CARE HOME ADULTS 18-65
Andelain 12 Eugene Road Preston Paignton Devon TQ3 2PQ Lead Inspector
Judy Cooper Unannounced Inspection 10th March 2008 10:30a. Andelain DS0000042639.V360872.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 Andelain DS0000042639.V360872.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. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Andelain Address 12 Eugene Road Preston Paignton Devon TQ3 2PQ 01803 559336 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 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.V360872.R01.S.doc Version 5.2 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 11th January 2007 Brief Description of the Service: Andelain currently provides accommodation for up to seven adults who have a learning disability; this can and does include adults who are over the age of retirement. 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 people, who live at the home, are supported to integrate with the local community whilst providing a small, family type home where they 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. The current range of fees are from £475 to £520 per week. A copy of the home’s inspection report is kept in the homes communal dining room and available to all. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This inspection took place on Monday 10th March between 10.30 a.m. and 4.00 p.m. with a second visit to the service on the 14th to meet with a newly employed staff member and check the staff member’s employment records. During the visits the opportunity was taken to tour the home, examine appropriate records and policies and talk with the people who live at the home as well as one staff member. The two owners were also present for the whole of the inspection process. A discussion was held with a visiting community nurse, on the first day, who is hoping to place a new person at Andelain in the near future. Other information about the home, including the receipt of 1 questionnaire from a person who lives at the home and 7 from the peoples’ relatives/carers has provided further feedback as to how the home performs. The owner also supplied information, prior to the inspection, about the services and facilities the home has to offer detailing such things as any improvements made or noting any areas where they feel improvements can be further made. This is a requirement of registration and is called an Annual Quality Assurance Assessment. All of the information collated from these various sources has been considered and/or used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well:
The owner and her partner interact very well with the people who live at the home and it was clear that the people enjoyed and were relaxed in their company. They are both fully involved in the peoples’ day to day lives and there is no segregation between the owner, her partner or staff and the people who live at the home, with all using the same facilities, having meals together or going out together. This helps foster and maintain an atmosphere of inclusion and equality. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 6 Peoples’ rights to individuality are fully upheld by the owner and her partner and staff and people are treated with the respect and dignity. Some people have very differing needs and the owner, her partner and staff do all within their power to meet these on an individual basis whilst also ensuring that the person is still fully included in the day to day activities within the home. For example one person is retired and stays at home during the day, however they are encouraged to participate in all aspects of the day to day running of the home and encouraged to have sense of ownership within the home. During the inspection it was noted that the person spent a lot of time knitting, a pastime they very much enjoy, whilst sitting in the comfortable, warm, communal lounge. Appropriate activities are made available and people are given support to undertake these if they so wish. People are also supported and encouraged to further develop existing independence skills, learn new ones and make their own decisions about how they live their own lives. The environment at Andelain is very clean, warm, homely, well decorated and well furnished. The owner and her partner and newly employed staff work in a “person centre” manner which means that each person is put at the centre of any care that is to be provided and are fully involved in any decisions in respect of this. The owner and her partner, who both know the people extremely well, undertake the majority of care within the home. This means that the people who live at the home are cared for in a very personal manner. A real strength of the home is the owner and her partner’s ability to ensure that the people feel a sense of ownership and belonging, and remain secure and settled at the home, taking into account that most of the people who live at the home are at a mature age and have needs relating to this. For example they enjoy the pleasant surroundings of the communal lounge or their own room in the evening or at weekends and don’t always want to go out socialising, this is facilitated but opportunities are still made available for others who do wish to go out. The owner and her partner also provide excellent care for people who live at the home when they are ill. This could be clearly seen in the very good care given to a person who recently died in the home. The care was provided in conjunction with local health care professionals and this enabled the person to remain at the home to the end. This was very much appreciated by the person’s family and allowed the person to be cared for by people that knew the person well.
