CARE HOME ADULTS 18-65
Adam House 21 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector
Mrs Marie Dickinson Key Unannounced Inspection 16th May 2006 09:30 Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Adam House Address 21 Ormerod Road Burnley Lancashire BB11 2RU 01282 830215 01282 414506 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 Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th January 2006 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 £875. There were voluntary optional charges for entertainment and transport. Information about the services provided is usually available in the home. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 16th and 17th May 2006. The inspection involved getting information from staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the house manager and the registered provider and included a tour of the premises. 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. What the service does well:
Before people come to stay at the home professional people assess them. Important information needed to support them in every day living is recorded and used to plan the care required. The house manager also spends time assessing peoples needs and the quality of this assessment process is excellent. Admission to the home is planned giving people enough time to settle in, knowing how their support will be provided. Service users healthcare needs were monitored. The home worked with other medical professionals such as Community Psychiatric Nurse, Psychologists and Psychiatrists for the benefit of service users. Activities and daily living was very much service user choice and the home was managed in a way to avoid institutional practice. Service users had opportunities to discuss issues of importance to them and of life at the home at house meetings. These were held on a regular basis so people could voice their opinions and make suggestions. The atmosphere in Adam House was relaxed, supportive and friendly. Comments about the home from a visiting professional showed the staff to be ‘welcoming’. Service users had confidence in staff and the house manager to help them with any difficulty they may have, or to deal with any concern. Staff employed at the home were given opportunities for training. They had regular supervision and meetings. Teamwork was evident and the house manager worked with the staff. Staff said they enjoyed their work and were confident to ‘speak out and raise issues if needed’. They felt ‘listened to’ by the house manager. The training programme had been developed according to the needs of the service users. The house manager was professional in how she managed the home to provide service users with a good service and showed a lot of commitment to her job. The views of service users and other people such as health and social care professionals, relatives and visitors were sought to keep a check on how well
Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 6 the service does. One comment read ‘the service offers a welcoming environment’ and ‘the service meets the aims and objectives’. What has improved since the last inspection? What they could do better:
The guide to the home needed to be improved, so people are clear what services and accommodation is available. To help people living at Adam House in planning for their future they should have a copy of their care plan to keep for reference. Service users should also be given the experience of accomplishments whilst working towards their longterm aim. This would help people to map out their lives and take a step-bystep approach to achieving these. By having realistic achievable aims, this will give service users a sense of well being and worth. People living in the home should have a copy of their own policies and procedures and ‘house rules’. These must be discussed, be clear and agreed, to help them know about their responsibilities in keeping house rules. To give service users the opportunity to discuss holiday arrangements, they should be made aware of the option of a seven-day holiday being planned. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 7 So that people can make telephone calls in the privacy of their own rooms, a telephone with a mobile handset should be provided. To make sure peoples’ medication is managed as safely as possible, some staff need further training and medication guidelines needed updating to provide clear up to date instructions. Guidelines for protecting people from abuse needed changing, to make sure managers and staff do the right things. There should be some formal agreement with staff about the homes code of conduct such as not gaining financially from service users. Work was still needed to improve areas of the home. A new sofa and chairs were needed to provide more comfortable and appealing seating for the residents. Work to replace unhygienic worktops, shelving and cabinet doors was needed in the kitchen. Work required by the fire department needed completing and attention needed to make the backyard more pleasant, and the woodwork of the smoking room window and backyard gate required replacing. Minor maintenance also required quicker response by the registered provider, such as providing a working light to the back of the home for safety purposes and request to hang pictures up in the home. To make sure service users have what they need in their bedroom they should be asked individually. Bedroom doors should have a closing mechanism to use without locking their doors to work alongside the lock currently provided. A manager needed to register with the Commission, to take legal responsibility for the day-to-day running of the home. Staff should be issued with a contract of employment and sufficient staff employed to make sure service users needs are met at all times. The registered provider must make sure good relations are maintained between all parties, by acting responsibly to requests for maintenance, provision of sufficient staffing and listening to the service users wishes in a positive manner. In addition to this requirements made under the Care Homes Regulations must be acted upon within reasonable timescales set. Information requested by the Commission must be provided and service users must be allowed to respond to Commission if they choose when approached. 