CARE HOME ADULTS 18-65
Abingdon 48 Alexandra Road Southport Merseyside PR9 9HH Lead Inspector
Mr Paul Kenyon Unannounced Inspection 14th December 2005 10:00 Abingdon DS0000005355.V271296.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 Abingdon DS0000005355.V271296.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. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Abingdon Address 48 Alexandra Road Southport Merseyside PR9 9HH 01704 533135 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) Raglin Care Limited Miss Gillian F Trickett Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 9 LD Date of last inspection 19th May 2005 Brief Description of the Service: Abingdon is a care home offering a service to nine individuals with a Learning Disability. The home is run by a local company, which provides a number of services in the Merseyside area. The service is managed by Gill Trickett and owned by Raglin Care Ltd. The home is located in a residential area of Southport and is located within easy reach of Southports main shopping centre. It is close to local amenities. The service operated from a converted detached house with facilities spread over three floors. A large garden is located at the back of the house. There are a number of communal rooms and these are generous in size and number given the number of service users living in the home at present. There is a passenger lift available yet the needs of service users at present do not warrant the inclusion of any specialist aids or adaptations at present. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection to be held at Abingdon this inspection year (April 2005 to March 2006). The inspection was held during the morning and early afternoon and the home did not know that the Inspector was to visit. The Inspector used a number of National Minimum Standards for Younger Adults to measure the quality of care provided at Abingdon. The inspection included a tour of the premises, examination of a number of records as well as gaining the views of residents living there at present. At the moment, eight residents live at Abingdon. The Inspector was able to hold detailed discussions with three residents and briefer comments were gained from a further two. The inspection coincided with a busy time for residents who had a number of outings planned leading up to the Christmas period. Despite this, they were still available long enough to express their views about Abingdon and these views are included within this report What the service does well:
Three residents spoke with the Inspector in detail about their experiences of living at Abingdon. Comments included: ‘I enjoy living here’ ‘I may be moving soon but I will miss the place’ ‘Staff have been so good to me’ ‘I make my own meals twice a week and I enjoy it’ ‘I am fine’ ‘I am happy here’ ‘I feel safe’ ‘I am settled here and I like it’ ‘I am looking forward to Christmas and can go and visit my family’ The service is good at providing a staff team that interact with residents in a meaningful fashion. Interactions between staff and residents are informal yet serve to guide individuals in their daily lives. Staffing levels during the inspection were over and above the usual levels yet this is a common feature on Wednesdays and allows residents to benefit from one-to-one support. At all times through the inspection staff provided residents with advice and support. This reflects the needs of residents in relation to emotional support as highlighted in care plans.
Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 6 The service is good at sustaining and promoting family relationships and where personal relationships develop, health promotion advice is given. The service is good at gaining the views of residents about what activities they want to pursue in a give week and supporting them to be involved in household tests as much as possible. The service is good at providing healthy eating to residents and also significantly encouraging residents to plan menus and cook meals to encourage independence. In cases where independence in cooking is not an achievable goal at present, the service has identified the need for one person to eat well given that this person has health needs at present. The home is good at recognising the personal care needs of residents and adopt an approach of prompting residents to maintain their on hygiene rather than using a ‘hand-on’ approach. The service is good at identifying the health needs of residents and assisting them to access medical services. The service is also good at also recognising the emotional needs of individuals and introducing specialist support to them where necessary. The service is good at taking the complaints of residents and others outside of the home seriously and providing all with the information needed for a complaint to be made. The service has tightened up is abuse awareness for staff. The service provides clean premises, which are free from offensive odour and are well decorated and very home-like in appearance. Improvements to the environment are made as necessary with the recent refurbishment of the kitchen. The service is good at identifying the training needs of staff and in turn the organisation is good at proving a calendar of training providing training that links to the needs of residents. The service is good at looking at measuring the quality of the service provides. A recommendation to further strengthen this is raised in this report. The service is good at providing health and safety training to staff, ensuring that accidents are recorded, that the environment is safe and checking on a monthly that all systems are safe. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 7 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. Abingdon DS0000005355.V271296.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 Abingdon DS0000005355.V271296.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): No standards in this section were examined. Standard 2, which relates to assessments completed before individuals are admitted, is not applicable given that the last person to come to live at Abingdon has since left the service. The other person to be admitted prior to this was in October 2003 and assessment information has been examined on previous inspections. EVIDENCE: Abingdon DS0000005355.V271296.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): No standards in this section were measured at this inspection. Standards 6,7 and 9 were examined at the last inspection and were met EVIDENCE: Abingdon DS0000005355.V271296.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): 15, 16 and 17 Residents are enabled to maintain family relationships as well as develop other personal relationships. All residents are encouraged to determine their own routines with an emphasis on pursuing household tasks to increase their independence. Residents benefit from a service that not only provides a healthy diet to them but also enables them to be independent in the planning and preparation of meals. EVIDENCE: Evidence through documents as well as discussion with residents suggested that family links are maintained and that some have established personal relationships. Residents confirmed that the forthcoming Christmas break would give them the opportunity to spend some time with their families and the staff team were witnessed arranging these times for them. Staff supported one resident on the day of the inspection to visit a family member. In situations were personal relationships have developed, these are supported by the staff team and any appropriate health promotion is outlined within care plans. All residents devise and plan their activities with staff support on a weekly basis and then sign to confirm their agreement with the plan. In turn a daily prompt for staff and residents is available outlining the routines they wish to
Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 12 pursue. Included in the plan is the need for residents to pursue daily household routines to maintain independence. On the day of the inspection, some residents were dealing with their own laundry with staff support and this continued in other tasks such as hovering and polishing. A laundry rota is available in the building as well as a rota for the washing and drying of dishes. Residents confirmed that they are encouraged to continue with these routines. Residents confirmed that they still have a key to their own bedrooms and were observed having unrestricted access to all parts of the house. A significant part of the support offered to residents is done through communication with staff. Staff on the day of the inspection were noted to interact significantly with residents. This was done in an informal manner and did involve some lighthearted banter. Advice was given to residents on a whole number of issues such as the forthcoming Christmas period, budgeting of monies and planning activities. No residents have specific dietary needs at present although it was evident through care plan information and through discussions with residents that many were aspiring to lose weight. In some cases, individuals had been encouraged to join local slimming clubs and their weights were monitored on a monthly basis. These aspirations were outlined within care plans. There is a significant emphasis on residents planning and preparing their own meals through the week (with staff support where appropriate). Many residents confirmed that they have the opportunity at least twice a week to plan their meals, do necessary shopping and prepare them. One resident confirmed ‘I enjoy this and I will cook for whoever wants it’. Another confirmed ‘I do mainly salads because I want to lose weight’. Other residents have the opportunity to prepare their own meals and in nearly all cases, residents are encouraged to make their own breakfasts and light lunches. The occasions on which residents prepare their own meals are recorded in their weekly activity plans, which are in turn signed by residents to confirm their agreement. The health needs of one resident at present are such that rather promoting independence in preparing and planning meals; the emphasis is on ensuring that the individual is having sufficient meals through the week. Food records are maintained for all residents yet a more detailed record for the individual referred to is maintained so that an assessment of their nutritional intake can be made. Food stocks were noted to be sufficient and appropriately stored. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19. Standard 20 was measured at the last inspection and was met. Residents receive personal care from staff in line with their needs and this support takes the wishes of residents into account. Residents have their physical and emotional needs fully met. EVIDENCE: The personal care of residents is outlined in all care plans and tended to relate to the need for staff to prompt residents to maintain their personal hygiene rather than to provide direct hands-on support. Some residents confirmed that they are able to see to their own personal care while others need more assistance. One member of staff was indirectly observed assisting one individual to maintain their personal hygiene. This was done exclusively by prompting the individual rather than providing hands-on care. All residents have access to mainstream medical services. This was evidenced through records available. All residents have had recent visits to Doctors, Chiropodists, Opticians and Dentists. One resident confirmed that they had a dentist appointment that day and was going for a general check up. In one cases, a general medical check up had taken place within the past two months for one person without any specific illness or symptoms having arisen. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 14 For some residents, more specialist support is needed. This tended to be centred on emotional needs that individuals had. As a result all interventions from Consultants or Psychologists were recorded and progress noted. One person had developed a health need of late and records suggested that the staff team in line with medical advice had arranged investigations. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Residents have the information to make a complaint available to them and feel that their views are taken seriously. Service users are protected by staff aware of the action needed to deal with allegations of abuse. EVIDENCE: A complaints procedure is available for residents and is on prominent display. This includes a commitment by the home to investigate any complaints within a set timescale as well as providing information on how to contact the Commission for Social Care Inspection. Complaints records are maintained. The Commission for Social Care Inspection has received no complaints about the service since the last inspection although it has been made aware of three complaints. One complaint was from a resident and had been addressed. The resident who made the complaint stated that’ they listened to me and it has all been sorted out’. Members of the local community have received two complaints. These have been addressed with the Manager having met with neighbours to discuss the issues to the complainant’s satisfaction. The degree to which residents are protected from abuse had been measured at the last inspection. Two requirements had been generated from this and these were checked during this visit. All staff have now signed the protection of vulnerable adults procedure. In addition to this, training in abuse awareness had been arranged with remaining members of staff to attend an awareness day in January 2006. A notice on display confirmed that this training had been arranged. A discussion between the Manager and a resident was indirectly observed. This included advice in respect of budgeting and activities yet did include reference to the purchasing of gifts for staff at Christmas. The Manager was witnessed
Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 16 reinforcing the gifts policy of the home to the individual. A whistle blowing procedure is available for staff and is on prominent display. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Residents benefit from a clean, comfortable and home-like environment. EVIDENCE: The home experienced significant internal refurbishment over the past two years. A development from the last inspection has been the refurbishment of the kitchen. This lead to a positive comment at a recent Environmental Health report that was available for examination. The standard of decoration has been maintained and additional new furnishings such as three-piece suites have been purchased. The day of the inspection coincided with the lead up to the Christmas holidays. Seasonal decorations had been put up and one resident stated that they were proud of the Christmas tree that had been placed in the hallway. At present there is no specific refurbishment plan for the next twelve months for Abingdon although this will be examined at the next inspection. A maintenance department is available for the reporting of repairs and a budget sheet confirmed that the Manager has an annual budget for repairs and refurbishment, which has been translated into a monthly target. A tour of the premises noted it to be clean, hygienic and free from offensive odours. A laundry is available, separate from food preparation and storage
Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 18 areas. This contains an appropriate level of appliances, is organised and has an impermeable floor in place. A domestic member of staff is employed by the home and was present during the visit. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35. Standards 32 and 34 were measured at the last inspection and were met Residents benefit from a well-trained staff team. EVIDENCE: Training records were available on the day of the inspection and suggested that many staff had attended training days with topics relevant to the needs of the residents they support. Currently, a training programme is offered by the organisation to its staff and covers a twelve-month period. The Inspector was advised that this would change form April 2006 and would include the Manager being able to access the training needs of staff with training tailored to their needs. Mandatory training has been completed with some refresher dates identified for those staff who need them. Training available to the staff team over the past year has included: -Induction training -Health and safety -Food Hygiene -First Aid -Epilepsy awareness -Protection of vulnerable adults training -Autism -Management of challenging behaviour.
Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 20 Certificates of training are retained and confirm that staff had received this training. The Manager provided further evidence of training designed for her role. This included Disciplinary issues, team building and employment law. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 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): 39 and 42 Residents benefit from a service that takes their views into account. All connected with the home have their welfare promoted and protected. EVIDENCE: There are a number of systems in place to enable the quality of the service provided to be measured. An operational manager who is employed by the organisation conducts regular inspection visits to the home and submits the reports to both the Manager and the Commission for Social Care Inspection. The Manager continues to have residents meetings. The minutes of two recent meetings were examined and were found to include reference to those issues that are important to residents. All residents who spoke with the Inspector are familiar with the inspection process of the Commission for Social Care Inspection and the staff team continues to facilitate discussions between the Inspector and residents. The home does not currently gain the views of individual residents or their families through annual questionnaires. This would enable the views of residents and families to be determined on an individual basis. Given that
Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 22 quality assurance methods are in place at present, it is recommended that an annual questionnaire to gain individual residents and family members views be devised. Two requirements at the last inspections have been addressed promptly. Training records confirmed that staff had either been on mandatory training or had been identified for future refresher training. The home has thermostatic control valves, which maintain water temperatures. Despite this temperatures are still checked on a weekly basis and records confirmed this. Staff have attended fire training, fire extinguishers were had been serviced within a twelve-month period (as confirmed by service records) and fire detection systems are checked appropriately. One resident mentioned fire alarm tests and this suggested that they were aware of their regular occurrence. Fire drills take place regularly with the last one being in November 2005. Accidents are recorded although some of these are centred on incidents as a result of challenging behaviour. When these occur, the Commission for Social Care Inspection is notified of these. A recent environmental health inspection in respect of food hygiene noted the need for a temperature probe to be purchased and food temperatures to be measured. This has been done. Risk assessments are in place for general working practices. These should be reviewed now and this is recommended. A gas certificate confirming the safety of the gas system is current although the Manager had identified that the electrical wiring needed to be tested as well as portable appliances. All health and safety systems are monitored on a monthly basis. Checklists are available confirming that a designated member of staff checks every aspect of the environment and makes a report of any issues that need to be addressed. Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X N/A X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Abingdon Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000005355.V271296.R01.S.doc Version 5.0 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA39 YA42 Good Practice Recommendations The home should develop questionnaires for residents and their families in order to gain their views on the quality of the service provided on an annual basis General risk assessments should be reviewed on an annual basis Abingdon DS0000005355.V271296.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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