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
During the past few months the owner has spent a lot of time caring for the very ill person who recently died at the home in January. She stated that this had resulted in her not having the time to undertake certain administration tasks to the required standard. However these administration tasks do need to be fully completed to ensure that all the peoples’ health and welfare needs are known and can then be fully and appropriately met by all people who provide care to them, for example: Care plans must be reviewed with each person when there are identified changes needed to any person’s care. Additionally, existing risk assessments must also be reviewed whenever a new risk is identified to ensure that all steps necessary are taken to minimise the newly presenting risk. This is to ensure that the people who live at the home remain protected from any unnecessary risks to their health and welfare. This is particularly important now that the owner is employing additional members of staff who will need to have this information quickly to hand to be able to provide the required care. (Previous requirement from last inspection) Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 8 Peoples’ daily records should be kept up to date. At this inspection there were gaps of several days where no entries had been made at all for any person. This means that there was no recorded information to hand about any person for this period of time. This could place people at risk in the event information was needed quickly to establish any pattern or change of behaviour that may need further intervention. The owner should maintain a record of activities undertaken and who participated in which activity and whether people had enjoyed them. This is so that the owner can monitor what activities suit which people and make sure that all the people get the opportunity to undertake a suitable/enjoyable activity. Records of meals provided should be kept to allow the owner and staff to know what people have chosen to eat and to ensure that this is a well balanced diet which will help ensure that peoples’ well being is a maintained. The administration of controlled drugs must always be undertaken in an approved manner to protect the person receiving the medication and the staff administering the medication. The owner should provide the home’s complaint procedure in an easy to understand format to enable all the people to be able to know how to make a complaint should they want to. Privacy locks should be provided to communal toilets/bathrooms unless a risk assessment gives clear reasons why this would not be in the best interests of the people. The remainder of the homes’ radiators that have not yet been protected must be risk assessed and then protected in priority order. This is to ensure that all the people who live at the home remain protected from the risk of sustaining a burn. (Previous requirement from last inspection). A risk assessment should be in place for the use of any portable heating appliance for the same reason. The owner must ensure that there are rigorous recruitment procedures in place in respect of new staff (including family members), such as the receipt of two written references and the obtaining of an enhanced criminal Record Bureau check to ensure that only suitable people who live at the home are employed to work with the people. This will therefore help ensure the people remain protected. Any use of volunteer workers must also be in line with guidelines regarding the protection of vulnerable people who live at the home. Therefore any volunteer working within the home, who has close contact with the people must also be prepared to undergo an enhanced Criminal Record Bureau check, which the owner can have access to, to ensure that the people remain protected. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 9 The induction provided for any new staff member should be recorded to ensure that both the owner and the staff member are aware of what has been discussed during this time of training and to allow the owner to be assured that the newly appointed member is staff is proficient in her role. The owner should complete training relevant to her role. This refers to the completion of a National Vocational Qualification at level 4 in Care Management. This will ensure that the owner has the up to date skills and knowledge to carry on providing good care for the people and keeping people free from harm. (Previous recommendation from last inspection). The owner must introduce a formal quality audit of the service, taking into account the views of the people who live at the home, their relatives/advocates and any other interested parties that may have contact with the home. The owner must then act on the information received by producing an individual annual development plan for the home, utilising this feedback. Having an individualised development plan will help ensure the home is always run in the best interests of the people who live there. (Previous recommendation from last inspection.) 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. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 10 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.V360872.R01.S.doc Version 5.2 Page 11 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): Standard 2. Quality in this outcome area is good. Although there have not been any new admissions for many years the owner has a satisfactory process in place to use when this does occur. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no new people admitted to the home since the last inspection. The current group of people have lived together for a long time and were known to the owner when she purchased the home. The owner has developed a range of documents that can be used when a vacancy becomes available, including a personal profile, assessment and care plan. Although the owner has not yet used these documents, as there had been no new admissions to the home, there is the possibility that a new person will be admitted to the home in the near future. The Community Learning Disability team nurse was visiting the home during the inspection in relation to this placement. It was evident from talking with the Community Nurse and reviewing the risk assessments in relation to the prospective new admission, that had been provided that this prospective person has a high level of specialised need. Therefore it will be very important that the owner ensures that she undertakes a full and detailed pre-assessment of the person to ensure that she feels the Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 12 home can fully and safely meet this prospective person’s very specialised high level of need. The owner was aware of the need to do this and demonstrated a good understanding of the prospective person’s needs. It will also be necessary for the owner to consider whether the person fits into the current categories of registration offered by the home. The prospective person has already been offered and took up the opportunity to visit the home, and the person now wished to take up residency. A person, currently living at the home wrote of the time when they first came to live at the home: We were shown around and consulted on room arrangements. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 13 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): Standards 6,7,and 9. Quality in this outcome area is adequate. The owner and her partner are skilled in planning for the overall needs and personal goals of the people who live at the home. However, not reviewing the peoples’ care plans and risk assessments as their needs change may be putting people at risk. This is because staff may not always be aware of all presenting needs and/or risks and how best to provide for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an historically small turnover of people at the home since the home first opened many years ago and none since the current owner bought the home approximately five years ago. The care of a person who has lived at the home for several years, but whose needs have recently changed, was looked at in detail. Although there were care plans for the all the people it was noted that the care plan and risk assessment for the person whose care was inspected had not been reviewed and amended in line with what was clearly a newly presenting physical and medical change to the person’s needs.