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. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 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 Adam House DS0000009527.V289747.R01.S.doc Version 5.1 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): 1,2,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The homes guide was not up to date to provide accurate and sufficient information to enable current and prospective service users to be clear about the services and facilities provided. The admission process was followed through properly. The level of assessment service users received was commendable, allowing their needs and wishes be known and planned for prior to moving into the home. Service users did not have individual contracts on file at Adam House. EVIDENCE: The service user guide and statement of purpose had not been updated. These documents remain in draft and are not currently available to give people information about the home. The draft guide did include useful information such as the amount of money allowance they would expect to receive, the complaints procedure and a policy on confidentiality. Reference is made to a holiday service users can have as a group. A copy of the new residents assessments completed by health and social care professionals and a care plan for mental health needs were available to look at. Together these documents provided a clear and detailed picture of what approach to meeting identified needs were required. A new resident said they liked the home and had decided themselves that they wanted to live there. The service users said that they had meetings with the house manager to discuss how staff would help. They said that they had talked to their family as well.
Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 10 The assessments had taken into account the resident’s needs in relation to the type of home environment, staffing levels and current residents living at the home. Written information taken from a service users file showed the homes manager had followed an in depth process of assessment that was commendable. This had taken six weeks to complete and involved making observations during meetings and time the service user spent at the home during visits. Evidence showed that the person had visited the home on occasions and extended this to overnight stays. Working with a Community Psychiatric Nurse, the combined assessments covered a mental health assessment with risk (safety) profile, physical health and problems in relationships with others assessment. There was no contract for this person on file at Adam House. Mrs Healy kept a record of the charges. To make sure service users know what the terms and conditions of their stay at the home, they should be given a copy of their contract, and a copy be placed on their file for staff reference. This is useful when restrictions for example are imposed for the person’s well being as part of the agreement to stay. Staff had received training to care for people with mental health problems. Records showed they worked with other professional people in caring for service users, such as community psychiatric nurses, psychologists and psychiatrists. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents assessed needs were recorded in detail. Being involved in writing their own care plans meant service users personal long-term goals were recognised. Staff had sufficient recorded detail to help service users with everyday living. Essential information, policies and procedures were not given to service users. EVIDENCE: The standard of service users care records was relatively good. The care plan written for the new admission had been written to combine health and social care. Information included strengths and needs, and showed who had a particular responsibility to help reach the desired outcome. The care plans seen for three service users were written with long-term goal setting. Needs were documented and the level of support required for everyday living indicated. The plans also included relationships with others, spiritual needs and personal care. Service users at the home said they mainly managed their own personal care. One service user said ‘I’m fairly independent and don’t rely on staff too much’. Daily care notes showed staff prompts in
Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 12 certain personal care situations. The plans were well written and the mental health care plan was central to the service users well being. To help service users realise their long-term goals however, short-term goal planning needs to be made. These goals should be simple easy to achieve accomplishments to give service users more focus and promote a sense of wellbeing. Records showed that for one service user the long-term goal she discussed could never be achieved, and therefore a more realistic goal should be set and worked towards with short term planning and support to help her through a grieving process for her loss. Another service user talked about their aim of leaving and had lived at the home for a number of years. Restrictions on service users doing what they liked that may cause them problems was recorded and agreed with them. Decision-making was encouraged and residents were given time to consider the individual choices they made. Information that showed how people might be at risk was clearly written. Action required to reduce the risk was also recorded and agreed with each resident individually. Whilst service users had the benefit of one to one discussions with staff, the home should make available, up to date information on for example policies and procedures. These would inform choices. There was evidence however service users right to make personal choices was promoted within the boundaries of their limitations. The care plans were reviewed at least every three months for the home and six months by the Community Psychiatric Nurse with specialist evaluations of the service users needs. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users were given opportunities to live a lifestyle that suited them. This included social activities and learning new skills for personal development. Service users were helped to keep in touch with their families and friends. Service users were provided with a nutritious and varied diet. EVIDENCE: Service users spoken with explained they were getting out and about and some activities were ongoing. Their views about their opportunities to take part in activities were positive. They did what they wanted to do and what they were comfortable with for example going to clubs, day centres or just going out for shopping. Service users were able to make full use of community facilities if they wished. To get out and about service users could walk to town, visit the library, parks, pubs and clubs without transport. Escort was provided with staff if required. The service user most recently admitted to the home said she enjoyed meeting her friends in town. Activities were her choice. Two service users enjoyed
Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 14 caring for a pet. The registered provider and house manager said service users had the option of a holiday they could choose and plan. Two service users said they had planned their own holiday and were not aware this option was available. Records showed family links and friendships were kept up for service users. The service user recently admitted said her son had visited. Visitors to the home were made welcome and visits could be made in private. Comments from a Community Psychiatric Nurse indicated staff were ‘welcoming’. The home was managed in a manner to avoid any institutional routines. Letters were delivered unopened and during the course of the inspection, staff working in the home treated service users with respect. Residents had their preferred name stated on their plan. They had locks on their doors and managed their own keys. They said they spent time in their bedroom when they wanted, and had agreed flexible times for going to bed and getting up. Meals and meal times was a relaxed event. During inspection one service user made her own sandwich for dinner. Other service users had lunch prepared by staff. Service users decided their own menus and staff helped them to prepare and cook food. Service users learning independent skills made meals. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Individual preferred routines likes and dislikes allowed residents to enjoy personal care in a dignified way. The healthcare of residents was monitored. Medication policies and staff training to promote best practice and reduce risks to service users was not satisfactory. EVIDENCE: Service users routine was special to them. Personal care was given according to their wishes. This was recorded in care plans. Most service users required only prompts for personal care and could manage themselves. Service users said they liked the staff and were happy with how they helped them. Going to bed and getting up was also a personal choice depending on any planned activity. Part of service users care included links with other professionals for example mental health care. Service users confirmed staff spoke to other professional people about their care with them. This included specialist support given by the Community Psychiatric Nurse and consultant Psychiatrist. Part of the staff role was to help them attend medical appointments. Medical care was promoted such as dental visits and routine medical checkups.This was evidenced in records. All service users were registered with a General Practitioner.
Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 16 Records of service users medication was kept that included information about service users medication, and what staff should be aware of if someone was not well. 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 and tidy. Medication administration records were being kept in order. The house manager explained the medication policies and procedures had not been updated as required during the last inspection, and staff training in this area had not been provided. During inspection untrained staff administered medication. . Adam House DS0000009527.V289747.