CARE HOME ADULTS 18-65
Arbour Street, 53 53 Arbour Street Southport Merseyside PR8 6SQ Lead Inspector
Mrs Elaine White Unannounced Inspection 6th February 2006 09:30 Arbour Street, 53 DS0000005233.V281699.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 Arbour Street, 53 DS0000005233.V281699.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. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Arbour Street, 53 Address 53 Arbour Street Southport Merseyside PR8 6SQ 01704 532441 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) Speciality Care (Rest Homes) Limited Mrs Jean Mulhearn Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 3 LD The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 13th October 2005 Date of last inspection Brief Description of the Service: 53, Arbour Street is a large semi-detached property, which has been converted into a small care Home, which provides personal care and support for up to three residents with a learning disability. Two residents were present throughout the inspection. The home is registered as a ‘home for life’ with Speciality Care (Rest Homes) Limited, and is managed by the acting manager Mr Werner Myburgh. The home is yet to appoint a registered manager who has been approved by the Commission of Social Care Inspection. Margaret Hill is the Regional Director and Responsible Individual. The home is situated in a residential area, which is located close to the town centre of Southport. The local amenities are accessible via local transport services and include cinema, swimming pool, shops, pubs, restaurants and parks. The home provides a homely domestic setting for the two young adults resident. Each has their own bedroom and communal facilities include two lounges, dining area, smallenclosed garden and kitchen. Each residential placement is based on an individual needs assessment, individual care plan and activity programme. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. A tour of the premises took place and the two residents were present and spoken with. General observations were made throughout the inspection. Care records and other home records were viewed and discussion took place with the acting manager and Greta Morphet the Director of Residential Services. What the service does well: What has improved since the last inspection?
Some improvements have been made to the environment i.e. new furniture in the lounge, new chair in one resident’s bedroom and repairs to the residents’ and staff bathrooms. However there are a number of outstanding requirements
Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 6 from the last inspection, which must to be addressed to improve the standard of the home. These will be highlighted with the requirements and recommendations of this report. Since the last inspection the residents have been away on a short break to the Lake District and now have access to a mini bus four days a week for activities. New staff applications for those who speak English as a second language are now subject to an assessment test prior to appointment. A statement of purpose is now in place. Medication training is planned for all staff on 13th February 2006. What they could do better:
A full tour of the premises highlighted areas of improvements needed, which are required to improve the standard of the home. These are outstanding from the last inspection and are highlighted within the body of the report with time scales set. Records viewed confirmed that the acting manager has sent notifications of the repairs outstanding within the ‘Arden College Property Repairs Notice’, which are sent to the college to inform them of improvements required. Medication records checked showed omissions made in the recording on the MAR sheets (Medication Administration Record) and medication was signed for in advance of administration. This was brought to the attention of the acting manager and Director of Residential Services during the inspection and requirements made within the report to improve the safe handling of medication at the home. Staff files and training plan viewed showed that statutory training fails to be provided for all the staff employed at the home. This must be provided to ensure staff have the skills to carry out their roles to meet the needs of the residents. The responsible person should ensure that all staff employed have the necessary visa documentation in place. Records viewed showed that a visa application is due to expire in February 2006 unless the necessary documentation is provided. This was discussed with the Director of Residential services during the inspection. Duty rosters must show a true account of staff working at the home.
Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 7 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. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 8 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 Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 9 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): 1.2. The home’s statement of purpose is now in place to outline the services provided. Assessment documentation is in place to ensure the home can meet the needs of the residents. EVIDENCE: Both residents have lived at 53, Arbour Street for many years and there have been no new admissions to the home since the last inspection. Assessments of need are in place and were completed prior to admission. The assessment covers health and personal care, risk assessments, social background and likes and dislikes. A statement of purpose is now in place, which outlines the services provided. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 10 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. Residents health, personal and social care needs are addressed in care plans. Residents are involved with decision making in the home through reviews and resident meetings. EVIDENCE: Residents’ care files record their health and general care needs. Care plans evidenced ‘pen portraits’ regarding all aspect of personal care, health and general needs, communication and behaviour. Skin care, hygiene, sleep pattern, weight and nutrition are recorded. An annual health check is also completed. All visits to health care professionals are recorded. A file viewed also evidenced a formal review conducted on 16th November 2005, involved the resident, acting manager, relative and social worker. The review confirmed their satisfaction with the care provided. Residents and staff were seen to communicate effectively. Resident meetings take place and residents are included in deciding menus and daily activities. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 11 Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 12 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): 14 The residents engage in appropriate leisure facilities. EVIDENCE: Activity plans viewed showed activities provided in the local community include, golf, disco, cinema, bowling, walks, resource centre and shopping. College transport is now available 4 days a week to provide the resident’s access to activities outside the local area. Residents mix with peer groups at the weekly disco and often visit other ‘houses’ where their friends live to have Sunday lunch. Residents are encouraged to maintain contact with their relatives. One resident who like to use the computer would benefit from having one for personal use. Since the last inspection the residents have been on a short break to the Lake District with staff support. Further holidays are to be planned for the coming year. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 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): 19,20 Resident’s health needs are assessed and met within a plan of care and residents have access to their own GP and other health professional where appropriate. Medication procedures need to be more robust to ensure safe handling of medication. EVIDENCE: Care files viewed evidenced visits by GPs and other community based services and health professionals. Records are made of all visits. The residents receive prompting and guidance from staff regarding their personal hygiene. Care plans evidence short, medium and long-term targets. Residents’ weights are recorded and monitored. A protocol is in place for staff to follow in view of the residents’ learning disability and their need for routines to be followed. Medication policies and procedures are in place however medication sheets checked showed that omissions had taken place in recording administrations. Medication was signed for prior to the medication being given. This was
Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 14 brought to the attention of the acting manager and Director of Residential services during the inspection and is included in the requirements of this report. The induction programme includes medication advice; however further training in safe handling of medication is required. Staff training in medication has been arranged for 13th February 2006. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. A complaints procedure is in place. The home has abuse policies and procedures to safeguard the residents and staff. EVIDENCE: The complaint procedure is displayed in the home. No complaints have been recorded since the last inspection. Both residents have relatives who act on their behalf and are regularly involved in their reviews. A recent review identified no concerns with the service provided. The home has an abuse policy and POVA (protection of vulnerable adults) training is now included in the home’s training plan. However training records showed that not all the staff employed have been trained in this area. This will be included within the recommendation of this report. Financial policies and procedures are in place and records and receipts obtained for all financial transactions made. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30. The home is comfortable, spacious and clean. Repairs and improvements should be addressed improve the standard. EVIDENCE: Arbour Street is a converted house. The home has three bedrooms, two lounges, dining room, kitchen, staff room, staff bathroom and residents’ bathroom. The bedrooms have personal possessions including electrical equipment, pictures and photographs. Since the last inspection a new chair has been provided in a residents room, new furniture in the lounge and repairs made to the resident’s and staff bathrooms. There are still a number of requirements outstanding from the last inspection, which includes repairs, replacement and redecoration. Records showed that notifications have been made to central office by the acting manager to request action to be taken. Outstanding requirements are contained within the requirements of this report with time scales set for action. These include – boiler repair (records show this is being attended to). Staff bathroom - new bath taps, repair light, tiling and decoration. The window is in need of replacing in the ‘drying’ room to provide ventilation, as recommended in the fire report. This room also needs decorating. Kitchen – requires redecorating, replace broken tiles and breakfast
Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 17 bar. Lounges – new carpets required, radiator cover. A front gate is yet to be replaced and the rear garden wall needs resurfacing. The front door is kept locked for security purposes. The residents do not have keys to their rooms or the home. Additional fire and smoke detectors to be installed as outlined in the fire inspection report. Fire drills take place and records are kept. Meals are served in the spacious dining room. Radiator covers are in place in some rooms. Policies and procedures are in place for infection control. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. A recruitment and selection procedure is in place. Training records showed gaps in statutory training. Some staff are taking National Vocational Qualifications (NVQ). EVIDENCE: Staff training and personal files demonstrated that recruitment and selection procedures are in place. A CRB (criminal record bureau check) and two written references are obtained provided prior to employment. The training plan shows that a training programme is in place, however there are gaps in the statutory training provided to staff employed. This is included within the requirements of this report. Further training recommendations include abuse and medication training for all employees. The responsible person should ensure that all staff employed have the necessary visa documentation in place. Records viewed showed that a visa application is due to expire in February 2006 unless the necessary documentation is provided. This was discussed with the Director of Residential services during the inspection. A team of six staff provide cover to the home with one member of staff on duty per shift.
Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 19 Two staff are enrolled on NVQ courses. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Policies and procedures are in place, reviewed annually and are available to staff. General records are maintained. The home is yet to appoint an experienced, qualified manager who has been approved by the Commission for Social Care Inspection. Self-monitoring reviews are completed. EVIDENCE: The home is yet to appoint a manager who has been approved by the Commission. Safety contracts for services i.e. gas, are up to date. The electrical certificate was found to be out of date. Fire alarms are tested weekly and drills take place. Records of these are maintained. Risk assessments are in place and kept up to date. A recent fire report made recommendations to install electronic smoke detectors. This is included within the recommendations of this report. Accident records are maintained and CSCI are notified of serious incidents. Meetings are held regularly for staff and residents to voice their opinions Policies and procedures are in place and annually reviewed.
Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 21 Relatives are encouraged to discuss the service provided via surveys, reviews and regular contact by phone. A company representative to monitor the progress of the home conducts monthly visits. These are forwarded to CSCI for information. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 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 3 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 2 X 3 X X 2 X Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 23 Yes Are there any outstanding requirements from the last inspection? Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 24 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement The responsible person shall ensure that all medication is recorded when administered. (Outstanding from the last inspection). The responsible person shall ensure that the repairs are completed, these include - leak in staff bathroom taps (which is draining water system) and repair rear garden wall surface. (Outstanding from the last inspection). Repairs from this inspection – light, tiling and decoration of staff bathroom. Timescale for action 28/02/06 2. YA24 23 30/06/06 3. YA20 23 The responsible person shall 30/06/06 ensure that furnishings are replaced and decoration is made to improve the standard provided, these include - radiator covers fitted throughout, new carpets in lounges, replace window in ‘drying area’ for ventilation, and decorate landing, kitchen and one residents bedroom. Replace cracked kitchen tiles and chipped worktop. Fit front garden gate. (Outstanding from the last inspection). The responsible person shall 30/06/06 appoint a manager who has been approved by the Commission for Social Care Inspection. (Outstanding from the last inspection). The responsible person shall 30/06/06 carry out the recommendations DS0000005233.V281699.R01.S.doc Version 5.1 Page 25 made in the recent fire report. The responsible person shall 30/06/06 ensure that all staff employed receive the statutory training 4. YA37 9 5. 6. YA42 YA35 23 18 Arbour Street, 53 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. 5. 6. Refer to Standard YA32 YA12 YA14 YA20 Good Practice Recommendations 50 of care staff should be NVQ level11 qualified. The residents would benefit from the purchase of a computer for their own use. The reduction in the staffing levels should not restrict the choice and range of activities available to the residents. The staff should be provided with ‘safe handling of medication’ and abuse training. Arbour Street, 53 DS0000005233.V281699.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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