CARE HOME ADULTS 18-65
Adam House 21 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector
I8Mr Jeff Pearson Unannounced Inspection 18th and 26th January 2006 09:30 Adam House DS0000009527.V271931.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 Adam House DS0000009527.V271931.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. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 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.V271931.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31/02/05 Brief Description of the Service: Adam House is part of Healy Care Dispersed Home Scheme which in Burnley consists of three terraced properties. The properties are situated upon the same road, in what is mainly a residential area. Each house is staffed separately, but there is some inter-working across the scheme. Adam House is registered to accommodate 6 adults under the age of 65 with a mental illness (excluding learning disability and dementia) The home is to the town centre with its shops, pubs, churches etc. The accommodation available is homely and domestic in style, there is a lounge, dining kitchen and smoking area. There are two shared and two single bedrooms. Staff are on duty to provided support 24 hours per day. Transport is available to enable service users to visit relatives, take short trips and outings within the community. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took 15 hours and was carried out over two days by one inspector. The main focus of the inspection was to monitor progress in meeting/addressing the requirements and recommendations highlighted during the previous inspection. There were 4 service users accommodated. The files/records of 3 service users were examined as part of ‘case tracking’, this being a method of focusing upon a representative group of residents. The records of the most recently recruited staff were looked at. During the inspection, service users, the house manager, registered provider and staff were spoken with. A tour of the premises was carried out. Some policies and procedures were looked at. Immediate requirement notices were issued on both days. What the service does well: What has improved since the last inspection?
Assessment information which showed details of peoples, diagnosis, needs and wishes were being kept in the home for staff to refer to as necessary. The contracts had been updated to provide clearer information on terms and conditions of residence. “The manager went through my contract with me and I signed it” One empty bedroom had been decorated and new furniture was to be provided. Another bedroom had been fitted with a new washbasin and more electric sockets this had improved the room for the occupant. A new ‘people carrier’ type car had been obtained to provide transport for the residents of the home. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Adam House DS0000009527.V271931.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 Adam House DS0000009527.V271931.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): 1, 2, 4, 5 The homes guide remained inadequate; it did not provide accurate and sufficient information to enable current and prospective service users to be clear about the services and facilities provided. The admission process ensured the residents’ were properly assessed, their needs and wishes known and planned for prior to moving into the home. Progress had been made with developing individual contracts/terms and conditions, but the agreed limitations were not being imposed. EVIDENCE: The statement of purpose, service user guide and last inspection report were available in the home. The service user guide remained unchanged and did not include enough specific details, about the services and facilities available at Adam House and was not in a ‘user friendly’ format. The house manager had produced a copy of the homes guide in a large print version for one service user. The case file of the most recently admitted service user included assessment information from Social Services and details of assessments completed as part of the Care Programme Approach (CPA). Pre admission visits had been carried out with records kept. The service user spoken with explained she had visited for meals and was getting used to the home and staff.
Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 10 The service users contracts seen had been updated to provide a clearer indication of the circumstances someone may be asked to leave the home, and the consequences of not abiding by the homes’ rules, such as smoking in bedrooms. The rules specified in contracts were not being adhered to (See standards 6, 9,42) Adam House DS0000009527.V271931.R01.S.doc Version 5.0 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, 9 Service users support needs and goals were reflected in their individual Plans, but the Plans did not include the restrictions on choice, as specified and agreed in the homes’ terms and conditions of residence. Assessing responsible risk taking again needed further attention, to ensure a reasonable balance is achieved between independence, choice, rights and personal safety. EVIDENCE: Service users spoken with were aware of their individual Plans; they said they signed in agreement with them. Plans examined as part of case tracking, were sensitively written and included details of each persons support needs and goals, the action to be taken. Restrictions on choice, such as smoking in bedrooms, had not been properly agreed and highlighted in service user Plans. Individual risk assessments had been updated, but the strategies for managing risks did not provide clear instructions for staff on how to respond. Staff were again unclear what to do in such situations and felt they did not have the support of the registered provider in disallowing smoking in bedrooms. (See standard 42) Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Insufficient staffing arrangements had limited the support for service users holidays, activities, community access and one-to-one support. EVIDENCE: Service users spoken, with explained they were getting out and about and some activities were ongoing. But it was apparent from observation, discussion and records, there were limitations on providing flexible support in response to individual needs, due to a shortage of staff. For example, with only one staff member on duty, should one service user wish to go shopping with staff support, this would not be possible without prior arrangement. Rules stating service users must not smoke in their rooms, were displayed in the home, this rule was still being ignored. One service user said they had not been on holiday for over a year. Adam House DS0000009527.V271931.