CARE HOME ADULTS 18-65
Adam House 21 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector
Mrs Marie Dickinson Unannounced Inspection 30 & 31st May 2007 10:00
th Adam House DS0000009527.V342879.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.V342879.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.V342879.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.V342879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th May 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 £905. There were voluntary optional charges for entertainment and transport. Information about the services provided is usually available in the home. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took place on the 30th and 31st May 2007. The inspection involved getting information from staff records, care records and policies and procedures, and an inspection of the premises including residents bedrooms. It also involved talking to residents, staff on duty, the registered provider, and the manager. Information requested for the inspection had not been received and there were no written comments from residents or relatives. 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 focussed to evaluate the extent of the fire damage to the home and the impact on people who use this service. 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. Residents were given an opportunity to live semi independently. This meant they were given a budget for food, do their own shopping, and prepare and cook meals. A pet was also allowed to stay in the home which meant a lot to those residents it belonged to. Residents went on holiday, which they said they enjoyed and were looking forward to going away again this year. The residents were able to maintain good contact with their family and there no restrictions placed on visiting.
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 6 Staff on duty treated residents living in Adam House sensitively and with respect. Residents said the staff were ‘good’, and ‘ok’. Residents were involved in recruiting new staff. The standard of recording staff supervision was very good showing staff development and training issues had been discussed. The new house manager showed commitment during inspection to provide residents with a good service and to support staff in their training needs. Issues raised in the inspection were duly noted and responded to in a professional manner. What has improved since the last inspection? What they could do better:
The statement of purpose and the resident guide must be made available with clear relevant information about the home. A copy of the most recent inspection report must be provided for residents in the guide, so they can be aware of how well the home is meeting the National Minimum Standards. The residents must be provided with clear information about the actual level of fees charged and details about the arrangements for paying the fees, within the contract. The registered person must make sure by providing accommodation to a prospective resident, staff are trained in mental health care so the resident can be assured their needs can be appropriately met. The care plans must detail all the needs of the residents, including their healthcare needs to provide staff with clear information about how best to meet, monitor and respond to these needs. To help residents to achieve good long-term outcomes, these should be accompanied by easily reached targets to promote a sense of well being, and worth. Records of these achievements should be kept for residents to look at. Residents should also be asked
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 7 regarding their preference for male or female carers to support them individually as sometimes only one staff is on duty. Key working should be introduced to support residents in a more personal consistent way. To make sure residents are kept safe identified risk must be managed better. Residents should also have a copy of policies and procedures they need to know to help them understand how things are done in the home and why. Residents need to know that when they raise any issue of concern it will be taken seriously and the home follows the complaints procedure properly. 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 residents and staff should be formally trained in adult protection issues. Residents would also benefit from knowing what their legal rights are whilst living in the home. To keep a safe environment, work required by the fire department, security lighting to the back, removal of discarded boiler and radiator, and backyard gate replacing, needed to be dealt with. In addition to this work is required to make good the fire damage to a bedroom and smoke damage to walls and ceilings in the home. Attention to rotting window frames was required and the back yard made pleasant to sit out during fine weather. To keep the home maintained, safe, and pleasant for residents and staff, minor work required should be dealt with more promptly. A separate telephone line should be considered so resident’s access to use, is not limited. Residents should be asked about their preferences for colour schemes when their bedrooms are re decorated. They must also be provided with adequate clean bedding, curtains, floor coverings, and fittings. Residents had been disappointed their request for curtains, carpet, and light shade had been ignored. The use of disabled yale door locks did not adequately protect residents privacy, and having no master key for staff to use was potentially a risk. Small requests such as a parasol for the yard should be agreed. Staff employed in the home must have essential training including training in mental health. This will help them care for the residents with sound knowledge of good practice. More staff must be employed as the current level of staffing placed them in a role of ‘minder’ rather than ‘enabler’ in providing a person centred approach to residents care. Although recruitment was generally all right, verbal references alone are not sufficient. Staff must also formally agree to abide by the homes policies and procedures, particularly regarding protection issues for residents. Issues around equal opportunities should be clarified for the staff and promoted. Supervision should be more frequent. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 8 A manager needed to register with the Commission, to take legal responsibility for the day-to-day running of the home. The current manager should be offered formal supervision and sufficient support to help him develop his skills in management and make sure the home is run in the interests of the residents. In order for staff to be fully supported, formal arrangements must be made for out of hours contact with a designated person. Formal consultation should be improved to enable residents to express their views and opinions of life in the home and have some input in any future planning. Further to this, the quality assurance process must be developed to ensure the service is run in the best interests of the residents. 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 supported to respond to Commission if they choose to 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. The summary of this inspection report can be made available in other formats on request. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 9 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.V342879.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information about the home was not up to date to provide accurate and sufficient information to enable current and prospective residents to be clear about the services and facilities provided. Residents did not have individual contracts and therefore did not know what the cost of their stay was and what was included for their overall care, and their legal rights. EVIDENCE: The statement of purpose and the resident guide remains in draft and therefore clear relevant information about the home was not available, such as informing residents of what they can expect from a placement. For example, there were no Terms and Conditions, or standard contract. No information about fees, or service users’ views of the home. There was no reference made to accessing Inspection Reports. Prospective residents and their families had insufficient information on which to make a considered choice of home. There had been no new admissions to the home since the last inspection and this standard could not be assessed. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 11 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. Outcomes in previous inspection did show that prospective people who may use the service and their families were able to visit the home and have an opportunity to meet with staff, and have a look around. No resident had been given a written statement of terms and conditions or a contract. Residents spoken to during inspection did not know what amount of fee they paid, what was included in the cost, any liability, and what their overall care would be. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A lack of consistency in the care planning process meant that staff were not always provided with information they needed to meet peoples needs. Risk taking 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: Where a good assessment had been made, information recorded was used to write care plans. Care plans were written with long-term goal setting. Needs were documented and the level of support required for everyday living indicated. This included relationships with others, spiritual needs and personal care. However essential information recorded from the initial assessments had not always been developed to link to the first stage of care planning in supporting people to work towards greater achievements.
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 13 Individual plans were not fully reviewed and up dated, since the last inspection. As a result there was some concern regarding the lack of detail of need that had become apparent over a period of time for residents. For example, mental health needs identified in assessment and central to residents well being, such as being able to go out in the community, had not been dealt with sufficiently. There was no agreed plan how this would be achieved and therefore no instructions for staff on how to give the necessary support. The care plan was not used as a working document and did not consistently reflect the care being delivered. Some residents had been given the option to have a copy of their care plan for reference. The managers said he was currently working on improving care plans and bring them up to date. Mrs Healey said residents did not always have the confidence to move on and do what they wanted in the long term. However to help people reach the desired outcome such as independent living, 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 character building and a sense of wellbeing. Two residents at the home said they mainly managed their own personal care. Comments such as ‘I do most things for myself’ and ‘I’m all right’ were made. Daily care notes basically showed what people did. There were no arrangements for providing Key Workers to support individual residents. Some residents did link into a member of staff by choice. However the inconsistency of the staff team meant this could not always be maintained Restrictions on residents doing what they liked that may cause them problems was recorded and agreed with them. However as identified in a random inspection 1st May 2007, following an incident involving a fire in the home, action required to reduce a known risk with smoking in bedrooms was not clear. Staff said not everyone followed instructions. This type of action by staff and management had potential serious consequences for all residents and staff working in the home. Equally during this key inspection other risks had been identified such as ‘staying out all night’. This means residents were at risk from poor management of their own and others behavioural needs. Decision-making was said to be encouraged and residents were given time to consider the individual choices they made. Whilst residents had the benefit of one to one discussions with staff, and weekly house meetings, the home should make available, up to date information on for example policies and procedures and any agreed house rules. These would inform residents on their rights and of the choices they made. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 14 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): 11,12,13,15,16,17. Quality in this outcome area is adequate. 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 insufficient staff were available and care plans not reviewed properly, those people who depended on staff support were unable to enjoy the same opportunities. The meals were sufficient in providing for their tastes, choices, and diet. EVIDENCE: The manager was aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. He considered residents living in the home were given opportunities for personal development. This was individualised and was discussed as part of care planning. However as care planning was not always clear about how to