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users felt their interests were protected. There was a complaints procedure they could follow. The protection of vulnerable adults policies and procedures must be updated. Formal agreements must be made with staff to protect service users. EVIDENCE: Service users in the home were aware they had the right to make a complaint should the need occur and were confident the house manager or the staff would listen to them. The complaints procedure assured service users their ‘complaints would be taken seriously’. Service users said they could talk to the staff. Systems were in place to record and follow up complaints. Service users said most issues were raised and discussed, in the weekly house meetings. Records showed these issues were not always taken seriously by the registered provider as action was not always taken to deal with problems. There had been no complaints received at the Commission and none recorded at the home The protection/abuse policies and referral procedures were still in the process of being revised and updated. This included the staff whistle blowing policy. This may result in protection and abuse matters not being properly dealt with properly. Some staff had received guidance on abuse and protection as part of National Vocational Qualification in care training, and in initial inductiontraining programme. Because not all staff were given a contract of employment, the registered provider had no formal agreement of protection issues such as staff not benefiting financially from service users, or agreement to abide by the homes code of conduct. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 18 Service users had the opinion their rights were protected and they felt safe living at the home. Staff were familiar with protection issues. From discussion they showed an awareness of abuse issues relating to mental health problems such as aggression and financial abuse from others. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,28,30 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. The living environment was generally satisfactory; some areas were in need of attention to provide a more comfortable, pleasant, living environment for service users and staff. Maintenance was not efficient. 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. There was no planned maintenance and renewal programme for the decoration or refurbishment of the home. Some of the furnishings in communal areas were looking worn, for example the sofa was ripped and chairs in the lounge were dirty, stained, ripped and not satisfactory. There were not many pictures on display. Issues raised in service users meetings included a request for pictures to be hung up. Identified repairs were not being followed up promptly. To deal with maintenance, the house manager submits a regular request for maintenance work needed to the registered provider. Records show these are repeatedly requested, and to date include:
Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 20 light on the back outside wall requires replacing, plaster in the kitchen requires repair, the thermostatic valve supplying the central heating system and hot water requires attention, casing is required for hot pipes running up the wall. The internal wall leading to the cellar requires plaster board and skimming. This was required by the Fire Authority(timescale June 2006) In addition to this whilst touring the premises, the kitchen was found to be poor. Laminated wood exposed woodchip in the doors, shelving and worktop. Tiles were loose on the walls. This was unhygienic where food is prepared. The room also required painting or adequately decorating and the tread leading to the yard required securing. The wall in the yard required painting and casing in the window of the smoking area was rotten in places. Some windows had been replaced with double glazing units. The backdoor of the yard was rotten wood. As highlighted in the previous inspection, bedroom door locks did not offer a choice of whether or not to use this facility when the service user was in the room. To allow staff to access the bedroom in an emergency the locking device in a standard yale lock was disabled. Service users were satisfied with their bedrooms. One person said they had what they needed in, such as wardrobe, drawers and bedside cabinets. This should be documented. Their rooms were personalised and personal possessions were evident. The main areas for service users making telephone calls were the kitchen, or the first floor landing which were not very private and a seperate line from the homes line was not installed. Records showed staff had requested a new mattress for the bed in the sleep in room in October 2005, this had not yet been provided. The home was clean. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 21 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): 31,32,33,34,35,36 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Sufficient staff were on duty to meet the needs of the residents most of the time. Staff were trained. Recruitment procedures did not include staff being issued with a contract. EVIDENCE: On the first day of the inspection there were two members of staff on duty. The staff rota indicated that at times there had been several short falls in providing sufficient staffing levels, in accordance with the agreed requirements. Weekend rotas show that one support worker is on duty at all times. Staff working on the 5pm-11.30pm shift also sleeps in the home overnight and is on call. Staff recruitment was ongoing within the organisation, and there had been one new recruit at Adam House since the last inspection. Staff files showed how recruitment procedures had been carried out. The application forms were completed properly. References had been applied for and Criminal Record Bureaux (CRB) and Protection of Vulnerable Adults (POVA) check had been obtained prior to staff working in the home. How service users are involved in staff recrutiment could be better documented, such as being involved in the interview process.
Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 22 Not all staff had been given a contract of employment. This is needed as a contract legally protects service users, staff and the organisation. Issues such as acceptance of gifts or confidentiality, whilst covered in induction would be formally agreed on. Records also showed how induction was given. This training was satisfactory. Staff confirmed they were offered other training in addition to this. A staff training matrix was seen. Staff had been registered for courses such as a four day health and safety and medication training. Quality assurance by Community Psychiatric Nurse recorded staff are helpful, and approachable.’ Staff said they had supervision as part of their work. These sessions were structured and were opportunities to discuss their position in the home and what was involved in caring for people with mental health probllems. Staff meetings were also regular with the house manager. The house manager had also completed a staff survey for quality assurance in care. Observation of staff working with service users showed they had good professional relationships and were respectful and sensitive to the needs of the service users. Service users made positive comments about the staff team. Both staff on duty discussed their role as support workers and what was involved in caring for people with mental health problems. They had relevant training to help them. It was clear they had a good positive relationship with the service users. In their discussions with residents during inspection, both staff showed they were knowledgeable about individual needs. One person said he did not really depend on the staff team to help him, but he could chat to them and if he did have any difficulty he was sure they would help. National Vocational Qualification in care training, and training in safe working practices was ongoing. One staff member was currently doing an apprenticeship in care, three of the five staff employed are National Vocational Qualified in care level 2 and above. The house manager had also completed a level 4. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42,43 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Although the management and leadership approach was satisfactory, the house manager has not yet been registered with the Commission or received a job description from Mrs Healy. Service users and staff were happy with the way the home was managed. Guidance and support was given to staff. The health, safety and welfare of residents, was promoted and protected. Quality assurance processes were in place. The registered provider did not demonstrate fully, how required improvements were being properly reviewed and developed. EVIDENCE: A completed application for registered manager had not yet been forwarded to the Commission as requested during previous inspections. Mary Healy registered provider had overall management responsibility for the home. She did not however manage the home on a day-to-day basis. This was the responsibility of the house manager. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 24 The house manager demonstrated a commitment during the inspection to provide a good service for the people living at Adam House. Service users and staff had confidence in her management. To be effective in role as manager Mrs Healy must allow the house manager more autonomy for management of the home. This should include being able to keep the home adequately maintained and staffed. The house manager benefited from supervision by a Community Psychiatric Nurse employed for this purpose. She said she found these sessions very useful. Mrs Healy declined from submitting an action plan to show how she would deal with areas required to improve during the last inspection. Response only to immediate requirements was received. Service users and staff had been consulted about the quality of the service. Other people, such as Social Workers, Consultants and relatives had also been surveyed recently. Written comments from a Community Psychiatric Nurse stated the home offers a welcoming environment and the service meets the aims and objectives. Adam House has been awarded an Investors In People Award’ as part of the scheme, which shows that there is some commitment for staff development. Records of house meetings showed how service users were consulted. For example the last meeting agenda and minutes covered issues about living together, menus and what service users wanted in the form of activities. The minutes were written well, extending a thank you to everyone for attending. Requests such as hanging pictures up were followed through by the house manager and places people wanted to go were arranged for them, such as a request to go to Manchester with Key worker and visit to garden centre. A more pro-active approach to responding to requests by Mrs Healy herself is needed to demonstrate to service users they are listened to. Service users were not given the opportunity to complete a questionnaire from the Commission to have their say about the home. Mrs Healy was asked to submit a business and financial plan during inspection to look at her intention to invest in management, staff and service users environment as a matter of urgency. A pre inspection questionnaire was sent to Mrs Healy by the Commission requesting information to help support an accurate inspection account. This was not received. The Fire Authority requirements had not all been complied with. Timescales given were June 2006. Mrs Healy was required to show how these outstanding works were being planned. The house manager had completed environmental risk assessments and health and safety risk assessment training was organised. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 25 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 2 2 4 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 2 2 2 X 2 2 Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 26 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 4,5,6 Requirement Timescale for action 14/06/06 2. YA6 15(2) 3. YA20 13 4. YA20 13,17 The statement of purpose and service user guide must include clear factual information about the services and facilities provided. A copy of the revised service user guide must be given to each service user. Previous timescale of 02/12/05 not met. Each service user should 14/06/06 be given a copy of their care plan that is accurate and current. All staff responsible for 14/06/06 dealing with medication must receive accredited medicines management training. Previous timescale of 31/12/05 Not met. Medication management 14/06/06 policies and procedures must be in accordance with current recognised guidelines and legislation. Previous timescale of 31/12/05 Not met.
