Inspection on 15/10/05 for Allanby House

This inspection was carried out on 15th October 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Allanby House 24/05/06

Allanby House 09/03/06

Allanby House 30/03/05

Allanby House 14/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Allanby House Wedgewood Drive Flimby Maryport Cumbria CA15 8QX Lead Inspector Nancy Saich Unannounced Inspection 15 October 2005 09:00 Allanby House DS0000022533.V253486.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 Allanby House DS0000022533.V253486.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. Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Allanby House Address Wedgewood Drive Flimby Maryport Cumbria CA15 8QX 01900 819039 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) Community Integrated Care Mrs Carol Wignall Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 6 people over 18 years of age with a learning disability who may also be older people Date of last inspection Brief Description of the Service: Allanby House is a modern, purpose built home situated in a residential area of Flimby. It can take up to six residents with learning disability and they may all also be older people. Community Integrated Care, a company that operates services for people with learning disability throughout the country, owns the home. Carol Wignall manages the home on their behalf. Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by Nancy Saich and started at around ten o’clock on Saturday 15th October 2005 and lasted for just over five hours. The inspector met and spoke to all of the residents and the staff on duty. She saw all areas of the home and read documents that supported what was said and what she saw. What the service does well: What has improved since the last inspection? What they could do better: The registered person must make sure that that the home only accommodates residents that can be cared for properly by the staffing arrangements that are in place. The registered manager must make sure that the written plans of care are up to date and that they give staff detailed strategies of how to care for residents. The registered manager needs to make sure that there are plans in place that will help residents to eat as well as possible. The registered person and the company must make sure that this home is properly staffed at all times so that all the residents can have suitable care at all times. One person who has been judged to need one-to-one care must always have a specific member of staff who cares for their needs. Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 6 The company and the registered manager must review the way the home operates so that every person who lives in the home has the best possible care they can have given their needs. This is especially important given that these residents are growing older and their needs are becoming more complex. 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. Allanby House DS0000022533.V253486.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 Allanby House DS0000022533.V253486.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): 3 The home needs to improve the way they check that individual’s needs are being met so that all of the residents get the care and services they want. EVIDENCE: There had been no new admissions since the last inspection so not all of the standards were checked thoroughly. At the last inspection a requirement was made about one person who needed their care needs checked out and worked on. Meetings had been held with social workers, specialist teams, family members and a medical consultant. However there had been no changes to this persons care although it had been acknowledged that there had been changes in need. The assessment had not addressed the extremely complex needs of this person and the requirement has not been met. Allanby House DS0000022533.V253486.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): 6,7,9 The arrangements for ensuring care and services are properly delivered were poor in that care plans and risk assessments were out of date. EVIDENCE: The inspector read all of the documents in the home that show how residents want to be cared for. She spent a lot of time reading two of these ‘care plans’ for people who had complex needs and one plan where the residents said they wanted to be more independent. One of the plans was detailed and up to date and the person said they had been involved in drawing it up. This person did not have a copy of the plan. Another resident who had been ill was unsure about the care plan. This plan did not address the change in health and personal care needs. The plan had not been changed for some time and referred to habits and preferences this person had chosen before ill health had changed their needs. This resident spoke about anxieties and these were not addressed by the plan, nor did it refer to the planning done by a team of occupational therapists who were helping this person to get well. Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 10 There is one person who has very complex care needs in this home. The care plan does detail these needs and behaviours but the plan has not been updated and staff were unsure as to what the doctor, social worker or specialist workers thought they should do when faced with difficulties. Risk assessments for these three people were out of date and lacking in details that would protect and encourage residents. One person needed more details for staff about how to help with moving and handling. There was evidence to show that staff really do want to help residents to make their own decisions but are struggling when residents make unwise or unrealistic decisions that may effect their wellbeing. There is building work next door to the home and there had been no updates to individual risk assessments that might cover any additional dangers. Allanby House DS0000022533.V253486.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): 12,13,17 Residents’ lifestyle choices are not being appropriately met in this home and this is especially limiting for people with complex needs. EVIDENCE: Residents do go out to classes and to local social events. A number of residents go to a local club for older people and this is part of village life. Other people go out to local events and they feel they are part of the community. Residents had a summer holiday and go out individually and in small groups to shop, visit the cinema or pursue individual interests. This works well when residents can manage with one member of staff. The staff group said it was more difficult for people with mobility or behavioural problems. Sometimes people cannot attend activities when there is not enough staff available. Residents said they enjoyed their food and they chose what was on the menu. They also went out to help with the weekly shop. The inspector thought that there were people in the home who were either under or over weight. There was very little reference to this in care plans and no plans in place for healthy eating. One resident who was trying to lose Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 12 weight wasn’t sure of the best way to do this. Staff said their strategy was to give smaller portions. Food stored showed that convenience foods were used. Staff said some residents did eat a lot of healthy foods but that sometimes due to the pressures on staff time they did rely on processed foods. Allanby House DS0000022533.V253486.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): 18,19,20,21 Staff try very hard to give suitable support to residents but are hampered by a lack of co-ordinated guidance on how to manage some of the behaviours displayed by the resident group. EVIDENCE: Residents were happy with the staff group and had no issues with the way they were treated. The inspector thought that staff managed the care needs as well as possible given the staffing levels and the needs of the residents. The lack of detail in the care plans did not help staff to understand the very complex needs of the residents. At least two people had very specific needs and the strategies in place did not address their needs. One person had complicated emotional and psychological needs and although staff were good at reassuring this resident there was no future planning for lessening this distress. Staff did have an understanding of the needs related to ageing but at least one resident had some problems coming to terms with change and staff had no guidance to help this person overcome this. There was very little guidance about what a persons wishes might be on their death. Medication was being dealt with appropriately Allanby House DS0000022533.V253486.