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 15 reach long term goals as short term achievements were not being recorded, progress made was not easy to judge. Information to assist with the inspection showed no activities take place. The manager said they had ‘no drivers’ in the home and therefore couldn’t use the company cars to take people out. There was not always enough staff to support residents with activities, because at evenings and weekends the rota confirmed there was usually only one staff on duty. To get out and about residents could walk to town, visit the library, parks, pubs, and clubs without transport. As part of the basic contract price, residents had the option of a minimum seven-day holiday outside the home they helped to choose. Two residents said they intended to go to the same place again this year as they want to take their dog with them. The manager said those who went on holiday enjoyed themselves, but was unsure of the funding arangements. Residents who had been on holiday said they had enjoyed themselves. Three of the residents said they went 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. This could be developed further to prepare them for living in the community. Development and progress therefore was not limited, although reviewing of options was infrequent, and there were no formal system for support such as Key working. More planning and support could be made for example to encourage 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 although the manager pointed out that residents couldn’t for example bring people they hardly knew into the home on a casual basis. There is one portable telephone for use between staff and residents in the home. Menus showed service users were offered variety and choice. The manager said 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.V342879.R01.S.doc Version 5.2 Page 16 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 needed to be dealt with better to promote the residents general well being. Medication policies and procedures and staff training promoted best practice and therefore reduced the risk of any error being made. 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. Such as ‘they are all right’ and ‘they are ok’. Personal care was given according to needs. Preferences for carers such as gender issues was not recorded and residents did not have the benefit from the support of a key worker. Support required was recorded in care plans as most residents required only prompts to attend to their own personal hygiene. The extent of residents understanding of care planning seemed limited as residents were not aware of formal
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 17 discussions taking place to discuss how they would like staff to support them. Residents did not have a Key Worker to help them 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 needs to be detailed better. From discussion with the manager one resident was putting on too much weight, however there was no plan on how to deal with this. There was no indication if a person should for example wear dentures or had their own teeth, as a more detailed health check assessment had not yet been completed as part of care planning. A full and complete assessment of this standard was not carried out. However 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. 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. The house manager explained the medication policies and procedures had been updated as required during the last inspection, and staff training in this area had been provided. The training matrix however had not been updated to show this. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure provided guidance on raising complaints, however residents were not given a copy and therefore did not fully understand the formal process. The protection of vulnerable adults policies and procedures were not satisfactory and the legal rights of residents not fully protected. EVIDENCE: Two complaints had been received at the Commission, which were referred back to Mrs Healey the registered provider to deal with. Residents in the home 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. Residents however felt that not all complaints were taken seriously, for example people smoking in their bedrooms. As one resident said ‘they knew but did nothing about it’. The complaints procedure assured residents their ‘complaints would be taken seriously’. Systems were in place to record and follow up any concerns people had. The protection/abuse policies and referral procedures were still in the process of being revised and updated. This included the staff whistle blowing policy. Some details were unclear and the policy stated “all reports of abuse, no matter how minor, should be immediately be investigated and acted upon by the person in charge; and It is the responsibility of the manager to ensure all accusations are followed through and investigated with or without consent of the person. All cases should be referred to social services without delay.” However, the policy then goes on to explain the action to be taken in the