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 14 However, the person’s initial care planning was seen to be in order and had taken into account the person’s physical health and medication requirements as well as their psychological, emotional and spiritual well-being, dietary needs etc. It was the updating of this plan that was not up to date. Although the owner could verbally explain in detail the changes these were not recorded anywhere and therefore if anyone, other than the owner, needed to know the changes to this person’s health and subsequent needs this information would not be currently available. Some other good work in respect of care planning has been commenced. This includes a personal history entitled “My life, My health” being collated in pictorial format with the person involved. One person has been supported to provide quite a lot of information in this manner and it was noted to be an excellent piece of person centred work. It is hoped that there will be time found available for all people to be given this opportunity. Another good example of communicating with people effectively is the provision of pictorial pictures of meals, which are being provided to one person to better help them communicate their food preferences. The previously commenced key worker system is no longer operational within the home but is hoped that this will be re-commenced as new staff are appointed and commence work. People who live at the home manage their own money and each person has their own bank account, which the owner will help a person access if needed by taking them to the bank to withdraw their money. There are frequent “resident” meetings where general day to day issues can be discussed. Minutes were available and these clearly demonstrated that the owner involves the people in day to day decisions about their lives at the home. The home currently does not use any form of restraint. The owner and her partner were noted as treating all people with respect and sensitivity and the atmosphere in the home was calm and pleasant, with all the people appearing to be relaxed and at ease. Three people currently attend a local community resource centre (another person does but was in the home during the inspection due to a health issue) and were seen on their return back to the home. They stated they were glad to be home and it was noted that they were made welcome on their return. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 15 They treated the home as “their own” and were clearly comfortable within the home’s environment, going about their general day to day business freely and unhindered i.e. watching T.V, having a drink, going to their rooms etc. It was also noted that one person just popped back at lunchtime for a cup of tea, spent some time in their own room and then went back to the resource centre. The person stated they enjoyed doing this and there were clearly no restrictions on them being able to do this. Another person is retired and enjoys spending time at the home, during the day, watching T.V, knitting etc. One person had recently had a friend to stay overnight, utilising a “put you up bed” sited within the person’s room. The owner had not undertaken any risk assessment in relation to this and had not considered that the person may have needs that the owner would need to know about to ensure this person’s and other peoples’ safety within the home during the stay. This was discussed with the owner and advice was given, that should this situation occur again, further thought should be given to ensuring the overnight stay was in accordance with the terms of registration the home operates under. A relative’s comment in respect to care given stated: “The owner has a very high standard of care and we trust her judgement”. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14,15,16 and 17 were inspected. Quality in this outcome area is excellent. The people have active and individual lifestyles, which are respected and maintained by staff. People who live at the home enjoy the food provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the people at Andelain have lived together for several years. Therefore they are relaxed with and enjoy each other’s company. They joke with each other and each person could join in a conversation, or indicate that they knew about each other’s lives and individual choices etc. The owner, her partner and the new staff members now employed continue to support the people with leisure activities they enjoy. For example, on the second day of the inspection the owner stated that all the people are going for a five day stay at a local holiday camp at Easter. This was the peoples’ own choice of venue.