DS0000009527.V289747.R01.S.doc Version 5.1 Page 27 Adam House 5 YA23 13(6) 6 YA23 13(6) 7 8. 9 YA24 YA24 YA24 23(2)(b) 16(2)(C) 23(3)(b) 10 YA24 23(2)(b) .11 YA24 23(2)(b) 12 YA24 23(2)(p) The protection and abuse policies and procedures must be ammended to include appropriate details for responding to suspicion, allegation or evidence of abuse or neglect. Previous timescale of 31/03/06 not met. To protect service users from risk of harm or abuse, the registered provider must have formal agreements with staff regarding significant issues such as precluding staff from any financial gain, that can impact on the welfare of service users. The home must be kept in a good state of repair, both inside and out. The settee and two armchairs in the lounge must be replaced. The mattress in the staff sleeping room must be replaced with a more suitable one. The internal wall leading to the cellar must be repaired with plasterboard and skimming as required by the fire authority. The woodwork to the smoking room window and backyard door must be replaced. To help prevent service users and staff from tripping in darkness the external night light at the back of the home must be usable at all times.
DS0000009527.V289747.R01.S.doc 14/06/06 14/06/06 01/07/06 01/07/06 01/07/06 30/06/06 01/08/06 14/06/06 Adam House Version 5.1 Page 28 13 YA24 16(2)(b) 14 YA26 12,16,23 15 YA28 13(4)(a) 16 YA28 16(2)(h) 17 YA33 18 18 YA37 8 19. YA38 12(5) Service users must have suitable telephone facilities that can be used in private. All Service users bedrooms must include the minimum furnishings as outlined in standard 26, of the National Minimum Standards, unless otherwise agreed. Agreement must be recorded. (Timescale of 29/10/04 not met) The exposed pipe work in the kitchen must be covered to reduce the risk of service users and staff from burning themselves. The kitchen requires work to remove/replace all hazardous to health porous woodchip and loose tiles. Sufficient numbers of staff who are trained and competent to meet the needs of the service users, must be available to work in the home at all times. Previous timescale 31/10/05 not met A completed application form in respect of a registered manager must be forwarded to the Commission. (Timescale of 31/3/05 not met) The registered provider must make sure she creates an environment that maintains good personal and professional
DS0000009527.V289747.R01.S.doc 01/07/06 14/06/06 14/06/06 01/07/06 14/06/06 30/06/06 14/06/06 Adam House Version 5.1 Page 29 20. YA42 13 relationships with service users and staff by being responsive to requests and management needs. Fire doors must be fitted 30/06/06 with appropriate magnetic closures in accordance with Fire Authority directives. 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. 3 4 5. Refer to Standard YA5 YA6 YA8 YA14 YA22 Good Practice Recommendations Service users should be given a copy of their contracts/terms and conditions of residence, and a copy placed on file for the house manager to reference. Service users should be given the opportunity to agree short-term goals to help reach their desired long-term outcome. To enable service users to review policies, procedures and services, the home should supply a copy of relevant policies and procedures and agreed ‘house rules’. It is recommended service users option of a seven-day Holiday as part of their contract price is made known to them. Matters of concern discussed during house meetings should be responded to as soon as possible. Records of meetings should indicate expected timescales and clarify reasons for not acting upon requests/matters raised. Should service users continue to raise specific issues about particular aspects of their care and lifestyle, these should be responded to as part of the complaints procedure. Plans should be made and put into practice, to improve the areas of the home in need of redecoration (Not fully addressed from last inspection) Pictures and wall coverings chosen by service users should be hung for them as requested. It is recommended the tread at the backdoor be repaired/replaced.
DS0000009527.V289747.R01.S.doc Version 5.1 Page 30 6. 7 8 YA24 YA24 YA24 Adam House 9. 10 11 12 13 14 YA26 YA28 YA28 YA34 YA34 YA38 Service users’ bedrooms should be fitted with more suitable locks, which are operated as a suite, with master keys being available as appropriate. It is recommended the kitchen units be replaced. It is recommended the kitchen be decorated. It is recommended service users be actively involved in recruitment of new staff. It is recommended staff be issued with a contract of employment. It is recommended the registered provider provide the Commission with information as requested within agreed timescales. Adam House DS0000009527.V289747.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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