CARE HOME ADULTS 18-65
Augusta Close (5 & 6) Parnwell, Peterborough PE1 5NJ Lead Inspector
Lesley Richardson Unannounced Inspection 4th July 2007 1:55 Augusta Close (5 & 6) DS0000015142.V347159.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 Augusta Close (5 & 6) DS0000015142.V347159.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. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Augusta Close (5 & 6) Address Parnwell, Peterborough PE1 5NJ 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) 01733 890889 Mr Alan Atchison ***Post Vacant*** Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st November 2006 Brief Description of the Service: Augusta Close consists of 2 properties, situated on a residential estate on the north eastern edge of Peterborough. Both houses are two-storey, detached properties in the same road. They are owned by Mr Alan Atchison and provide care and support for up to 9 people with learning disability. 5 Augusta Close has 4 bedrooms and 6 Augusta Close has 5 bedrooms, both houses have a lounge/dining room, kitchen, bathrooms with shower and toilet and a separate toilet. The houses share access to a large back garden with patio and lawn. The houses are within walking distance of local shops, pubs, a post-office and public transport. Peterborough city centre is about 5 miles away and is easily accessed by public transport. Fees for the home range between £500 and £750 per week. A copy of the CSCI inspection report is available in the manager’s office. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection of this service and it took place over approximately three and a half hours as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and examining records and documents. Information obtained through returned questionnaires from people who live in the home is included in this report. Four questionnaires were returned from people living in the home. One requirement from the last inspection has not been met. No further requirements or recommendations have been made as a result of this inspection. This is a good service. What the service does well:
This home gives people with learning disability a safe place to live. People already living at the home made some good comments about the home and the people who work there. These include, “! like it here”, “the staff help me a lot”, and “I like all the staff”. Information about people who would like to live at the home is obtained from a social worker or care manager. Someone from the home would also carry out an assessment. This makes sure the staff at the home can properly care for a new person and that the new person would like it at the home. This information is written down and it tells the care staff what people need help with and how they like to be helped. People are able to make decisions about what they do and everyone at the home said they are able to do this. One person said, “I always make my own decisions, I attend college and the lighthouse, I visit or have my boyfriend stay over. I go out when I want to”. There are lots of things people living at the home are able to do. Most people go out during the day; some people have college courses and other people work. In the evening and at weekends people go out, stay in, have take away meals and do what they want to do. Everyone helps look after the home, and everyone takes it in turns to cook the evening meal. The staff sometimes help with this. People go to the dentist, have their eyes tested, see their doctor or sometimes see a specialist in hospital. The staff also sometimes go with them for these appointments. The policies and procedures that tell the staff how to do things in the home have all been rewritten and contain a lot more information. This has helped staff members when there have been adult protection issues, as they have reported these properly and to the right people. People at the home said they
Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 6 know who to talk to if they are not happy and how to make a complaint. Most people said staff members do something when they tell them about a problem. It means people at the home know they can safely tell staff members about their concerns and that something will be done. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 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 Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Improvements to the information available to staff means the home can make a more accurate assessment of needs and whether they can care for those needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure to guide staff in the best way to assess people hoping to move into the home and to make the move easier. An assessment is obtained from the placing authority and the home will also carry out their own assessment. People are able to visit the home for increasing amounts of time until they are able to decide whether they want to live at the home or not. No new people have started living at the home since the last inspection. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. Although some work has improved the information for staff, more work on care records is needed to make sure there is a structured and logical information system that enables people at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person at the home has an individual care plan and a support plan, which some people have written and others helped to write. Everyone is consulted about their support plan and they sign the document to say they are happy with it. The care plans give staff guidance about how to care for people, but it is difficult to identify long and short term goals for people at the home. Care records are disjointed and it can be difficult to find information. Assessments are completed for areas where there is a risk. For example, following an adult protection issue there is risk assessment and guidance advising staff where they can and cannot allow one person to be and the action the need to take if this happens.
Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 10 The manager said the format of care plans and risk assessments is under review and there are plans to change these over within the next few months. Work already completed in other areas of the home show this is likely to be achieved, which will support staff in enabling people at the home to live their lives as they want to but safely. People are supported to make decisions about their own lives. If those decisions go against medical advice, such as smoking, the decision to continue with the activity is assessed for risk and agreements are made so that person is as safe as possible. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. Social activities and visits from relatives and friends provide stimulation and opportunities for community links for people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People at the home attend day placement, workshop activities, or employment during the day. They take part in activities, such as computer courses and taichi, at local venues, and attend clubs and entertainment venues aimed at the local community and their peer group. People living at the home said they liked going out to day placements and activities. Staff members are polite to people at the home, they respect their wishes and know when people want to be alone. People at the home are able to see who they wish, and have friends to visit and stay if they want. Locks are fitted to some bedroom doors at individual’s request.
Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 12 Details of friendships and family members are kept in care records. One person said her boyfriend visits and stays some weekends and she sometimes stays where he lives. People living at the home are responsible for housekeeping tasks, which mean that they are able to keep up skills and responsibilities for their home. One person said, “we all do our cleaning jobs”. Staff members accompany people on shopping trips and they help with food preparation. There is no restriction on the food available and people are able to make their own drinks and snacks when they wish. Meals include vegetarian options, which are cooked separately if the main meal is not vegetarian. People said the are able to make their own decisions and decide what they want to do at all times. One comment from a survey said, “I always make my own decisions, I attend college and the lighthouse, I visit or have my boyfriend stay over. I go out when I want to”. The home has an ‘easy read’ information booklet on making decisions available for people living at the home. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Improvements to the systems in place and staff training show that the health care needs of people at the home are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Everyone living at the home has either written or has helped write their own support plan. This gives staff information about how that person wants to be treated, what they like to do and how they like to do it. People said during the inspection and in comments made in surveys that staff treat them well and they are able to do what they want to. Care records show people have access to a variety of health care professionals. The home has a new medication policy and procedure, which includes information on giving medicines to people who have difficulty swallowing, giving topical medicines (creams) and has the Commission for Social Care Inspection’s own professional advice about medication administration records (MAR) in care homes. The MAR sheets looked at had been completed appropriately, including information detailing medication entering the home. Medication for each person is kept in a locked storage cupboard in the house
Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 14 they live in, temperature checks for these areas are kept and show these are within most recommended ranges. Most staff members have received medication training, and the manager has completed training that allows him to train the staff at the home. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. There has been considerable improvement in the way adult protection issues are handled. This means people at the home can be confident their concerns will be listened to and the proper action will be taken. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has new policies and procedures for complaints and protecting people from abuse. These documents are comprehensive and give staff clear guidance. The complaints guidance advises staff that all complaints, including verbal complaints need to be recorded and the action that must be taken. Local adult protection guidelines are available, but not with the protection from abuse policy and procedure. A cross reference to this guidance should be available so that staff can access the information if they need to. There have been no complaints received by the home since the last inspection. There have, however, been a number of adult protection issues. These have been referred to the local adult protection team properly and this team has coordinated any investigation. This is a marked improvement on previous practices and shows allegations made by people at the home are taken seriously and acted upon. People sending back surveys all said they know who to speak to if they’re not happy with something and how to make a complaint. ¾ said care staff listen to them and act on what they say, although one person said that one member of staff doesn’t always listen and they would then go to someone else. This
Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 16 was discussed with the manager during the inspection who said that as staff had helped people complete the forms this issue had already been brought to his attention and further action was being taken with the staff member. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 17 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): 24 and 30 Quality in this outcome area is good. The standard of the home has improved to provide a safe and homely place for people to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is made up of two detached houses next to each other, with a combined garden area at the back of the properties. Both houses were clean and tidy with no offensive odours. New furniture and carpets have been bought for No. 6 and people at the home said rooms are decorated when needed. One person his having his room decorated by a team he works with. Rails have been put at the front doors of both properties and at the conservatory entrances from the garden. People returning surveys said the houses are usually always clean and fresh. Generally the standard of cleanliness throughout the houses was very good, although both upstairs bathrooms had areas of mildew and mould on tiles. As people living at the home have responsibility for household tasks, it is
Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 18 important that staff members help them in keeping all areas in a state that everyone would be comfortable in. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 19 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): 32, 34, 35 and 36 Quality in this outcome area is good. Updated guidance, increased staffing levels and training means that staff have the skills, knowledge and time to meet people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new care staff have been employed at the home since the last inspection. The manager said he has identified missing checks in existing records and is working to make sure they comply with the Care Homes Regulations. The home has a new recruitment policy and procedure, which identifies what information is required before a new member of staff starts working at the home. Staff records show supervision is conducted on a monthly basis, and includes professional development and the current working practice of the staff member. The manager said shift-working patterns have been reviewed and staffing levels have been increased so that there are two staff members available for
Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 20 people during waking hours. This is following an issue that identified the need for a staff member to be present in both houses when people are awake. Training records provided before the inspection show nearly all staff have received mandatory health and safety training, adult protection and medication training. Some staff members have also received training in challenging behaviour and cultural awareness. The manager said there are two staff members who have found it difficult to attend training due to their limited working hours and this is being addressed in supervision sessions. The manager is aware all staff must complete health and safety training. Four of the six staff members have a national vocational qualification at level 2 or above. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 21 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 and 42 Quality in this outcome area is good. Improvements made at the home since the manager has been in post show the home is being managed in the best interests of people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been two changes of manager since the last key inspection. The present manager started working at the home in March 2007. He has experience managing other services for people with learning disabilities and has completed a wide range of training specifically for this group of people. He has a national vocational qualification at level 4 in health and social care, a registered managers award and he has previously been registered as a manager with the Commission for Social Care Inspection. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 22 The manager has produced an annual development plan. This identifies the aims and objectives for the home, areas that must be improved and areas that should be worked on to help that improvement. New surveys for people at the home, their relatives and stakeholders (care managers, health care professionals) in the community have been produced. A quality assurance survey is scheduled for the next two months, which will allow people to let the home know what they are doing well and what they should improve on. Information provided before the inspection shows annual maintenance checks and servicing is completed. Staff members complete health and safety checks around the home and the results recorded in the relevant house folder. Checks for fire alarm, equipment, fridge/freezer and hot water temperatures were recorded appropriately. The hot water temperatures were recorded as high as 49oc, but mainly at 48oc, which is higher than the recommended 43oc. The home should contact the appropriate authority for advice about this, or provide risk assessments that show it is safe for people living at the home to have hot water at this temperature. Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 23 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES 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 YA42 Regulation 13(4)(a) Requirement Hot water must not exceed recommended temperatures unless it is safe. This is to protect people at the home from injury. (Previous timescale of 15/12/06 not met.) Timescale for action 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Augusta Close (5 & 6) DS0000015142.V347159.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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