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 17 Last year there had been three weekends away to local venues including local theatre trips with an overnight stay at a hotel. The owner stated that sometimes additional members of her family help in the home by undertaking forms of voluntary work such as helping a person create their own personal history. There were no records in respect of this or checks such as CRB’s carried out/requested etc. This should be undertaken in respect of any person who works alongside vulnerable people who live at the home. People who live at the home use all the local facilities such as local churches, shops, pubs etc. and are well supported by staff to undertake other activities such as shopping, going for a walk, going to the local pub etc. However there were no written records of activities provided, or of future ones planned. People who live at the home stated that they liked living at Andelain and liked the owner and her family. They said they liked the food and that they felt happy at the home. A visitors’ signing in book was available and it was clear that from the relatives’ feedback received that there are good communications between the owner and the peoples’ relatives/carers with such contact remaining an integral part of Andelain. The home has a very welcoming atmosphere, and the relationships with families/carers are very much encouraged. The main meal of the day is in the evening after all the people return home from various activities. Meal choices are decided daily and reflect what the people feel like. No records are kept of the daily meals provided. The owner stated that sometimes she will cook several choices. Snacks and drinks are available throughout the day, as required, and it was noted that the person that popped back at lunchtime was freely able to go into the kitchen to prepare a drink etc. Comments received from parents/carers stated such things as: X is very happy and content, always clean and tidy and very well fed. “X can phone us at any time and the owner has often phoned our mother for X to speak to her. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 18 X comes home regularly to stay and the owner informs us if X asks to visit in between.” “They make the residents comfortable and happy in an environment that is safe warm and happy.” “X is ill at the moment – almost bedridden, but was free to choose activities when healthy.” X is given the opportunity to make decisions always but is not able to make decisions for themselves at all times because X has severe learning difficulties. We are fortunate that the home takes care of X’s needs in a most satisfactory way”. A person living at the home stated: We have a busy time and I go to Hollicombe weekdays I have a television and video in my room and can go and be quiet or join in with the other residents. At weekends we go out or are at home. I am very happy and content and have some lovely friends living at home with me. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 19 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): Standards 18,19,20 and 21. Quality in this outcome area is adequate. The owner and staff provide sensitive, flexible personal support and care to maximise the peoples’ rights to privacy, dignity, independence and choice. They also have a good awareness regarding the peoples’ health and emotional needs and ensure that good health is maintained as far as possible. Medication procedures are mostly robust, but there is a need to ensure that correct practises are carried out in respect of any controlled drug being administered to ensure peoples’ safety in this area is upheld. The owner and staff encourage the people to feel valued and as a consequence people were confident and feel able to “be themselves”. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples’ health needs are well understood by the owner and staff, with specialist training provided as necessary, for example care staff working at the home recently attended epilepsy and person centred awareness training to help ensure that they can meet the needs of the people. Adequate care of people with specialist needs is in place.
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 20 For example in respect of a person, who has recently been diagnosed as suffering with epilepsy, the owner, her partner and staff are monitoring the situation, which has resulted in the person staying at home rather than going to their day centre placement. This is to allow the owner, her partner and staff to note whether the medication prescribed is beneficial and therefore ensure the person’s condition is controlled. During the inspection it was noted that this person was supported in a sensitive non intrusive manner, which allowed them to be independent whilst still being supported at the same time. The owner and her partner, along with the new staff they have employed, support people who live at the home with routine health care and there was also evidence of the appropriate use of healthcare professionals to advise on specific health and psychological related issues, for example one person has had a speech and language therapist assess and provide advise to enable the person to be better able to communicate verbally, whilst another was visited by a trainees psychologist. The owner and her partner, who were solely providing the care in the home during the first day of this inspection, were observed as providing sensitive personal support to all the people The home’s medication cupboard was inspected and noted as being locked with the storage of medicines in order. Medication was being administered and recorded