CARE HOME ADULTS 18-65
Adam House 21 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector
Mrs Marie Dickinson Unannounced Inspection 15th January 2008 10:00 Adam House DS0000009527.V357569.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 Adam House DS0000009527.V357569.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. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Adam House Address 21 Ormerod Road Burnley Lancashire BB11 2RU 01282 830215 01282 414506 healycare@ntlworld.com 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) Mrs Bridget Mary Healy vacant post Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th May 2007 Brief Description of the Service: Adam House is a large garden fronted terraced property in what is mainly a residential area. It is very close to Burnley town centre, near to the College, library, main shopping area, churches and local parks. The home is owned by Mrs Healy and is registered to accommodate 6 adults under the age of 65 with a mental illness (excluding learning disability and dementia). The accommodation provided is domestic in style and consists of a lounge, dining kitchen and smoking area. There are two shared and two single bedrooms. Staff provides support 24 hours per day. Transport is available to enable service users to visit relatives, take short trips and outings within the community. Weekly charges for personal care and accommodation is £905. There were voluntary optional charges for entertainment and transport. Information about the services provided is usually available in the home. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
A key unannounced inspection was conducted in respect of Adam House on the 15th January 2008. this is the second key inspection carried out within the past twelve months. The inspection involved getting information from an Annual Quality Assurance Assessment completed by the manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the manager, and an inspection of the premises. There were no written comments from residents or relatives. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Younger Adults. One additional visit had been made to the home since the last inspection. This visit was in relation to compliance of statutory notices served at the home in relation to the environment. What the service does well:
Residents living in the home had a meeting every week to discuss issues that were important to them such as what they would like in the home, menus and activities they would enjoy. The home was near to the town centre and residents said they could go shopping and get out and about easily. There was park nearby and College across the road. The atmosphere in Adam House was relaxed, and the residents could do what they wanted such as what time to eat and get up and go to bed. Information received at the Commission showed the home considered they did well by: ‘Allow decisions to be made by residents. Support individuals to access community resources. Two residents were being supported to move from residential care and live independently in the community. Residents went on holiday, which they said they enjoyed and were looking forward to going away again.
Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 6 The residents were able to maintain good contact with their family and there no restrictions placed on visiting. Residents were very pleased with the improvements made to their environment. The home was decorated and furnished to a good standard. Residents said the staff treated them well. They were ‘good’, and ‘ok’. Staff were observed during inspection treating residents living in Adam House sensitively and with respect. The new house manager took a positive approach to the inspection process. Issues raised in the inspection were duly noted and responded to in a professional manner. What has improved since the last inspection?
The statement of purpose and the resident guide had been updated and made available to people living in the home. It contained relevant information about the aims and objectives of the home. A copy of the most recent inspection report was made available so residents and prospective residents could read of how well the home is in meeting National Minimum Standards. To help residents to achieve good long-term outcomes, new care planning had the potential to set easily reached targets to promote a sense of well being, and worth for residents. Monitoring forms had been devised to record this. Residents are consulted regarding their preference for male or female carers to support them individually, and key working has been introduced to support residents in a more personal and consistent way. Residents had their own house rules, which supported communal living. Residents had also been given a complaints procedure showing them the process to make a complaint or raise any issues they may have. Guidelines for protecting people from abuse had been written for staff to make sure managers and staff do the right things. Staff were issued with a contract formalising an agreement and code of conduct such as not gaining financially from service users. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 7 A considerable improvement had been made to the environment. This included complying with work required by the fire department; security lighting installed at the back of the home; removal of discarded boiler and radiator in the yard, and backyard gate replaced. In addition to this work required making good the fire damage to a bedroom and smoke damage to walls and ceilings in the home had been completed to a good standard. New window frames had been fitted to the back of the home and the back yard provided a more pleasant area to sit out during fine weather. A handyman was available for minor work required in the general maintenance of the home. Information received at the Commission for this inspection indicated residents were asked about their preferences for colour schemes when their bedrooms are re decorated. They were also provided with adequate clean bedding, curtains, floor coverings, and fittings. New carpets had been fitted in the hall, stairs and landing. An improved level of staffing meant the possibility of residents having a person centred approach to their care could improve. Formal consultation with residents had improved enabling them to express their views and opinions of life in the home and have some input in any future planning. Progress had been made with Quality Assurance process to help ensure the service is run in the best interests of the residents. What they could do better:
People using the service must be informed of the fees they are charged. They need to know the amount, and who is responsible for paying this. The registered person must make sure by providing accommodation to a prospective resident, staff are trained in mental health so the resident can be assured their needs can be appropriately met. Residents care plans must include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. This would provide residents with a more person centred approach to their care and personal development. Risk taking must be dealt with properly to keep people safe. Risk assessments/risk management strategies must be completed in response to residents’ individual physical and mental health care needs. It is essential residents physical and emotional health needs are managed properly. House rules should be revised to make sure they are appropriate for residents. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 8 A procedure should be available for staff to support them to deal with the event of a death. Staff must be given formal training in adult protection issues and have a clear procedure as to the homes stance on the use of ‘restraint’. All bedroom doors must be adequately fitted to ensure protection in the event of a fire. Residents’ bedrooms should be fitted with more suitable locks, which are operated as a suite, with master keys being available as appropriate. The recruitment process must include full employment history. To avoid the risk of essential information not being recorded, the application form currently being used should be revised. It is essential that information given on references is carefully considered in deciding the suitability of a person for that role. Interview notes should be taken to support a decision to employ. When deploying people to work at the home the wishes and feelings of residents must be considered to avoid any possibility of poor resident/staff relationships. Movement of staff between homes should be managed better in supporting residents to receive a consistent approach to their care. Staff training must be complete to ensure residents individual and joint needs are met appropriately. This must include induction that meets with general guidance of the National Minimum Standards. The home has been without a registered manager for a prolonged period. A completed application form in respect of a registered manager must be forwarded to the Commission. The rotation of managers between homes should cease. This will support the manager to provide some stability for staff and residents and allow for positive development. Information requested by the Commission should provide more detail how the home is meeting National Minimum standards. Residents must be supported to respond to Commission if they choose to when approached. Policies and procedures should be kept up to date with current good practice. This will support staff to work effectively and safely. The registered provider must visit the home unannounced and produce a report of the visit for the Commission. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 9 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. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 10 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 Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home was up to date, providing information to enable current and prospective residents to be clear about the services and facilities provided. Residents were given individual contracts that informed them what was included for their overall care, and of their legal rights. EVIDENCE: The statement of purpose and the resident guide had been updated and made available to residents in the home. This provided information about the home, such as terms and conditions, and a standard contract. There had been no new admissions to the home since the last inspection and standard could not be assessed. However the manager said they were currently going through an admission process that involved an assessment of need and introductory visits in the near future to look around and meet the people living and working in the home. Since the last inspection residents had been given a written statement of terms and conditions/contract. Those seen did not include the amount of fee that an Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 12 individual paid. Prospective residents and their families overall however, had sufficient information on which to make a considered choice of home. The specialist care residents require, and the skills, ability, and knowledge of staff that will be caring for them had not been considered properly. Training records showed staff were not given good quality training to enable them to develop and be aware of current good practice in mental health. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans were in place but did not take into account all identified needs for residents, which meant staff was not instructed as to the best way to support residents. Identified risks was not always properly assessed and planned for, which could affect the resident’ wellbeing and safety. People were consulted and had some involvement with the daily running of their home. EVIDENCE: There was evidence that the service did understand the right of the resident to take control over their own life and make their own decisions and choices. Care planning used, although showed some needs, did not address these properly and completely. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 14 The management complete care plans and from discussions around care planning, there appeared a lack of understanding of how to document guidance for staff. Instructions were vague for staff to support people in areas of need. The introduction of short term goal setting improved the possibility of showing measurable achievements for residents, and the support required to enable them to reach their full potential. New records had been introduced to monitor this. Individual plans had been reviewed. As a result of the lack of detail, there was concern mental health needs identified in assessment and central to residents well being, were not been dealt with sufficiently. There was no agreed plan how this would be achieved and daily records showed inconsistencies on how staff support was given. For example, supporting people where certain limitations were agreed such as cigarette management. Care plans therefore were not used as a working document and did not consistently reflect the care being delivered. Most residents managed their own personal care. Observations made showed support that was required for one resident was not structured. There was no obvious encouragement for the resident to progress their daily routine. Comments such as ‘I’m all right’ were made in relation to staff support. Daily care notes basically showed what people did. Acceptable risk taking had been considered. Risk management needed to be clearer for staff as vague instructions recorded such as ‘therapeutic’ must be clearer as to what that involves. This will ensure there is a consistent approach by all staff when dealing with risk. Decision-making was said to be encouraged and residents were given time to consider the individual choices they made. They had the benefit of one to one discussions with staff, and weekly house meetings. In addition to this the home had introduced ‘house rules’. These showed residents were expected to do for example ‘not go in each other’s room unless invited and treat everyone’s room as private’. Some of the rules however did not match with communal living and linked better to care management such as ‘no one has money to waste on unnecessary spending’. It was suggested they be reviewed. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had a degree of independence and opportunity to take part in chosen activities, access community resources and keep in touch with families and friends. However because all identified need was not considered, those people who depended on staff support did not have equal opportunities in developing life skills. The meals were sufficient in providing for residents tastes, choices, and diet. EVIDENCE: The manager said the staffing levels had improved and there were staff available to give one to one support to people in their personal development needs. This was individualised and was discussed as part of care planning. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 16 Information to assist with the inspection showed management considered the service did well by: ‘Allow decisions to be made by service users. Support individuals to access community resources’. To get out and about residents could walk to town, visit the library, parks, pubs, and clubs. Residents had a weekly planner to show what activity they would be doing on a daily basis. Not all need identified had been transferred on these, such as a need to ‘develop domestic skills and cooking’. Therefore it was unclear as to when and what level of support given would accomplish this. As part of the basic contract price, residents had the option of a minimum seven-day holiday outside the home they helped to choose. One resident said she had been to Blackpool and had a ‘really good time’. during inspection residents were observed going out independently. Two residents were involved in semi-independent living arrangements. They managed a budget, did grocery shopping and planned and cooked their own meals. Progress had been made to support the residents in moving into their own home in the community. Support was being given to encourage all residents to take responsibility of their own rooms. The home was managed in a manner to avoid any institutional routines. Letters were delivered unopened and observations made of staff working in the home showed they treated people living in the home with respect. All bedrooms had locks on their doors and people managed their own keys. Relatives and friends were made welcome to the home. Residents had access to a portable telephone. Records showed menus were discussed at house meetings, and residents decided what the menu should consist of every week. Routines in the home were observed as flexible. Residents were seen having breakfast and other meals at different times. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People’s health and general wellbeing was being monitored, with support being provided to access health care services. Support with personal health care issues however, needed to be dealt with better to prevent any serious risk to residents general well being. Medication policies and procedures and staff training promoted best practice. EVIDENCE: Records showed people using the service were registered with a General Practitioner and that appointments had been made and kept. Appointments had also been kept with care coordinators, consultants, and community psychiatric services. Comments from people living in the home indicated staff treated them well. Personal care was given according to needs, however better planning was
Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 18 needed to promote organised care. Preferences for carers such as gender issues had been addressed since the last inspection. There was evidence residents were involved to some extent with care planning. Those residents who were self caring said they did not need any help as they managed very well. Health needs were monitored, however appropriate action, and intervention in dealing with any changing needs of residents must be detailed better. Records showed there was a considerable risk in health management for one resident. From discussion with the manager it was evident no risk assessment had been completed to deal with refusal of treatment for health issues. Whilst the home recognised a person right to determine their own outcomes, there were no indications made as to when clinical intervention would be sought in the event of a noticeable deterioration in health related problems. There was no written procedure to support staff in the event of a death of a resident. Records of residents medication was kept that included information about service users medication, and what staff should be aware of if someone was not well. The training matrix showed four staff had been trained to level 2 in medication and one staff in drug awarenesss. Residents could self medicate following an assessment to make sure this would be safe. Two service users in the home self medicated. This was managed safely. Medication storage was secure. Records showed one resident was not taking essential medication perscribed and the manager said a referral had been made to the psychiatrist regarding this, as there was a deterioration in the person acting in a rational manner. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure provided guidance on raising complaints that supported residents to raise any issue of concern they may have. The protection of vulnerable adults policies and procedures were generally satisfactory and the legal rights of residents protected. However the lack of formal training for staff and no restraint policy available meant staff might not be aware of how to handle difficult situations. EVIDENCE: Residents in the home said they were aware they could make a complaint should the need occur. They were confident the house manager or the staff would listen to them. They discussed issues in their weekly house meetings. The complaints procedure assured residents their ‘complaints would be taken seriously’. Systems were in place to record and follow up any concerns people had. Information received at the Commission for inspection indicated the home planned to improve this process. Safeguarding policies and referral procedures had been revised and updated. This included the staff whistle blowing policy. Guidance on abuse and protection issues was covered briefly in National Vocational Qualification in care training. Training records showed there had been no improvement in staff training and remained at a level of two out of eight staff having formal training. The training matrix indicated plans for four staff to attend training
Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 20 had been booked. There was no restrain policy or procedure for staff to follow, should this be necessary. Residents had a contract that protected their legal rights. In addition to this staff had been issued with a contract and therefore the registered provider had a formal agreement of protection issues such as staff not benefiting financially from residents, and formal agreement to abide by the homes code of conduct as set out by General Social Care. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was warm, comfortable, and well maintained. This meant residents were provided with accommodation that met their needs. EVIDENCE: The home is ideally located for the town, near to all main shopping facilities and recreation. Parking is in a controlled parking area. The home does have daily parking permits for visitors who must remember to request them. As a result of legal notices being served to the provider in relation to improvements required to upgrade the home, an additional inspection was carried out in September 2007 to monitor progress made. Where improvements were found to have been made, these had been sustained. The outcome was as follows.
Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 22 New windows had been fitted to the rear of the home. The backyard gate had been replaced with a wrought iron gate and a brick wall replaced wooden fencing. A security light had been fitted to the rear of the building Essential repairs were completed in the fire-.damaged bedroom with refurbishment and decoration to a good standard. Residents had been supplied with suitable bedding. The groundfloor bedroom overlooking the yard had been fitted with net curtains giving a degree of privacy for the person occupying this room. Exposed wiring in the cellar had been sealed as required by the fire authority. Unused items such as a central heating boiler in the yard and a disused payphone in the hall had been removed. Information received at the Commission for this inspection showed the manager recognised the need for improved maintenance in the near future. Following a tour of the premises these observations were made. The lounge was very pleasant and had some new furniture provided. The hallway stairs and landing had a new carpet fitted. The old payphone had been removed. The home was very clean and tidy. One bedroom door had a noticeable gap at the bottom of the door which potentially was unsafe in the event of a fire. Residents were happy with the improvements and although did not allow inspection of their rooms said, they had everything they needed. As highlighted in the previous key inspections, bedroom door locks did not offer a choice of whether or not to use this facility when residents were in their room. The locks were a standard yale lock that had been disabled to allow staff to gain acess in an emergency situation. The manager said a master key was available for staff to use. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. Staffing levels had improved which meant the needs of residents were further met. Staff training provided was not satisfactory in providing residents with an effective, consistent, and person centred approach to their care. Recruitment practices showed full attention was not being given to protecting residents. EVIDENCE: Rotas seen for the previous weeks showed an improvement with the numbers of staff on duty at any given time. No staff worked alone during the day, although staff worked long shifts of twelve hours. One carer was on night duty covering waking watch. The manager said staffing levels in the home allowed for staff to meet the needs of the residents, and supported a person centred approach to care. Information received at the Commission indicated residents were involved in staff recruitment. This is good practice, however there was no evidence to support this. Records showed consideration had not been given to one resident
Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 24 needs and feelings relating to problems in poor staff/resident relationship, when transferring the staff involved back to the home. Records showed recruitment practice was not satisfactory. Two staff applications were looked at. Application forms did not have sound employment histories and no records were made at interview of gaps in employment. Interview notes had not been recorded for one applicant. Applicants had attended interviews at the home. References and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment and references received. There was no evidence that information disclosed on one reference which questioned their suitability had been fully considered. Staff said they had been given a contract of employment, therefore knew the terms and conditions of working in the home. New staff were expected to have induction training. Records showed that this was not completed, although there were guidance booklets to follow. Despite one staff having a written warning regarding conduct, work performance was not being monitored. The issues relating to poor staff/resident relationship was not considered and placed a resident in a vulnerable position of further exposure to this. Supervision given to staff was not regular. Staff meetings allowed for the participation of all staff. Training records showed not all staff caring for residents in the home had received adequate quality training to enable them to deliver care based on current good practice in mental health, or in basic specialist training, providing them with the necessary skills, ability, and knowledge to do their job well. The training matrix showed gaps in essential training being given such as mental health and protection of vulnerable adults. Three care staff had attained National Vocational Qualification in Care level two. Four staff had attended training in approaches to mental health. Job descriptions and roles were defined, and one resident said she was very happy with her care. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management arrangements were not fully effective and therefore did not allow for the home to develop long term strategies for best practice issues in day to day running of the home. This meant residents health, welfare, and safety was not altogether considered. EVIDENCE: There was no registered manager at the home and the Commission had not received an application for this position. Since the last inspection Mary Healy, registered provider had appointed a new manager as the previous manager had been transferred to another home in the scheme. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 26 The acting manager had been in post for approximately four months. She said she was currently completing an application to register at the Commission. She had previous experience of management and had completed level 3 National Vocational Qualification in Care. The manager had worked under the direct supervision of another manager within the scheme. Arrangements were in place for emergency management out of hours contact. Information required of the care provider by the Commission for this inspection gave minimal information to support inspection findings. No comment cards were received at the Commission from residents or relatives giving their view of the service provided. This needs to be improved upon. Mrs Healy the registered provider has complied with some of the requirements made and has shown some commitment in providing residents with a good standard of accommodation. More consultation regarding the quality of the service had been introduced since the last inspection. Adam House holds Investors In People award’ as part of the scheme. Staff meetings were held. The agenda is set with an opportunity for staff to put any item on they wanted to discuss. The residents held weekly meetings that provided some opportunity for them to be consulted and voice their opinions. The manager said requests made by residents was followed through and she could deal with them. There was no annual development plan available at the home. The Fire Authority requirements had been complied with. A safety handbook was available for staff, this included health and safety policies and procedures. Staff signed to say they had read these. Information received at the Commission indicated installations and equipment had been serviced. Not all staff had undertaken training in safe working practices. Some training had been planned. There was no evidence of the registered person completing monthly reports commenting on the effectiveness of the homes operation. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 27 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 3 2 X 3 3 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 3 25 2 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 1 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 2 2 2 3 2 X 3 2 Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 28 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. YA5 2. YA6 Standard Regulation 5(b)(c) Requirement Timescale for action 31/03/08 31/03/08 3. YA8 4. YA9 5. YA19 6 YA23 7 YA25 People using the service must be informed of the fees they are charged. 12/09/07 15(1)(2) The residents care plans must include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. 15(1)(2) Personal support required must be given in an agreed structured way so that care is provided in a consistent manner. 13(4)(a-c) Risk taking must be dealt with properly to keep people safe. Risk assessments/risk management strategies must be completed in response to individual resident’s needs. Previous timescale of the 12/09/07 not met. 12(1)(a)(b) It is essential residents day to day physical and emotional health needs are managed properly. 13(6) Staff must be given formal training in adult protection issues and have a clear procedure as to the homes stance on the use of ‘restraint’ 13(4)(a) All bedroom doors must be
DS0000009527.V357569.R01.S.doc 31/03/08 31/03/08 31/03/08 31/03/08 29/02/08
Page 29 Adam House Version 5.2 8 YA33 12(4) 9. YA34 19(5)(a) 10 YA35 18(2) 11 12. YA36 YA37 18(2)(b) 8 13 YA43 26 adequately fitted to ensure protection in the event of a fire. The wishes and feelings of residents must be considered when deploying staff to care for them. The recruitment process must include obtaining full employment history. It is essential that information given on references be fully considered and risk assessed to show the person is fit to work at the care home in the position offered. Staff training must focus on mental health care, to ensure residents individual and joint needs are met appropriately. Staff employed must complete induction that meets with National Minimum Standards. A completed application form in respect of a registered manager must be forwarded to the Commission. Previous timescales of 31/3/05, 30/06/06, and 12/09/07 not met. Mrs Healey Registered Provider must visit the home once a month and make a report of the visit, forwarding a copy of the report made to the Commission. 29/02/08 29/02/08 31/03/08 31/03/08 31/03/08 29/02/08 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 YA8 Good Practice Recommendations It is recommended house rules be revised to make sure they are appropriate for residents. Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 30 2. 3. 4 5. YA11 YA19 YA21 YA26 Care plans should show how residents are to be supported in their personal development. A detailed and ongoing health assessment should be completed as part of care planning. A procedure should be available for staff to deal with the event of a death. Residents’ bedrooms should be fitted with more suitable locks, which are operated as a suite, with master keys being available as appropriate. It is recommended at least 50 staff be trained in National Vocational Qualification in care level 2. It is recommended the movement of staff between homes is managed better supporting residents to receive a consistent approach to their care. It is recommended the current application forms used be reviewed. Interview notes should be taken. It is recommended staff supervision be increased. It is recommended the rotation of managers between homes cease. Information requested by the Commission should provide more detail how the home is meeting National Minimum standards. Policies and procedures should be kept up to date with current good practice. 6 7 8 9 10. 11 12 13 YA32 YA33 YA34 YA34 YA36 YA38 YA38 YA40 Adam House DS0000009527.V357569.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Regional Contact Team Unit1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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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