CARE HOME ADULTS 18-65
Atkinson Grove Respite Bungalow 3 Atkinson Grove Huyton Knowsley Merseyside L36 7RS Lead Inspector
Miss Diane Sharrock Unannounced Inspection 13th September 2005 1:00 Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Atkinson Grove Respite Bungalow Address 3 Atkinson Grove Huyton Knowsley Merseyside L36 7RS 0151 480 5673 0151 480 5673 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) Knowsley MBC - Health & Social Care Headquarters Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (3) of places Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Service users to include up to 3 YA with LD or up to 3LD (E) To have a mimimum of 1 waking night staff each night. To have a temporary variation for two named Service Users requiring Nursing Care To have a temporary variation to admit a fourth Service user in the sleep in bedroom until 31st July 2005 The service should employ a suitably qualified and experienced Manager who is registered with the CSCI 3/11/04 Date of last inspection Brief Description of the Service: Atkinson Grove is owned and managed by Knowsley Social Services. The Responsible Individual is Mrs Anita Marsland. Knowsley Social Services have appointed a Manager Judith Bailey who has worked at the unit for many years. The home is a purpose built bungalow with three single bedrooms, The unit offers respite facilities to Service Users living in the Huyton, Halewood, Knowsley and Kirby areas. The service offers personal care in a residential setting and staff access the local District Nursing team to provide any additional Nursing/ clinical procedure. At present two Service Users bring their own Nursing staff during their stay at the Bungalow and the District Nurse provides input for other Clinical needs. A previous variation had been approved for the registered beds to be increased to 4 as a temporary measure only for one named Service User up to the 31st July 2005. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 4.5 hours. It was an unannounced visit and was carried out as part of the regulatory requirement for care homes to be inspected at least twice a year. There has been no cause for any visits to the home since the last routine inspection in 3/11/04. A partial tour of he bungalow was conducted. Care records and other care home records were inspected. The Staff on duty had general discussions with the Inspector and the Inspector met 3 of the Guests who were residing at the bungalow at the time of inspection. The Bungalow has recently had a fourth bedroom registered due to the authorities application for a temporary emergency placement. This has had an impact on the project in various ways, mainly due to the increase to an excessive number of both Staff and Guests being in such a small area and the effects to the current support of individual activities and changes to any planned events. What the service does well: What has improved since the last inspection?
Staff produced a Health and Safety report march 05 which had identified various actions already carried out by the Provider. The Manager has also organised a Maintenance certificate file which had details for portable appliances which are checked annually and the home also have their own maintenance record book. The Manager described a recent Team building day that most staff attended in December 04 and the benefits of these events to the team. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 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. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The Statement of Purpose needs to be updated to accurately describe the current service and meet all parts of the standards. EVIDENCE: The Manager had developed a very detailed Service Users guide and produced a Statement of Purpose which should have been adapted to include details to the change of the service as a temporary measure up to 31st July 05. The Provider is required to update the Bungalows Statement of Purpose to reflect the current temporary increase of registered beds. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6.8 One care plan was in need of review to reflect this standard around their needs, goals and individual requests. Guests should have the provision to make comments to changes to the current service, this standard is not met on this occasion. EVIDENCE: Individual plans of care are available and identify relevant aspects of health and personal care and plan accordingly. The staff have helped develop a style of plan called “essential lifestyle plans” that identifies a planned approach to individual choice, likes and dislikes, however Staff state they are not yet in place for all Guests. One plan was noted to be in need of updating due to changes in needs. In discussion with Staff they explained various needs that were not even included in the care plan. This care plan did not evidence whether the named Guest was in agreement with their care or residency at the bungalow. There was no evidence of a planned action to this person’s or any evidence of an advocate being in place to support this person’s rights in making an informed choice about their future. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 10 Regular Guests have not been informed of the current changes to the project prior to their planned admission and respite period. The Provider is required to update the Bungalows Statement of Purpose to reflect the current temporary increase of registered beds and arrange for the Guests to be informed of changes prior to their break at the project and informed of possible changes to their usual stay and access to activities. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.15.16.17. The standards for activities were not met on this occasion and Staff acknowledged the effect of this to the service, its philosophy and Guests. Family members are fully informed and involved and in regular contact were requested. This standard was met. During the inspection there were many examples of good practice with Staff interactions towards those Guests staying at the Bungalow. Daily choices are offered with appropriate support for meals, this standard is met. EVIDENCE: Staff were observed to have a good rapport with Guests and were observed to assist Guests in various choices. Staff identified how the atmosphere in the bungalow had changed while so many Staff and guests were now in place, this point was evidenced during this inspection, as previously the bungalow offered 3 bedrooms and now there could be in excess of 10 people in such a small domestic building. During this inspection there was 7 people in the Bungalow. These comments and points should be reviewed by the Provider so that actions can be taken to ensure the original aims of residency at the bungalow can again be achieved.
Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 12 The care plans, essential life plans and daily record book all emphasise the importance of promoting as much choice as the Guests are able to exercise. Care records show all relevant persons important to each Resident and support is given by Staff to maintain regular contact or communication. Staff are aware of each Guests likes and dislikes to food and prepare meals daily offering choices with all meals. Staff usually develop and produce the activities programme planned for the week and a selection of previous plans showed a varied selection of daily social activities. However on this occasion Staff explained the current problems in able to provide a daily activities plan due to the current temporary arrangement of having 4 Guests in the unit and the unpredictability in having to provide increased support to one Guest which they felt effected other Guests and impinged on the Philosophy of this “Chance for a break project”. Again this point needs to be reviewed by the Provider. Staff also acknowledged that on occasions they can be short of Staff and this also effects plans for activities which sometimes have to be cancelled. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20 Medication procedures were found to be in good order, this standard was met Care records are detailed however one care plan needed to be updated to include one Guests physical and emotional needs, this standard was met in part. EVIDENCE: Staff described how they have recently made contact with members of the multi disciplinary team including District Nurses. Guests are assisted in accessing these services while staying at the bungalow for their respite period. Care records identified access to these services, however one care plan needed to be updated and include all of the Guests physical and emotional health needs, including all changes during their stay at the bungalow. The home has its own medication cupboard and Staff manage all aspects of each Guests medication during their stay. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22.23 The home has a complaints policy that Guests, Relatives and Staff have access to. This standard is met. Most Staff are trained in “Abuse Awareness” and know about the policies that should be carried out. Training and records should be developed to show ongoing evidence and commitment to keep Staff updated in all necessary training. This standard is met in part and a requirement is made. EVIDENCE: The Manager has reviewed the previous lengthy complaints procedure and has produced a condensed version that most people agreed was more user friendly, this is now displayed on the notice board and accessible to everyone. Training records need to be updated to show an accurate record of each individuals training record identifying when they next need an update for the “protection of vulnerable adults and abuse awareness. Some training records for staff had no record of some staff ever attending such training. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 This standard is met and the home offers a comfortable environment. EVIDENCE: The Bungalow was found to be well maintained and decorated to a good standard, with all areas being clean, tidy and homely. The home did not have a maintenance and decorating plan to show a planned approach to all parts of the home which would keep the Guests and Staff informed and involved of changes to the bungalow. This should be developed as previously discussed to show compliance and to provide a structured development plan for the Manager to use for future planning of the home. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 16 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): 35.36 This standard was met in part around training however further mandatory and developmental training was in need of being reviewed and put in place for all Staff. A requirement has been made. Supervision for all staff should be planned and detailed to meet the standards. EVIDENCE: Staff described the various training sessions they had attended recently and explained that they were happy with all of the courses they had attended and felt they were appropriate to the work they carry out. Staff training records were found to have not been updated and some records identified that some Staff may not have received mandatory training for over 2 to 3 years. The Provider is required to ensure that all Staff are suitably qualified, competent and experienced. Some records indicated that some staff had not received training on “challenging behaviour, moving and handling, health and safety and protection of vulnerable adults. The Provider is required to always provide suitably trained Staff to accommodate the needs of any Guest admitted to the bungalow based on the admission assessment and decision to admit that person. Some Staff have not yet received supervision, an action plan should be developed to identified a structured approach for supervision inclusive of all Staff. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 17 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): 37.40.42 Staff acknowledged that the current respite facility has been effected and is not running as it should in terms of what the project advertises and usually offers. Risks assessments were in need of being up to date and in place for 1 identified guest, a requirement has been made. One bedroom did not have curtains or appropriate covers to the window which did not reflect the best interests of the Guest, a requirement has been made. EVIDENCE: Risk assessments are usually carried out by identified Care Managers and the homes Manager. In discussion with Staff it was evidenced that one guest needed a detailed and up to date risk assessment in place regarding previous challenging behaviour and it also needed to identify appropriate action and instructions for Staff to follow. A general risk assessment also requires implementing to ensure that appropriate action is followed when in communal areas. This should identify what actions the Provider needs to take to ensure the aims of the project are met and that guests receive the short terms breaks they have always enjoyed, inclusive of individual support for activities.
Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 18 One bedroom was found to have no covers to the bedroom window and Staff explained that they had borrowed a plastic sheet from the day centre to put up at the window when needing to promote the Guests right to privacy. The Provider is required to always provide suitable facilities to any Guest admitted to the bungalow based on the admission assessment and decision to admit that person. The Provider is required to provide suitably adapted covers to the window. Other alternatives were discussed, which if used appropriately would help to maintain the persons privacy and dignity at all times and would be a more suitable alternative offering a more homely facility rather than a make shift plastic mat to the window. It was evidenced that the manager stiil doesnot have full time supernumary hours due to recent staff coverage of the bungalow, this should be reveiwed To identify and develop Managerial hours. The Manager agreed to update the current Staff files to ensure that all details are appropriate to meet the National minimum standards and regulations. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 2 X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 3 LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Atkinson Grove Respite Bungalow Score X 2 3 X Standard No 37 38 39 40 41 42 43 Score 2 X X 1 X 1 x DS0000037680.V258487.R01.S.doc Version 5.0 Page 20 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 YA34 Regulation 19 Requirement Timescale for action 22/12/05 2 YA37 18 1 a 3 YA35 18 1 a b c2 The Responsible Individual must provide an updated list of all staff declaring what records are in place regarding Schedule 2 of the care home regulations 2001as kept stored at central personnel. 06/12/05 The Responsible Person must ensure that the staffing of the home meets the ongoing needs of the Service Users, and submit evidence to the CSCI describing the actions taken to meet this regulation and inform the Guests of actions to be taken to support them with activities during their stay.The management of the current facility should be reviewed with appropriate action taken. The Responsible Person must 22/12/05 provide documentary evidence to the Commission that all Staff at the home will be suitably qualified, competent and experienced to meet the needs of the Service Users , and submit a detailed action plan to the Commission stating what actions will be taken by the company to
DS0000037680.V258487.R01.S.doc Version 5.0 Atkinson Grove Respite Bungalow Page 21 4 YA1 4 6 5 YA40 12 4a 16 2c 6 YA6 15 1 2 7 YA19 15 1 2 b meet this regulation. Updated training needs of staff should include all areas detailed within this report. The Responsible Person must submit an updated and accurate Statement of Purpose to CSCI so that all parts of this regulation will be met. The Responsible Person must provide suitable facilities to all Guests admitted to the home and provide suitable coverings to bedroom windows to promote a persons dignity and privacy. For the Responsible Individual To review the care of one Guest, as discussed on inspection and detailed in this report, including updated risk assessments. To arrange immediate reviews with their appropriate care Managers and inform the CSCI of any outcomes. The Responsible Person is required to provide evidence that all Service Users will be provided with a detailed, accurate and appropriate care plan according to their needs. Please submit an action plan to the Commission detailing what actions will be taken to meet this regulation. 22/12/05 06/12/05 06/12/05 22/12/05 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 Refer to Standard YA35 YA42 Good Practice Recommendations To provide evidence of 5 days paid training for all members of staff and ensure all training records are up to date and recorded appropriately meeting all staffs needs. To identify and develop Managerial hours for the present
DS0000037680.V258487.R01.S.doc Version 5.0 Page 22 Atkinson Grove Respite Bungalow 3 YA30 4 YA36 Managerial role. To provide an updated “written and maintenance/decorating/refurbishment programme so that effective consultation and information can be provided for everyone. To develop ongoing and regular minuted staff and Guest meetings and develop areas of open discussions with all parties to keep them informed of all matters within the Bungalow. To continue with ongoing Staff meetings and develop the implementation of supervision as per this standard. Atkinson Grove Respite Bungalow DS0000037680.V258487.R01.S.doc Version 5.0 Page 23 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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