Inspection on 05/12/05 for Addington Close (12)

This inspection was carried out on 5th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Addington Close (12) 07/05/09

Addington Close (12) 10/05/07

Addington Close (12) 11/05/06

Addington Close (12) 11/07/05

Addington Close (12) 22/11/04

Addington Close (12) 21/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Addington Close (12) 12 Addington Close Devizes Wiltshire SN10 5BE Lead Inspector Malcolm Kippax Unannounced Inspection 5th December 2005 9:25 Addington Close (12) DS0000028256.V271399.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 Addington Close (12) DS0000028256.V271399.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. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Addington Close (12) Address 12 Addington Close Devizes Wiltshire SN10 5BE 01380 720001 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) Ordinary Life Project Association Mrs Helen Patricia Morgan Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 3 service users with learning disabilities at any one time. Date of last inspection 11th July 2005 Brief Description of the Service: 12 Addington Close is one of a number of homes that are run by the Ordinary Life Project Association (OLPA). 12 Addington Close is a bungalow in a residential area of Devizes. The home fits in well with the neighbouring properties. The accommodation is domestic in style and consists of a living room, a dining room, a kitchen and three single bedrooms. Service users receive support from a manager and small team of permanent staff. Agency carers and relief staff also regularly work in the home. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 9.25am and lasted for 6½ hours. Two service users were at home and spoken with throughout the inspection. There was a meeting with an agency carer. One of the permanent staff members was also present for most of the day. The home’s manager was working at the time and available throughout the inspection. The communal areas were looked at and a selection of the home’s records was examined. There had been no changes in occupancy during the last year. Two service users have lived together since 1995 and the third person moved into the home about 2½ years ago. What the service does well: What has improved since the last inspection? What they could do better: Service users’ independence and safety is being affected because of a lack of environmental adaptations and maintenance to the driveway. Service users want this work to be done and OLPA has a duty to ensure that the necessary changes are made to meet their needs. OLPA has not replied to the Commission’s request for a response to the work that needs to be done. A Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 6 more pro-active and responsible approach is needed to dealing with matters that affect the service users’ wellbeing. An immediate requirement was issued for OLPA to produce a timescale for completion of the work and for risk assessments to be undertaken. OLPA has not yet produced a system of quality assurance for use in the home, which meets the expected standards. The manager has produced a business plan with some clear objectives, however this is limited by a lack of organisational input and timescales for the completion of objectives. Records in the home showed that service users are not well protected by the arrangements made for the recruitment of staff. References had not been obtained before a new staff member started and there was no evidence of a POVA / CRB check having been made. 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. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 7 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 Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 8 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): Standard 2 did not apply at this time. There were no vacancies and there have been no changes in the home’s occupancy during the last year. EVIDENCE: Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 9 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): 9 The manager and staff are keen to promote the service users’ independence. However service users are at risk, and their independence is reduced, because parts of the environment have not been suitably adapted. (Standards 6, 7 and 8 were inspected and met at the last inspection). EVIDENCE: The service users’ files contained risk assessment forms that had been completed on an individual basis. Some involved generic hazards, such as hot water temperatures, and others concerned more personal activities. The latter included an assessment of the risk to a service user’s independence, if not able to leave the home unaccompanied or unsupported. Guidelines about this had been produced for staff. It is good practice to balance safety and a service user’s rights in this way, as part of a risk assessment process. One service user was able to go out independently and does several activities without the direct support of staff. Another service user said that they liked to be as independent as possible, but was restricted by the way in which the house could be accessed. See Standard 26. This had been discussed at a Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 10 recent house meeting, when one service user had asked why nothing had been done to improve the situation for the other service users. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Service users have different activities, which reflect their interests and how they wish to spend their time. Changes in need are having an impact on what the service users do. (Standards 13, 15, 16 and 17 were inspected and met at the last inspection). EVIDENCE: One service user attends a resource centre during the week and makes the journey independently. The manager said that this service user had a job coach and employment opportunities were being looked at. The other service users have a more varied week, which includes a mix of planned, regular activities and other outings that are arranged on a flexible basis on the day. Two service users were home based on the day of the inspection. Each person went out during the day; one had appointments with their GP and with an optician. This service user was spending more time in the home as a result of deciding to stop one regular activity. She continued to attend some clubs on a regular basis. There was no pressure to participate in particular activities and changes in the service user’s physical needs were also a factor in what the Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 12 service user wished to do. The manager is aware that changes will have an impact on the level of support that the service user will need from staff in the future. Another service user was doing jobs in the home and also went out on a shopping trip during the inspection. He said that on two other days he went out to a day centre and had recently started a college course about computers. He enjoyed his activities during the week and was happy with his level of independence. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Service users receive the support that they need with the safekeeping of their medication. The procedures will be sufficiently robust when an administrative discrepancy has been corrected. (Standards 18 and 19 were inspected at the last inspection. Standard 18 was almost met and standard 19 was met). EVIDENCE: A recommendation had been made at the last inspection about having a policy concerning gender and the provision of personal care. This has not been produced. Staff members administer the service users’ medication and there are suitable storage arrangements in place. One service user who was asked about medication said that he was happy for staff to make the necessary arrangements and to keep it safe on his behalf. Consent forms had been completed and were contained on the medication file. The patient information leaflets were also available together with other guidance that had been written for staff about the service users’ prescribed drugs. The medication arrangements looked well organised. The records of administration and stock were up to date. Receipt of some new medication Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 14 had been promptly recorded after it had been collected during the inspection. Earlier in the day a service user had been well supported with getting a GP’s appointment at short notice. The medication included painkillers that had been prescribed for one service user. This was to be given four times a day, according to the instructions on the pack, although it was recorded as PRN (as required) on the administration of medication forms. This was brought to the manager’s attention, who said that staff members were administering the medication, ‘as required’, as the GP intended. This needs to be followed up to ensure that the instructions are consistent, with no uncertainty as to when the medication needs to be given. Staff members who administer medication receive training in the medication procedures an ‘in-house’ basis from an OLPA Service Co-ordinator. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users have the information they need about making a complaint. There is staff awareness, which helps to protect service users from abuse. However the home’s policy and procedure lacks an important detail. (Standard 22 was inspected and almost met at the last inspection). EVIDENCE: One service user spoken with kept a copy of the OLPA complaints procedure in a drawer in his bedroom. He knew of people he could talk to if he was not happy with something. Service users have been reminded at the house meetings of how to make a complaint and who they can contact. The minutes showed that the meetings are a good way in which service users can raise matters that concern them at the meetings and people are identified to be responsible for following these up. The agency carer met with said that she had received training in adult protection from her employer. She was aware of the ‘No Secrets’ booklet and had also seen relevant guidance in the file that is kept in the home for agency staff to read. Abuse awareness is included in the OLPA training programme for support workers. The subject is covered in a short statement in the home’s policy and procedure file, which makes reference to ‘No Secrets’ and to a guidance document on the protection of vulnerable adults from abuse in Swindon & Wiltshire. The statement did not refer to another document that was in the home, which was titled ‘OLPA Abuse Prevention Awareness and Reporting Procedure’. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 16 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 (in part), 29 and 30 Service users’ independence is reduced because environmental adaptations have not been made. (Standards 24, 26 and 28 were inspected and met at the last inspection. Standards 24 and 26 were met and standard 28 was almost met). EVIDENCE: Since the last inspection, the Commission has received information about some maintenance work and environmental adaptations that have been recommended by an occupational therapist. The manager requested an O.T. referral in 2002 and as a result of this the OLPA was written to, with a recommended to carry out repairs to a driveway so that one service user in particular can use it without the increased risk of hurting herself. The service user concerned wears a lower leg calliper and uses a walking frame. The driveway was reported to be in a bad state of repair, with an irregular surface that is prone to flooding. There appears to have been no action taken by OLPA to remedy the situation. As a consequence of the increasing frailty of two service users, the O.T. has also said that it is necessary to improve access through the front and back Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 17 doors. This involves changing the door thresholds so that they are less of an obstacle to service users. The Commission has written to OLPA about this but received no response about the work that needs to take place. The threshold at the front door was seen to be a problem to a service user during the inspection. An incident had also been reported in which the driveway had flooded with 2” of water outside the front door. One service user found this difficult to negotiate and it made another service user feel very unsure because of his limited eyesight. One service user would like to have a shower fitted in the home. The shower has been bought, but the manager has been told that this will be too expensive to install. The home accommodation looked clean and tidy. An environmental health officer visited the home in November 2005. There were no recommendations or requirements made in respect of the kitchen. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 18 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, 34, and 35 Service users are supported by staff members who they like and who know their needs well. The appointment of a new staff member has been beneficial. Training is provided through in-house activities but the benefits for service users are reduced by the lack of an accredited programme of induction for new staff. Service users are not adequately protected by the organisation’s recruitment practices. (Standard 33 was inspected and almost met at the last inspection). EVIDENCE: The staff team includes experienced support workers. Relationships during the inspection were observed to be friendly and positive, with a good rapport evident between staff and service users. Service users were spoken to, and about, in a respectful manner. Service users said that they get on well with staff. Most training activities are arranged as part of an OLPA programme, which covers a range of subjects. Following induction, support workers are expected to progress to NVQ at level 2. Two staff members have still to complete this qualification. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 19 A new member of staff has been appointed since the last inspection. There were significant shortcomings in the recruitment documentation in the home. There was no record of a POVA / C.R.B. check having been undertaken. One written reference was available. This had been received after the new staff member had started working in the home. The new staff member did not have previous experience of learning disability services. There is an OLPA induction programme. Learning Disability Award Framework accredited training is not being provided and OLPA are therefore not achieving the standard for staff training and development. OLPA have previously been recommended to arrange this, which staff can then use to provide the underpinning knowledge for progress towards achieving NVQs. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 20 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): 42 and 43 There are procedures in place that help to protect service users although protection is reduced by a lack of consistency. Service users are at risk because of a lack of attention to the physical environment. External management of the service is not sufficiently focussed on improvement and on raising standards in some important areas. (Standards 37, 38 and 39 were assessed at the last inspection. Standards 37 and 38 were met; standard 39 was almost met). EVIDENCE: As reported under standard 29, changes in the facilities are needed in order to promote the service users’ independence. The condition of the current facilities means that they are also hazards, which affect service users and put one service user in particular at risk of hurting herself. The manager had written to the occupational therapist about the carrying out of risk assessments. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 21 The record in the fire log book showed that tests of the fire alarm system are not being carried out weekly. Fire safety is talked about in the house meetings. There is a health & safety file, which includes a policy on safety. A form was completed for health and safety checks in 2004, which included inspection dates for various facilities. The bath chair had been serviced in August 2005. There is a manual handling checklist and risk assessment. This was last reviewed in October 2005. Some staff members have not signed to confirm that they have seen this. A risk assessment in respect of radiators was undertaken in October 2005. A cover has been fitted to the radiator in the bathroom since the last inspection. A check of one staff training record showed that training in first aid, moving and handling, fire training and food safety had been undertaken. It was reported at the last inspection that a more pro-active approach, at an organisation level, is needed to improvement and to annual development. The lack of attention and response to recommendations made by the occupational therapist is evidence that improvements are not being appropriately carried out. The manager has produced a business plan for 2005 / 2006, which includes objectives that will be of benefit service users. This is a very positive initiative, which should be supported by OLPA with the production of an action plan for achieving the objectives. There is no professionally recognised system of quality assurance. The manager said that OLPA was looking at making some new arrangements. Feedback from the service users is obtained through house meetings and individual review meetings. In the absence of an organisation approach to quality assurance, the manager was recommended to include this within her own business plan. Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X N/A X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X 1 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 1 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Addington Close (12) Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 2 DS0000028256.V271399.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13(2) Requirement Information about the administration of medication must be accurately maintained in accordance with the GP’s instructions. A date for completion of environmental adaptations and work recommended by the occupational therapist must be confirmed with the Commission. Two appropriate references must be obtained prior to a staff member starting work in the home. Evidence of the completion of POVA / CRB checks must be available in the home. The Commission must receive confirmation that a POVA / CRB check has been carried out in respect of the most recently appointed staff member. Risk assessments must be carried out in respect of service users accessing the home via the driveway, front door and entrance lobby, and by the back entrance, steps and patio doors. The alarm system must be tested at least weekly. DS0000028256.V271399.R01.S.doc Timescale for action 06/12/05 2 YA29 23(2) 19/12/05 3 YA34 19(5) 06/12/05 4 5 YA34 YA34 19(1) 19(1) 06/12/05 31/01/06 6 YA42 13(4) 12/12/05 7 YA42 23(4) 06/12/05 Addington Close (12) Version 5.0 Page 24 8 YA43 24 The Commission must receive confirmation of the system that is in place for reviewing at appropriate intervals; and improving, the quality of care provided at the home. 31/01/06 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 Refer to Standard YA18 Good Practice Recommendations That a statement on personal care is produced to include the organisations policy on gender and personal care and to provide details of any limitations and restrictions that may apply in the provision of personal care. That, in addition to the ‘in-house’ training, staff members also receive training in medication from a specialist outside the home. That the policy and procedure on abuse is developed to include all relevant guidance that it provided for staff members. That a programme of refurbishment is produced for the home (this recommendation is outstanding from the previous inspection). That an appropriate system is used for calculating staffing levels based on the needs and personal goals of the service users (this recommendation is outstanding from the previous inspection). That LDAF accredited training is provided for new members of staff. That the manager’s business plan is developed to include timescales for the meeting of objectives. The plan should include a quality assurance component until a separate system of quality assurance is developed. That OLPA reviews its management arrangements to ensure that requests from the Commission for information are responded to in a timely manner. 2 3 4 5 YA20 YA23 YA23 YA33 6 7 YA35 YA39 8 YA43 Addington Close (12) DS0000028256.V271399.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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