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): 22,23 The home is failing to protect some residents and to give other residents a ‘voice’ in the home. EVIDENCE: These two standards were checked by talking to staff and residents. Some residents had problems with the noise levels both in and outside the home. One person thought they might benefit from a more independent lifestyle. Another person gave non-verbal signs of distress. None of these matters were being addressed as concerns and complaints although there had been some support from an advocate in the past. Staff were aware of what might be abusive and had some concerns that they were not managing some things as well as they could. One person was selfharming and the inspector observed staff trying to help this person. The records about this were not as precise as they could be. The inspector could not see any written guidance to prevent or lessen this behaviour. Allanby House DS0000022533.V253486.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, 25,28,29,30 This house provides a very pleasant home for the residents. There was some risk to residents because of the easy access to the building work in the grounds. EVIDENCE: This home is very well designed and has all the equipment and adaptations necessary for people who have mobility problems. It was nicely decorated and furnished. Residents said they really liked their rooms and most people had their bedrooms arranged just as they wanted. They were very proud of their rooms and enjoyed their privacy. The lounge, dining room and kitchen were comfortable. Some residents did not use these communal areas very much but this was probably due to issues within the group. This home does not have any housekeeping staff and the team does well to keep high standards of cleanliness and tidiness in the house. C-I-C are building in the vacant lot beside the home. Some residents had found the building work difficult. On the day of the inspection the site could be reached from the side of the house. There were open excavations on this site Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 16 and residents and members of the public could be in danger. There was no risk assessment available about this potential danger. Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 17 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): 33,35 The inspector judged that staffing levels were insufficient to deliver the best care and services available. EVIDENCE: On the day of the inspection there were three staff until one o’clock and then only two staff until the following morning. These staff were expected to clean the entire house, shop, wash and iron, cook and deliver personal care to six people. They were also expected to act as ‘key workers’ for residents. This means that they should spend time with individuals and take them out to activities. It also means they should update and rewrite care plans and risk assessments. Currently one person is recovering from a serious illness and another person needs constant care and attention. This person needs one to one attention and the staffing levels were insufficient to meet this need on the day. The inspector was given copies of rosters for the four weeks prior to the inspection. Residents and staff said that sometimes there wasn’t enough staff to take residents out to individual activities or to work on person centred care planning or to prepare a meal from ‘scratch’. The inspector was impressed by the commitment and caring approach of the staff. Staff had attended suitable training courses and had a good range of skills and knowledge. She did think that there wasn’t enough staff on to do all the tasks necessary to give all the residents the kind of lifestyle they wanted and deserved. Allanby House DS0000022533.V253486.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 The management systems are failing residents in this home and these failures are having an impact on the well being of individuals. EVIDENCE: The management systems had failed to deal with the problems of high dependency levels and staffing problems. This means that the care and services are not working efficiently. The inspector thought that the team were used to working in this way and had accepted that they would, as they said, “cope”, “get by”, “get through the shift”. This feeling of running a home day by day was evident in staff and residents alike and was often used by them to explain why they had to make compromises in things like activities, care planning and cooking. The inspector thought that there were demands on the staff that meant they were simply holding things together and not helping residents to plan and be involved in both the daily life of the home and in the future development of the service. Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 19 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 X 2 X x Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X X 3 3 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 X 3 x CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Allanby House Score 2 2 3 2 Standard No 37 38 39 40 41 42 43 Score 2 X X X X X X DS0000022533.V253486.R01.S.doc Version 5.0 Page 20 YES Are there any outstanding requirements from the last inspection? 1 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 3 Regulation 14 Requirement Full, multidisciplinary assessments must be completed and recorded for two residents. Any actions that come from these assessments must have suitable plans in place.(This is an outstanding requirement that has been extended in both time scale and content). The registered person must ensure that all care plans are updated and give more detail of residents needs. Risk assessment and risk management must be included in each care plan. The registered person must review the catering arrangements to give residents healthy choices and to ensure that individual nutritional plans are in place for people who have weight problems. The physical and emotional health care needs of all the residents must be included in the revised care plans. The registered person must support residents to express their concerns and complaints DS0000022533.V253486.R01.S.doc Timescale for action 15/12/05 2 6 15 15/12/05 3 4 9 17 13 (4) 16 (2) (i) 15/12/05 15/12/05 5 19 15 15/12/05 6 22 22 15/12/05 Allanby House Version 5.0 Page 21 7 23 13 (4) 8 24 23 9 37 24 and must take action to address these. The registered person must ensure that there are strategies in place to lessen the risk of self harm. The registered manager must make sure that no one can access the building site next to the home. The company and the registered manager must conduct a management review that will look at the issues of resident dependency levels and the staffing of the home. 15/12/05 30/11/05 15/01/06 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 2 3 4 5 Refer to Standard 7 12 18 21 33 Good Practice Recommendations Residents must all be consulted about future planning. The home must be appropriately staffed at all times to allow residents to attend the activities they have chosen. The manager and the staff team need to review the individual support needed by all the residents. It is recommended that the staff team are supported in looking at the emotional needs of residents who are facing the losses that ageing may bring. The company and the manager must review the deployment of staff to make the best use of staff time. Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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. Extracts may not be used or reproduced without the express permission of CSCI Allanby House DS0000022533.V253486.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!