CARE HOME ADULTS 18-65
Andelain 12 Eugene Road Preston Paignton Devon TQ3 2PQ Lead Inspector
Andrea Peryer Unannounced Inspection 1st February 2006 11:30 Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Andelain Address 12 Eugene Road Preston Paignton Devon TQ3 2PQ 01803 556504 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) Miss Carole Louisa Byrne Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (7) of places Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Registered for a maximum of 7 LD Registered for a maximum of 5 LD(E) Date of last inspection Brief Description of the Service: Andelain currently provides accommodation for up to six adults who have a learning disability; this can include adults who are over the age of retirement. The home is planning an extension that will bring the number of available registered places back up to seven. In the meantime, the homes certificate remains unaltered at seven registered places. The home is sited on the level near to all local facilities and consists of three storeys (the third floor being for the owners personal use only). The home benefits from a level garden to which there is easy access from the home. The owners intention is to ensure service users are supported to integrate with the local community and provide a small, family type home where service users are supported to live as independent lives as possible and to make good use of all the nearby facilities including local shops, Churches, seafront etc. Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out over lunchtime with the owners present throughout the day and with some of the residents who were spoken too in their private rooms or in the homes lounge. The focus of the inspection was to look at the meals service in the home and look at the policies and procedures in the home for the administration of medicines. The progress of the homes review and update of documentation was also considered throughout the inspection. What the service does well: What has improved since the last inspection?
The proprietors have continued to make slow progress with the records maintained in the home having made major changes to paperwork since taking over the home. This has included re looking at detailed care plans and risk assessments and developing a range of policies and procedures, including the development of a quality assurance system to continue to look at improvements. Overall the owners have continued to redecorate and refurbish the home continually improving the overall appearance of the home and providing a good standard of accommodation for residents. This has recently included updating the fire safety equipment in the home and progressing with recommendations made by the environmental health department. Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Andelain DS0000042639.V281648.R01.S.doc Version 5.1 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 Andelain DS0000042639.V281648.R01.S.doc Version 5.1 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): x Not inspected on this occasion EVIDENCE: Andelain DS0000042639.V281648.R01.S.doc Version 5.1 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 owner has developed detailed individual plans for residents, which includes how residents make choices, take risks and are supported in making decisions EVIDENCE: The proprietor has continued to complete care plans and daily ongoing records for each resident. The proprietor said that they were not as up to date as they could be as there had been a busy time for residents with lots of things happening over Christmas and the short break away at a holiday park that the residents had really enjoyed, but which meant paperwork had not been fully completed. Changes in residents care has meant a significant increase in the time the proprietors spend on an individual basis with residents, ensuring residents get one to one attention when physically unwell. This has also meant an change to night time arrangements with the proprietors providing waking and sleeping in services at night. Risk assessments were discussed at the last inspection and the proprietor confirmed that there had been some updating but that the risk assessments continued to need fully reviewing and completing for each resident. Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 10 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): 17 Residents are offered a healthy diet and enjoy their meals and mealtimes EVIDENCE: The unannounced inspection was carried out over the lunch time period. On arriving at the home the proprietor was preparing fresh vegetable for the evening meal in the homes small domestic kitchen. The proprietor confirmed that this was part of the normal routine of the home and that the food shopping for resident’s meals included fresh produce on a daily basis. The residents lunch time routines vary according to what the residents are doing on that day, for some residents this means a sandwich lunch served on trays in the lounge, while for others it is a sandwich lunch in their own rooms. This also means that sometimes meals are obtained out of the home on trips out such as cafes and restaurants and some are provided by family when the residents visits family and friends. The proprietors confirmed that residents had a choice of what they wished to eat at any time throughout the day or night depending on the residents preferences and ensuring that this did not conflict with any special dietary needs such as a diabetic diet or a reduced calorie diet. Discussion took place on how difficult this was sometimes to achieve as residents and residents families often chose foods that was not
Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 11 always the most appropriate and the proprietor described how residents were supported in controlling their diets without being restricted in a way that made residents unhappy. A recent environmental health report highlighted some areas of improvement such as ensuring the proprietors and any members of staff employed in the home have a basic food hygiene certificate. The home has a menu plan, but any changes to the plan are not always recorded and it is not always easily to see what residents have eaten. Although the recording of foods and fluids is difficult as residents are attending day opportunities or are away from the home efforts should be made to try and record what residents are eating this will help to identify any food that might be a potential factor in the event of any out break of diarrhoea and vomiting and also shows the level of choice residents have in the type of food they eat. Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Residents do not retain and administer their own medication. Residents are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Medication is stored in a secure cabinet and the home operates a blister packed monitored dosage system that is supplied by the pharmacy. Residents do not control or administer their own medication as the proprietor and resident have agreed that it would not be safe for them to do so. The proprietors do support and supervise residents to use medication appropriately for example using inhalers. Medication administration is recorded on computerised carbonised sheets that were dated and signed after administration. Since the last inspection the proprietors have obtained a returns book for the disposal of medicines and are using this to record all medicines returned to the pharmacy. Medication records included a photograph of the resident, a list of homely remedies that might be used, a list of allergies and details of any changes in medication. The proprietors have written policies and procedures for medication administration and their detailed knowledge of the residents care including any visits to the doctor or changes in medication ensures that residents are protected from harm.
Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 13 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): x Not inspected on this occasion EVIDENCE: Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 14 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): 24,30 Residents live in a homely comfortable and safe environment, which is clean and hygienic. EVIDENCE: The home continues to present as clean and homely with shared and private rooms comfortably furnished and personalised by the residents with personal items of their own choosing such as photographs and mementoes. On the day of the inspection residents were in the homes lounge which is an area that the proprietors have completely redecorated since purchasing the home and this area can be used as an additional private area, if required, for resident’s to meet visitors in private etc by closing the doors between the dining area and the lounge. One resident’s room requires redecorating and a new carpet, this was discussed at the previous inspection and the proprietors are aware of the need to go ahead with the plans to refurbish this area. The owners are continuing to explore ways to ensure that residents laundry is not brought through the kitchen area and residents, going in and out of the laundry and kitchen areas is as limited as possible to reduce the risk of any cross infection/ contamination of foods. Since the last inspection the proprietors have made improvements in the fire safety precautions, updating the sensors in the fire detection system and have started to work through recommendations made by the environmental health department.
Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 15 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): x Not inspected on this occasion EVIDENCE: Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Resident’s views underpin the development of the home and the resident’s safety, welfare and best interests are protected and promoted. EVIDENCE: The proprietors confirmed that they are continuing to work on developing a quality assurance system that is clearly linked to the standards in the Care Standards Act 2000 and are based on positive outcomes for the residents, based on residents’ views and how residents want to spend their time. This demonstrates the owner’s commitment to ongoing improvement. The proprietors described the care residents continue to receive at the home and this included ongoing intervention from a range of professionals including social services reviews and regular contact with a GP regarding the physical care needs of one particular resident. To ensure the safety of one resident’s the proprietors have increased staffing arrangements in the home to increased waking responsibilities at night. This has meant that the proprietors have spent more and more personal time in the home carrying for residents and demonstrates their commitment to providing a family focused service to residents, in which residents are treated as part of the proprietor’s extended family to ensure their welfare and best interests are protected and promoted.
Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 17 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 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x x x 3 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 x 3 x 3 x x 3 x Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA7 YA17 YA24 YA30 YA39 Good Practice Recommendations Review and update risk assessments Complete food hygiene training and record residents diet Complete as planned the decoration and re-carpeting of one residents room Continue to explore ways to ensure laundry and kitchen areas are not areas in which residents routinely pass through Continue as planned to develop the homes quality assurance system Andelain DS0000042639.V281648.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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