noted that the statement of purpose and service user guide was not displayed in the home; this included the most recent inspection report. The owner and staff then took some time to find these documents; people living at the home did not have their own copy. On examination of the records it showed that the statement of purpose was out of date, information on current fees was not included and it still made reference to the previous Home Manager, even though she no longer worked there. Through discussion people living at the home confirmed that they did not have copies of these documents. Individual care records examined of people whose care was tracked showed written evidence that management at the home had sought from Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 10 commissioning a contract for the person. Statements of residence had then been sent and copies of these were also seen. Pre admission assessments were also noted to be in place. These documents had been completed prior to the person moving into the home. They gave a detailed description on the needs of the person and included their personal likes and dislikes. In addition supplementary information was also seen, this had been provided by the placing authority and showed the assessment of needs as carried out by the relevant Social services Department. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 11 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 & 9 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Improvements in care planning ensure staff have the information to know the support that is needed by the people living at the home. EVIDENCE: It was seen that changes had been made to the care plans since the previous inspection. Care plans were comprehensive and written in a paragraph format. One person for example needed assistance in relation to the management of their diabetes. This was detailed within their plan of care. Guidance to staff showed what they should do and the support that they should offer this person concerning their diet, accessing medical assistance and providing emotional support. Through discussion with staff they showed a good level of knowledge of the content of the care plans, demonstrating that these documents were used by the staff team to ensure consistency in the care offered. Information from the returned comment cards from people living at the home indicated that they are satisfied with the care provided by the staff at the home.
Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 12 People at the home confirmed that they were able to make decisions about their lives through discussion with them at the site visit. One person said, “Of course l decide what l want to do”. Examples of choices included, relationships that the person wished to maintain or develop, clothing and social activities. Documentary evidence was also seen to show 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 the individual. Risks to people were discussed as part of their care planning review; these documents showed that the person, staff and a representative were given the opportunity to review the care services at the home and for the person to be involved in planning their care. If it had been identified that the person needed encouragement and support with independence this was documented. One person at this visit was seen to assist with the preparation and domestic duties of the midday meal. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 13 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, 15, 16 & 17 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Meals are sufficient to provide people with a varied choice and diet. EVIDENCE: A choice of meals was available over the week; menus submitted by the home reflected a varied diet and staff informed the inspector that people that lived at the home were involved in setting the menus and on occasions assisted in the homes ‘ shopping’. The kitchen was seen to be clean and tidy. The people livening at the home through discussion and through feedback from returned comment cards confirmed that they were satisfied with the food. One person spoke of the contact with their family, they could visit family members at their own home. Another person showed the inspector their cat; they advised that they had the ground floor room with a door to the garden so
Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 14 she could get in and out. The person described how important having the cat was to them and staff provided them with the support to keep their pet. The staff on duty at the time of the site visit advised that none of the people were engaged in paid employment at this time. People through discussion spoke of their attendance at varying local facilities and described their programme of learning. Information examined supported this. Entries made within the care records described the social and leisure activities the resident’s had received. Records viewed on the day of inspection indicated that activities that had been provided for example were shopping trips, walks and going out for a pub meal/drink. People also spoke of a holiday in Blackpool last year and another was being planned for later on this year. The care records seen also identified very different individual interests of the people and they were specific in the identification of the persons preferred leisure interests, regular contact with family members and visits to their homes were also included. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 15 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 & 20 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Medication systems are sufficient so people receive their medication as prescribed. EVIDENCE: Entries seen within daily notes demonstrated that people had access to optical services. In addition one person was noted to have received specific advice from a dietician at the local hospital relating to the management of their diabetes. Through discussion one person confirmed that if they felt they needed to see a Doctor that the staff would arrange an appointment to see them, as they did not feel able to do this themselves. Medication was seen to be locked in a secure cabinet. The stock and records examined at this visit showed both to be correct. Staff advised that distance learning training had been undertaken in the safe administration of medication. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 16 Reponses from returned comment cards indicate that people at this time feel that their healthcare needs are met. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 17 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 & 23 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People feel able to raise concerns with staff if they wanted to and feel staff will listen and respond. EVIDENCE: Staff and documents showed that no complaints about the service had been received since the last inspection and for sometime prior to that inspection. Returned comment cards to the Commission for Social Care Inspection showed that people were aware of how to complain. One person said, “If l wasn’t happy l would say straight away”. Staff through discussion confirmed that they were aware that if they received a complaint that this would need to be responded to and reported. Information supplied by the home as part of the pre inspection paperwork detailed that staff had undertaken training in abuse. Staff were aware of the homes policy in this area a and stated that they would raise any concerns that they had immediately. No referrals have been made by this service at the time of this visit under the local protection of vulnerable adults guidance, therefore a previous requirement could not be assessed for compliance. Therefore this requirement will remain not because it has not been met, but assessment of its compliance was not able to be carried out. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The building is mostly suitable to meet people’s needs but the unregulated high temperature in the conservatory/lounge poses a risk of discomfort to people living at the home and staff alike. EVIDENCE: As reported at the previous inspection redecoration and refurbishment of areas of the building had greatly improved during 2006. Areas seen at this visit included individual rooms, sitting room, kitchen/dinner and computer room they were noted to be clean and decorated to an acceptable standard. People through discussion confirmed that they felt satisfied in the main with their accommodation. However as reported at the inspection undertaken in May 2006 the room temperature in the conservatory was above that of the rest of the building. The
Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 19 inspector at that time had been advised that quotes had been obtained in relation to the fitting of ceiling blinds to this room following a previous requirement. The blinds had not been replaced, several people living at the home described sitting in this area as uncomfortable and to hot. This conservatory is the only space available for people to use as a sitting room in the home and they use it to watch television. Discussion was held with the owner of this home regarding this matter and that the requirement must be met without exception. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The systems in place for the recruitment of staff and vetting of prospective employees are robust and protect people. EVIDENCE: Examination of two staff files was undertaken to look at recruitment practices. It was noted that the files contained proof of identity; verification of employment history and that Criminal Records Bureau clearance had been obtained. Information regarding training of staff submitted by the home show that staff had undertaken training in areas including health and safety. Through discussions with staff it was confirmed that they had undertaken a variety of courses including those specifically to better understand the needs of the people living at the home. In addition staff confirmed that they received regular supervision sessions with the Deputy Manager at the home. The Deputy manager had been providing additional support and on call help since the previous home manager had left.
Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 21 Staff stated that during this time they are able to review their individual work performance and can then with the support of management agree on actions to be taken to improve in their performance, which in turn improves the standard of care within the home. Observation of interaction between staff and people living at the home showed that a good amount of conversation took place between them. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 22 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 & 43 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and safety systems in this home are sufficient to provide an environment for people that reduce the risks associated with this area. EVIDENCE: The Home Manager had left since the previous inspection. The owner confirmed that he had made attempts to recruit a replacement but had received a limited response to advertisements placed. The interim arrangements in place were that the Deputy Manager was undertaking an acting up role; she stated that this was not permanent. Staff through discussion confirmed that they had satisfactory support at this time. The owner visited the home regularly and the company employed a person to undertake Regulation 26 visits who also supplied guidance and support. People at the
Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 23 home through discussion said that they felt satisfied with how the home was running at this time. Documents were seen to show that people living at the home had been asked their views on the care provided. In addition meetings were being held where the daily life in the home could be discussed, minutes of these meetings are maintained in the home. Health and safety procedures such as fire safety checks were noted to be satisfactory. Staff had received statutory health and safety training. Written information supplied by the home showed staff were also trained in First Aid. Environmental safety was subject to review by the staff and also by an authorised professional agent who carried out audits on the conduct of the service under Regulation 26. Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 24 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 3 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 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 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 X 3 Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4&5 Timescale for action A statement of purpose and 31/07/07 service user guide containing all matters detailed in the relevant regulations, must be made available to all people in the home and prospective people so that they know what services the home can and will provide. The registered person must 30/06/07 ensure that allegations of abuse are reported to the Local Authority as well as the Police. (Previous requirement, not able to be assessed at this inspection) Blinds must be fitted to the 31/05/07 ceiling of the conservatory. (Previous requirement timescale of 31/05/06 not met) Requirement 2. YA23 12(1)(a)13(6) 3. YA24 12(1)(a)16(2)(c) Abacus House DS0000029303.V339418.R01.S.doc Version 5.2 Page 26 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.V339418.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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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