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 19 absence of consent, or of none involvement by social services or the police, in “line with the victims wishes”. Also, the over- emphasis in the policy of ‘investigating’ reports of abuse; this raises questions on whether it is right to look at such matters, instead of following an acceptable course of action by taking basic details, then refer to the right agencies for their attention. Guidance on abuse and protection issues was covered briefly in National Vocational Qualification in care training. Training records showed only two out of eight staff had any formal training. Because residents did not have a contract their legal rights may not be protected. In addition to this not all staff had a contract of employment, and therefore the registered provider had no formal agreement of protection issues such as staff not benefiting financially from residents, or formal agreement to abide by the homes code of conduct as set out by General Social Care Council. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some progress had been made to provide residents with a reasonable comfortable environment that met their needs. However attention was required in some areas to improve standards. 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. After the last inspection a business plan was received at the the Commission indicating the rquired improvements to the environment would be completed by June/July 2006. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 21 As a result of a fire at the home in April 2007 one bedroom was severely damaged and other parts of the home damaged by smoke. This was being dealt with through the homes insurance. There had been some progress made to improve the physical environment of the home and comply with work required to improve the premises. There was no evidence however of an on-going maintenance programme in place, other than essential maintenance when a problem had already arisen. Following a tour of the premises these observations were made. Some of the furnishings in communal areas had been replaced. New leather settees had been provided in the lounge. Residents had wanted their pictures hanging on the wall and this had been done. The kitchen had been refitted and decorated and the exposed pipework covered over. Identified repairs needed were still not being followed up promptly. To deal with general maintenance, the house manager submits a regular request to the registered provider to arrange this. Records show these are repeatedly requested. Repairs needed seen at the last key inspection included the light on the back outside wall to be replaced, and as yet remains out of order. This is not acceptable because in addition to security issues, the back yard is the assembly point in the event of a fire. The exposed wiring in the cellar required covering as requested by the Fire Authority (timescale June 2006). The wall in the yard required repainting and casing in the window of the smoking area was rotten in places. One residents bedroom window was also in a state of wood rot setting in. The backdoor in the yard was rotted and unsafe. Part of the yard was taken up with an old boiler that had been removed from the cellar. There was wooden garden furniture provided. Residents had requested a parasol that had not yet been provided. 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. This was not ideal as no master key was available. During the random inspection in May 2007, obervations of residents bedrooms showed little care was taken to keep them in a satisfactory condition. There was insufficient storage space for personal possessions that were kept in black bin bags and carrier bags. Bedding did not appear to be laundered regualrly. Residents were generally satisfied with their bedrooms. However one bedroom had been decorated because of the smoke damage and the residents occupying the room said they had not been consulted over choice of paper. The carpet was dirty, threadbare and frayed around the edges. The occupants
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 22 had asked for this to be replaced but stated Mrs Healey said it was all right. They had also asked for some curtains which they were promised. However although they had looked at samples of materials they did not get any. As a result of this staff took the curtains from the sleeing in room and put them up. According to the residents. ‘the quality was not very good as they let the light in.’ Other observations showed the light shade was old and bedding provided was in a very poor condition, old and heavily stained. Residents did not have a consistant schedule to support them to take care of their rooms, although following the fire, some support had been provided. Excessive possessions such as bin bags of clothes and personal items residents had collected were temporarily stored in the attic room. The groundfloor bedroom overlooking the yard did not offer the resident occupying it with any privacy unless the curtains were closed. To allow residents to be able to make a telephone call in private a portable handset had been provided. However this was the telephone for management use in the home as no separate line had been installed. The broken payphone in the hallway had not been removed. The staff sleeping in room was no longer needed as staff are employed for waking watch only. Generally the home was clean. A new washing machine had been installed. Adam House DS0000009527.V342879.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): 32,33,34,35,36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing arrangements and training provided were 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: There are no reliable records of staff training that has been undertaken in the home. The training matrix showed gaps in essential training being given such as mental health and protection of vulnerable adults. Four care staff had however attained National Vocational Qualification in Care level two. The manager said he was making enquiries about some external courses in mental health for the staff, although there was no training plan in place. The manager said that because staff are moved to other homes in the scheme, it is difficult to maintain training for the home and accounted this to the reason training levels were not consistent. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 24 The manager said Job descriptions and roles were defined, and residents said they were happy with their carers. Rotas seen for the previous weeks showed there was only one member of staff on duty every evening and at weekend. On one occasion there had been no staff on duty between 1pm and 2pm. One carer was on night duty covering waking watch. Carers often worked twelve hour shifts on their own. Staffing levels in the home did not meet the needs of the residents as lone working placed carers in a role of ‘minder’ rather than enabler in providing a person centred approach to care. This was evident when records in the home showed on occasions a resident went missing, was aggressive, or did not return to the home until the early hours of the morning accompanied by a stranger. Staff interviewed at the random inspection on the 1st may 2007 and at the home during this key inspection, raised concerns about being overstretched with staffing. Since the last inspection the manager said two new staff had been appointed. Residents had been involved in staff recruitment. This is good practice although it could be evidenced better. Staff files were not readily available as they were held at Healey House. Records showed recruitment checks to be complete and generally satisfactory. References and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. Application forms had been completed and the applicants had attended two interviews at the home. However in one instance no interview notes had been taken and verbal references had been accepted on their own. Some of the staff had not been given a contract of employment. Staff expressed dissatisfaction and lack of consistency regarding equal opportunities throughout the scheme. New staff were expected to have induction training. Records were not seen of completed induction. Supervision was also being given to staff, however these sessions were not regular. Supervision notes taken by the manager were very good records of staff development within the home. Staff meetings allowed for the participation of all staff. The manager said all staff had signed the employee handbook and safety handbook. Adam House DS0000009527.V342879.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): 37,39,40,41, 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management arrangements did not provide for safe, effective day to day running of the home which 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. Mary Healy, registered provider had appointed a new manager as the previous manager had resigned. The acting manager had been in post for approximately five/six months. He had completed level 3 National Vocational Qualification in Care and had done level 2 in mental health, drug awareness, counseling and was currently doing
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 26 level 2 in drug awareness. He said he had been given a job description. He had completed an application form to be registered with the Commission. This had been passed onto Mary Healey to deal with. The manager demonstrated a commitment during the inspection to provide a good service for the people living at Adam House. However, the lack of keeping the home adequately maintained, inconsistent staff and staffing levels, and poor record management did not support this intention. The manager said he did not receive regular formal supervision. He considered he should and had raised this issue with Mrs. Healey. To be effective in role as manager Mrs Healy must provide the necessary support and autonomy for management development. Arrangements were not in place for emergency management contact. The rota did not show which senior or manager was on call. This has serious implications as identified during the random inspection on the 1st May 2007, and also for incidents that occur such as missing persons or aggressive outbursts. Staff had expressed concern over the lack of formal arrangements for management support evenings and weekends when only one staff is on duty sometimes working a twelve hour shift. Mrs Healy had submitted a business plan and a commitment to have outstanding work completed by June/July 2006. Some of the requirements made remain in breach of regulation and several timescales have been given. Residents and staff had not been consulted about the quality of the service since the last inspection. Adam House has been awarded an Investors In People Award’ as part of the scheme, showing some commitment for staff development. Staff meetings were held regularly although the manager said Mrs. Healey did not attend these. 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. Any request such as the parasol for the back was passed to Mary Healey if the weekly budget did not cover the cost. The manager said there had not been any quality surveys for residents and others to find out about the homes performance. There was no annual development plan available. Information to help support an accurate inspection account had not been completed or forwarded to the Commission and no comment cards were received from residents or relatives giving their view of the service. . 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. A safety handbook was available for staff, this included health and safety policies and procedures. Staff signed to say they had read these. People had been evacuated when the recent fire started in the home. Risk assessments were not completed properly and on occasions instructions not followed through. No strategy was in place to deal with one
Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 27 person who will not respond to the fire alarm. Environment assessments were in the process of being completed by a contractor. Documentation was not readily available to show that installations and equipment had been serviced. Not all staff had undertaken training in safe working practices, and there was no clear evidence to show this had been arranged or planned for. Significant incidents recorded in care notes had not reported to the Commission. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 28 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 X 3 2 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 1 2 2 2 2 2 X Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 Regulation 4,5,6 Requirement Timescale for action 20/08/07 2 YA5 3 YA6 4 YA9 5 YA23 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 timescales of 02/12/05 and 14/06/06 not met. 5(b)(c) People using the service must be informed of the terms and conditions of staying in the home. 15(1)(2) Residents care plans must be readily available, kept under review and revised accordingly with the involvement of the residents. The plans must include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. 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 resident’s behavioural needs. 13(6) The protection and abuse policies and procedures must be