appropriately. The home uses a recognised monitored dosage system, which is overseen by the supplying pharmacy. No person self administers at the moment. There is a medication profile for each person, with a photograph of each person and records of medication administered seen were up to date. It was also noted that the owner did recently need to administer a controlled medication. However the proper procedure in respect of this had not been followed. The home’s own medication policy dated December 2007 states: “The administration of controlled drugs will be witnessed by another designated appropriately trained member of staff”. However records inspected showed that the owner did not ensure that there were two staff witnessing the administration of the medication at this time. This meant that the both the owner administering the medication and the person receiving it could have been at risk, as the safe guards necessary to help prevent any errors being made were not put into operation. People are encouraged to make individual decisions about all aspects of their day to day lives, which was evident from peoples’ records and their general interactions with the owner and her partner where choice was always noted as being offered. For example people were asked what they would like for tea, where they would like to go on holiday and recently whether or not they wanted to attend the
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 21 recent funeral of their fellow resident (all chose to go and were supported in this). A special note should be made of the excellent care that the owner and her partner made available to the person who needed terminal care. This person had been at the home for a number of years and rather than be moved to another care service the owner nursed the person, supported by local visiting professionals until the person’s death. Records were seen of the care given and these clearly evidenced that the person was given in depth, appropriate care with support being provided as needed from outside professionals. Other people in the home were able to explain what had happened and were aware of this person’s death. As previously stated they had chosen to go to her funeral and she was remembered with great affection. It is to the owner and her partner’s credit that such a sensitive time was handled so well resulting in the people being more easily able to come to terms with the situation. Relatives’ comments included the following: “They are very caring and compassionate people who show X much love and kindness”. “X cannot communicate by voice but X’s actions and eyes speak volumes. X has always been happy to return to Andelain and the owner and her family are their family. They run a wonderful home and I am for ever grateful to them. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 22 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): Standards 22,23 Quality in this outcome area is good. The home’s complaint procedures are in order and people who live at the home are protected by the owner ensuring that she, her partner and her staff are aware of vulnerable adult procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback cards confirmed that people and their families/carers felt able to voice any concerns with the owner and her partner and said that they felt they listened to them and kept them well informed. Feedback stated said that they had been made aware of the homes complaints procedures. The Commission has received no complaints about the home and the owner stated that there had not been any internal complaints since the last inspection. The home’s complaints procedure gave details of the Commission but had not been provided in a way that would be easily understandable to the people who live at the home who may have difficulty understanding the written word. Therefore it is recommended that the owner creates a pictorial form of the complaints process. The owner has purchased a training package in respect of adult protection from an external provider and intends to use this, in-house, with staff members to ensure that she, her partner and newly appointed staff remain updated/are aware of how to deal with an alleged or actual abuse situation.
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 23 However, the owner has in the past had this kind of training and in her previous work life had some experience in this area. A relative’s feedback comment stated: “X is never made to do something X does not want to do. “X is extremely happy where X is – if X was not I would soon know”. A person living at the home stated: I can make myself known if I am unhappy”. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 24 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): Standards 24 and 30. Quality in this outcome area is adequate. Andelain is clean warm, comfortable and homely. Peoples’ bedrooms are individually personalised and well furnished. As not all hot surfaces have yet been covered this could compromise the peoples’ safety in respect of them sustaining a burn if they fell against the hot surface. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On touring the premises and viewing peoples’ bedrooms it was noted that they were comfortably furnished and had been personalised by the individuals concerned with personal items of their own choosing. Peoples’ rooms and the shared spaces are furnished in a clean, homely and personalised fashion with items such as photographs and mementoes being situated throughout the home, both in personal bedrooms and in communal areas. All areas of the home were very clean and tidy and there were no offensive odours.