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): 20 No progress had been made with updating medication policies and staff training to promote best practice and reduce risks to service users. EVIDENCE: Medication storage was secure and tidy. Appropriate records were being kept of medication administration. Risk assessments had been completed for service users having involvement with their medication. The house manager explained the medication policies and procedures had not been updated. Only the house manager had undertaken accredited medication management training. There was no written individual protocols for administering ‘when necessary’ medication. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 14 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): To ensure service users have correct contact information further details were needed in the complaints procedure. No progress had been made in updating the protection and abuse policies and procedures; this may result in protection and abuse matters not being properly dealt with. EVIDENCE: The complaints procedure was in the service user guide; this included most details but needed to include the contact details of the Commission, which were elsewhere in the guide. 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 of meetings showed various matters were being raised and followed up. The protection/abuse policies and referral procedures were still in the process of being revised and updated. The staff whistle blowing policy was also being updated. Some staff had received guidance on abuse and protection as part of NVQ training, or the initial induction training programme. There had not been any staff training on dealing with aggressive or challenging behaviour. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 15 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, 26, 30 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. EVIDENCE: The home was in reasonable decorative order. One empty bedroom had been decorated and was awaiting furniture. Service users had brought with them items to personalise their bedrooms. The home was adequately clean. A new washbasin and additional electric sockets had been provided in one room. The laundry area was easily cleanable and had suitable washing equipment. 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 and chairs in the lounge. There were not many pictures on display. Identified repairs were not being followed up promptly. Bedroom door locks did not offer a choice of whether or not to use this facility. The main areas for service users making telephone calls were the kitchen, or the first floor landing which were not very private. 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.
Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 Staff training and development was ongoing, this needed to continue to ensure all staff are appropriately trained. Staffing arrangements were insufficient in providing appropriate support for the service users. Staff recruitment practices indicated full attention was not being given to protecting the service users. EVIDENCE: On the first day of the inspection there was only one member of staff on duty. The staff rota indicated that there had been several short falls in providing sufficient staffing levels, in accordance with the agreed requirements. A senior member of staff came to Adam House from one of the other homes in the organisation, which then caused a staffing shortage in that home. An immediate requirement notice was issued to the registered provider requiring action to improve this matter. Staff rotas indicated that on several occasions the house manager had again covered support workers shifts. There again had been changes in the staff team since the last inspection, staff recruitment was ongoing within the organisation, but there had been no recent recruits at Adam House.
Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 17 Observation of staff working with service users indicated positive relationships had been developed; staff were respectful and sensitive to the needs of the service users. Service users made positive comments about the staff team. Records were seen of the induction training for new staff, NVQ training and training in safe working practices was ongoing. The house manger had completed NVQ level 4. The sample of staff records seen had some required details missing including written references. Full employment histories had not been obtained and there were no explanations for gaps in employment. Medical declarations did not include sufficient information to make an informed judgement about health matters. The objectivity of one staff members’ recruitment was questionable. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Although the management and leadership approach was satisfactory, the house manager was unable fulfil her designated role. Some quality assurance processes were in place, but improvements were still needed to show the home was being properly reviewed and developed. Some arrangements had been made to maintain health and safety; further safeguards were needed to promote the well being of residents, staff and visitors. EVIDENCE: A completed application for registered manager had not been forwarded to the Commission. The house manager was enthusiastic and expressed commitment in providing a good service for the people living at Adam House, but due to the lack of staff, senior/deputy support, was unable to effectively manage the home. The staff rota indicated the house manager had been covering various shifts in the home. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 19 Service users and staff had been consulted about the quality of the service, but the results of the survey had not been collated or formally responded to. Other people, such as Social Workers, Consultants and relatives had not been approached. There was no development plan available. Service users’ smoking in bedrooms was considered to be a risk to health and safety. The Fire Authority had recently visited the home and insisted smoking in bedrooms was not acceptable. An immediate requirement notice was issued in respect of this matter. The Fire Authority had also made requirements on staff training, making sure doors close properly and magnetic door closures. Arrangements had been made for fire risk assessments to be completed by an outside contractor. Environmental risk assessments had been completed by the house manager, who considered health and safety risk assessment training was needed. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 20 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 2 3 X 3 2 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 2 X X X 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 1 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Adam House Score N/A X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 1 X DS0000009527.V271931.R01.S.doc Version 5.0 Page 21 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 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. (Timescale of 02/12/05 not met) Appropriate risk assessments/management strategies must be completed, on service users engaging in activities which may affect their health or well being (Timescale of 31/10/05 not fully met) Staffing arrangements must be flexible and responsive to meet service users needs. (Timescale of 31/10/05 not met) All staff responsible for dealing with medication must receive accredited medicine management training. (Timescale of 31/12/05 not met) Medication management policies and procedures must be in accordance with current recognised guidelines and legislation. (Timescale of
DS0000009527.V271931.R01.S.doc Timescale for action 31/03/06 2. YA9 13 03/03/06 3. YA12YA13 16,18 19/01/06 4. YA20 13 31/03/06 5. YA20 13,17 31/03/06 Adam House Version 5.0 Page 22 31/12/05 not met) 6. YA22 22 The complaints procedure must include the contact details for the Commission. Each service users must be provided a with a copy of the complaints procedure The protection and abuse policies and procedures must be ammended to include apprporite details for responding to suspicion, allegation or evidence of abuse or neglect Identified repairs must be attended to in a timely way. The sofa and chairs in the residents lounge must be replaced. The mattress on the bed in the staff sleep in accommodation must be replaced. All Service users bedrooms must include the minimum furnishings as outlined in standard 26, of the National Minimum Standards, unless otherwise agreed. (Timescale of 31/12/05 not met) 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. (Timescale of 31/10/05 not met) The recruitment process must include the obtaining of full employment histories and satisfactory written refernces. Records must be kept to explain gaps in employment. (Timescale of 16/09/05 not met) A completed application form in respect of a registered manager must be forwarded to the Commission. (Timescale of 30/11/05 not met) A formal system for reviewing and improving, the quality of care provided at the home must
DS0000009527.V271931.R01.S.doc 31/03/06 7. YA23 13 31/03/06 8. 9. 10. 11. YA24 YA24 YA24 YA26 16,23 16,23 23 12,16,23 31/03/06 14/04/06 14/04/06 31/03/06 12. YA33 18 19/01/06 13. YA34 17,19 27/01/06 14. YA37 8 16/03/06 15. YA39 24 31/03/06 Adam House Version 5.0 Page 23 16. 17. 18. 19. YA42 YA42 YA42 YA42 13, 23 13, 23 13, 23 13, 23 be implemented. (Timescale of 31/12/05 not met) The homes rules on smoking must be enforced. Fire doors must be made to close appropriately in accordance with Fire Authority directives Staff must receive appropriate fire safety training in accordance with Fire Authority directives. Fire doors must be fit with appropriate magnetic closures in accordance with Fire Authority directives. 26/02/06 17/02/06 31/03/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA5 YA6 YA14 YA16 Good Practice Recommendations The terms and conditions specified in contracts should be used to provide appropriate boundaries for the residents. Any limitations on choices should be agreed with service users and incorporated in their individual Plans. The residents should be offered the opportunity of a holiday as part of the basic contracted fees. Service users should be clear of their role and responsibility in keeping the homes rules; all staff should know how to respond to situations where service users do not abide by the rules. Plans should be made and put into practice, to improve the areas of the home in need of redecoration. The residents should be supported to choose pictures/wall decorations to display in their home. A telephone (preferably on a separate line) with a mobile handset should be obtained. Service users’ bedrooms should be fitted with more suitable locks, which are operated as a suite, with master keys being available as appropriate. Staff training and development in National Vocational Qualifications and the subjects specified in the National
DS0000009527.V271931.R01.S.doc Version 5.0 Page 24 5. 6. YA24 YA24 7. 8. YA26 YA32 Adam House 9. YA34 10. YA42 Minimum Standards for Younger Adults, should continue to be provided. Recruitment practices should ensure references are not requested from the applicants’ family members and relatives working in the organisation should not interview applicants. Those responsible for carrying out health and safety risk assessments should be provided with appropriate training. Adam House DS0000009527.V271931.R01.S.doc Version 5.0 Page 25 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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