DS0000009527.V342879.R01.S.doc 20/08/07 20/07/07 20/07/07 20/07/07 Adam House Version 5.2 Page 30 6 YA23 13(6) 7 YA24 16,23 8 YA24 23 9 YA24 23 10 YA24 23 11 12 YA24 YA24 13(4)(a) 13(4) 23(2)(p) 13 YA24 23(2)(b) 14 YA24 23(2)(d) amended to include appropriate details for responding to suspicion, allegation, or evidence of abuse or neglect. Previous timescale of 31/03/06 and 14/06/06 not met. A formal agreement from staff to abide by a code of conduct and ethics to protect residents from risk of harm or abuse must be obtained. Previous timescale of 14/06/06 not met. The home must be kept in a good state of repair, both inside and out. Previous timescales of 31/03/06 and 01/07/06 not met. The internal wall leading to the cellar must be repaired with plasterboard and skimming as required by the fire authority. Previous timescale of 30/06/06 Not met. The woodwork to the smoking room window and backyard door must be replaced. Previous timescale of 30/06/06 not met. The ground floor bedroom window overlooking the backyard must be repaired or replaced. The boiler and radiator left in the yard must be removed to prevent the risk of an accident. To help prevent residents and staff from tripping in darkness the external night light at the back of the home must be usable at all times. Previous timescale of 14/06/06 not met. The structural damage to bedroom 2 caused by the fire on the 13/04/07 must be repaired to a satisfactory standard. The stairway and landing area must be decorated to make good the smoke damage caused by the fire.04/05/07
DS0000009527.V342879.R01.S.doc 20/08/07 10/09/07 10/09/07 10/09/07 10/09/07 20/07/07 20/07/07 10/09/07 10/09/07 Adam House Version 5.2 Page 31 15 16 YA25 YA33 16(2)(c) 18 17 YA34 18 18 YA37 8 19 YA37 10(1) 20 YA38 12(5) 21 YA39 24 22 23 YA42 YA42 17,19 37 Bedding provided for residents must be clean of are a reasonable quality. Sufficient numbers of staff who are trained and competent to meet the needs of residents with mental health problems, must be available to work in the home at all times. Previous timescale 31/10/05 and 14/06/06 not met The recruitment process must include the obtaining of full and satisfactory written references to support verbal references, and the recording of information to show all appropriate checks have been carried out. A completed application form in respect of a registered manager must be forwarded to the Commission. Previous timescales of 31/3/05 and 30/06/06 not met. Arrangements must be made to make sure there is a responsible person available to support staff at all times. The registered provider must maintain good personal and professional relationships with residents and staff by being responsive to requests and management needs. Previous timescale of 14/06/06 not met. A formal system for reviewing and improving, the quality of care and facilities provided at the home must be implemented. The homes rules on smoking must be enforced. Notifications of any event which adversely affects the well-being or safety of a resident must be reported to the Commission immediately. 20/07/07 10/09/07 20/07/07 20/07/07 31/05/07 20/07/07 20/08/07 31/05/07 31/05/07 Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 32 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 6 7 8 9 Refer to Standard YA5 YA6 YA8 YA11 YA12 YA16 YA18 YA19 YA22 Good Practice Recommendations Residents 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. Residents should be given the opportunity to set shortterm goals to help them reach their desired long-term outcome. To enable residents to review policies, procedures and services, the home should supply a copy of relevant policies and procedures and agreed ‘house rules’. Records should be kept of how residents are to be supported in their personal development. Sufficient staff should be available at all times to support people in engaging in activities. Options available for residents to take responsibility for their own lives should be explored. Residents should be given the opportunity to decide on preference for male or female carer to support them with personal care and have an appointed carer. A detailed and ongoing health assessment should be completed as part of care planning. Matters of concern raised individually or 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 residents continue to raise specific issues about particular aspects of their care and lifestyle, these should be responded to as part of the complaints procedure. A separate telephone line should be installed for residents and the broken payphone removed. More support should be provided to assist residents keep their rooms clean. Residents’ bedrooms should be fitted with more suitable locks, which are operated as a suite, with master keys being available as appropriate. Residents should be given the opportunity to choose their own colour scheme and wallpaper and furnishings when their rooms are being redecorated. Suitable curtains or blinds should be provided to improve
DS0000009527.V342879.R01.S.doc Version 5.2 Page 33 10 11 12 13 14 YA24 YA25 YA26 YA26 YA26 Adam House 15 15 16 17 18 YA26 YA34 YA34 YA36 YA38 privacy in the ground floor bedroom. Suitable storage space should be provided for residents belongings and avoid the use of bin bags. It is recommended equal opportunities be promoted. It is recommended staff be issued with a contract of employment. It is recommended staff supervision be increased. It is recommended the registered provider provide the Commission with information as requested within agreed timescales. Adam House DS0000009527.V342879.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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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