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 25 Currently there is no need to have a contract to dispose of clinical waste as there is very little. Gloves etc were noted as being available in the home to be used as needed. The owner and her partner had refurbished and redecorated a bedroom on the ground floor and have recently turned the previous laundry room into a spacious well appointed bedroom also on the ground floor. They have also provided an assisted shower in an adjoining toilet area and refurbished this room during the process. This now provides a light and useful addition to the home’s communal bathing facilities. Additionally new carpets and curtains have been provided in two upstairs rooms. The laundry room has been relocated to an area of the home that was not used previously. The laundry room was seen to contain all necessary equipment etc to maintain the laundering needs of the people who live at the home. The owner’s partner confirmed on the second day of the inspection that he had informed the local fire and rescue service of the changes and was liaising with them to ensure that the changes were in line with the fore department’s requirements, to ensure the people who live at the home remain safe. Although some radiators had been covered since the last inspection, not all have yet been guarded with four remaining unprotected throughout the home (3 on the first floor and I in the communal bathroom). Risk assessments are also still not in place in respect of these unguarded hot surfaces. These need to be carried out and the radiators guarded in priority order, as people may be at risk of burning themselves or suffering an injury if they fell falling onto an unprotected radiator. It was also noted that the owner has not provided privacy locks to communal toilets and bathrooms. The owner’s partner stated that this is to prevent any risk of a person feeling trapped inside and nor being able to operate such a lock. However there were no risk assessments in place to indicate that this had been discussed with individual people who live at the home who had then agreed with this measure. A relative’s comment in relation to areas of care including the environment stated: “A stable happy environment with good food, clean comfortable surroundings with a room to go to if you wish some privacy”. A person who lives at the home stated: My home is beautiful and clean and bright and really homely. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 26 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): Standards 32,34 and 35. Quality in this outcome area is adequate. There are enough staff on duty to provide for the current numbers and needs of the people. However, newly recruited members of staffs’ details had not been completed as required which may place people at risk from being cared for by unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner and her partner act as the main carers for the people who live at the home. The changing increased needs of the people has now meant employing more staff and to date there have been three new appointments made. One person’s recruitment record was seen. There was an application form, a completed recent CRB check and proof of identification. However, although the owner stated that a reference had been obtained prior to employment, this was not available and a second one had not been applied for.
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 27 In respect of the other two new staff members they are both relatives of the owner and commenced employment a few weeks ago. However there were no employment details at all in respect of either person. It is necessary to undertake the same recruitment procedures for all staff, irrespective of whether or not they are related to the owner. This is to ensure that all the people who live at the home remain cared for by suitable staff. The owner stated that she had ensured that the new staff and herself had attended relevant training such as epilepsy training, person centred training and fire training had been provided. She has also purchased in house training packages from an external provider on such areas as dementia care, adult abuse training, health and safety, dying, death and bereavement and challenging behaviour training. It is the owner’s intention to take new staff through these training packages herself. She also demonstrated her awareness to make sure that peoples’ needs are met as she has employed an additional member of staff at weekends to allow the people extra choices such as being able to go shopping etc which by having additional staff can be facilitated. On the second day of the inspection a newly appointed member of staff was spoken with (this member of staff is not related to the owner) and she was able to confirm that the owner had showed her what to do in her role and that she had attended the above stated training. The needs of the prospective new person, as previously mentioned in the section entitled: Choice of Home, are such that a condition of this person’s residency is that a waking night staff member is provided. Currently the home does not provide this. The situation was discussed with the owner who stated that she would do the waking night duty herself, until she has appointed a suitable night care worker and ensured their employment checks are in order. She would then put those staff that do have an up to date CRB check to work in her place during the day, namely her partner and one other member of staff. The other two recently employed staff members have not yet been properly vetted and would therefore be unable to provide care without being supervised. The other member of staff is only able to work certain days of the week as she is currently attending a care and social work course three days a week at the local college. This staff member stated: “I like working here, it’s a good place. It’s their home. It’s not like I am coming to work, they see me as part of their family. I do not do medication, as I am
Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 28 not trained in this. I feel confident in my role and can approach the owner if needed”. The owner confirmed that this staff member’s induction course had been provided on a need to know basis. There were no written recorded details of the induction programme but there were details of courses that the staff member had attended such as epilepsy training, person centred awareness, fire training, and she stated she was learning about nutritional needs of the people. A person living at the home stated: We have a very good relationship with staff. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 29 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): 37,39,42. Quality in this outcome area is adequate. The owner of the home is responsive to the peoples’ needs, however some necessary areas of management administration had not been completed to the required standard, which may mean that the people are compromised in respect of their safety and welfare. Although peoples’ views are taken into account regarding the day to day routines the owner has not formally undertaken any quality audit review. Therefore she cannot ensure that the home continues to be run in the best interests of the people who live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner holds the Advanced Care Management Certificate (City and Guilds) a qualification in Foundation Management, and a qualification in Community Care. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 30 She has had many years of experience of owning and managing a care home for people with a learning difficulty. The owner had previously enrolled to do a National Vocational Qualification at level 4 in Care Management but had stated at the last inspection, undertaken in January 2007, that she did not intend to continue or complete this course and has not pursued it any further. However she does do other regular training to update her knowledge such having attended recent epilepsy training, person centred awareness training and from information, received from the owner prior to the inspection, it was apparent that she is aware of current new legislation including the implications of the new Mental Capacity Act. The home is run on a friendly informal basis with people living in the home as part of an extended family. The owner and her partner have a range of systems to protect people from harm and promote well- being however these were not being completed fully and as a consequence peoples’ safety, protection and welfare may be compromised. As examples, a person’s risk assessment was not up to date, recruitment procedures had not been completed as required and the administration of a controlled drug had not been undertaken in accordance with pharmaceutical guidelines. Although the owner and her partner had previously developed a quality assurance system it had not been yet been completed or implemented (as was also noted at the last inspection undertaken in January 2007). However there are regular “resident meetings” when it was noted from the minutes that the people are encouraged to discuss any issues with the running of the home that may affect them. Any action taken, following these discussions was also documented. There were also some areas of health and safety that required attention for example, four radiators had still not been guarded and there is a need to risk assess the use of any portable heating appliance as was noted as being used in one bedroom. The home did have an accident reporting book but there were no entries as the owner stated that there had not been any accidents within the home since the last inspection. The homes’ fire log book was seen and fire precautions were noted as being undertaken. Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 31 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 3 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x 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 x 12 3 13 3 14 3 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 4 2 x 2 x x x 2 Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 32 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 14(1) (a) 14 (2)(a) (b) Requirement The registered person shall not provide accommodation to a person at the care home unless, so far as it shall be practicable to do so (a) the needs of the person have been assessed by a suitably qualified person or suitably trained person The registered person shall ensure that the assessment of the peoples’ needs is (a) kept under review and (b) revised at any time when it is necessary to do so having regard to any change in circumstances. Complete review and update risk assessments. Previous timescale of 12/04/07 not yet met 2 YA20 13(2) The registered person shall make 11/04/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Timescale for action 11/04/08 Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 33 This refers specifically to ensuring that correct procedures are followed in relation to the administration of any controlled medications. This is so that people who live at the home remain protected at all times 3. YA24 13 (4)(a) The registered person shall 11/04/08 ensure that - (a) all parts of the home to which people have access are so far as practicable free from hazards to their safety. ( c ) Unnecessary risks to the health or safety of people are identified and so far as practicable eliminated. Radiators must be risk assessed and then guarded on a priority basis. This is to ensure that the people who live at the home remain protected from the risk of sustaining a burn. Previous timescale of 12/04/07 not yet met 4 YA34 19 (1) (b) (i) The registered owner must ensure that there is a robust recruitment programme operating within the home, which includes the receipt of two written references. This will ensure that only suitable people are recruited to provide care to the people who live at the home and therefore protect the people who live at the home. The registered owner must introduce a structured system to
DS0000042639.V360872.R01.S.doc 11/04/08 5 YA39 24 (1) (a) and 2 14/07/08 Andelain Version 5.2 Page 34 monitor the quality of the service provided. This should include the views of service users and other stakeholders. An annual development plan must be drawn up after obtaining these views and this report must be made available to the Commission. This will ensure that all involved in the receipt of care are able to have a say into how that care is delivered and that the home has a structured plan to address any shortfalls and build on the positive aspects of the home. (Previous recommendation) 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 Refer to Standard YA12 YA17 YA22 YA24 YA27 YA32 YA37 Good Practice Recommendations The owner should maintain a record of activities undertaken and who participated in and enjoyed them. Records of meals provided should be kept. The owner should provide the home’s complaint procedure in an easy to understand format. A risk assessment should be in place for the use of any portable heating appliance. Privacy locks should be provided to communal toilets/bathrooms The owner should record induction training provided to new staff members. Reconsider the completion of a National Vocational Qualification at level 4 in Care Management. Peoples’ daily records should be kept up to date. YA41 Andelain DS0000042639.V360872.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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