Inspection on 13/02/06 for Barnhill Road (11)

This inspection was carried out on 13th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barnhill Road (11) 09/07/07

Barnhill Road (11) 23/01/07

Barnhill Road (11) 04/11/05

Barnhill Road (11) 15/10/04

Barnhill Road (11) 19/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Barnhill Road (11) 11 Barnhill Road Wavertree Liverpool Merseyside L15 5BE Lead Inspector Pat Kearney Unannounced Inspection 12th February 2006 12:00 Barnhill Road (11) DS0000025220.V283480.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 Barnhill Road (11) DS0000025220.V283480.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. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Barnhill Road (11) Address 11 Barnhill Road Wavertree Liverpool Merseyside L15 5BE 0151733 7646 9999 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) www.c-i-c.co.uk. Community Integrated Care Janet Sloane Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mrs Sloane starts adequate and recognized training in relation to the needs of the client group by 31st August 2005. 4th November 2005 Date of last inspection Brief Description of the Service: 11 Barnhill Road is registered with the CSCI to provide care for three adults under the category of learning disability (LD). The home is part of and is managed by Community Integrated Care. The home is situated in the Wavertree area of Liverpool. The home benefits from being part of a small residential area and is close to local amenities, bus and rail routes. The building is a bungalow and has been adapted over the years to meet the needs of the service users. Service users occupy single rooms and share communal bathroom, kitchen and lounge/dining room facilities. The home is accessible to wheelchair users; the accommodation provided is spacious and the home is well maintained and furnished to a high standard. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place on 12th February 2006 and lasted almost three and half hours. A full tour of the premises took place. A range of records such as care plans, Essential Lifestyle Plans, staff personnel files, policies & procedures and medication charts were examined. The Senior Support Worker and a support worker were on duty. The two staff on duty and the three service users were spoken to during the course of this inspection. . What the service does well: What has improved since the last inspection? One new staff member has attended the 5 day corporate induction course and another is due to attend the next course in March. Since the last inspection there has been a period of instability at the care home, with the suspension and subsequent dismissal of the former manager this has affected the staff morale and management at the home. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4.5.. The homes Statement of Purpose and Service Users Guide are well written and comprehensive providing service users and/or their representatives and any potential service users with details of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: The homes Statement of Purpose and Service User Guide have been reviewed and updated in the past year. A copy of the Service Users Guide and Statement of Purpose is kept in the hallway and is accessible for visitors to the home to read. All three service users currently living at the home has been resident there for a number of years. It is Community Integrated Care( C.I.C.) the organisation that manages Barnhill Road have a policy that any new service user would be admitted following a comprehensive assessment involving health and social care professionals, service users and their relatives. Each service user has an Essential Lifestyle Plan (E. L. P) which is reviewed and updated annually. This document is intended to cover every aspect of a service users life and includes their preferences, choices, hobbies and interests and provides a detailed insight into the person being cared for and the lifestyle they wish to have. This plan is especially useful as the services users have severe communication difficulties. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 9 The senior support worker on duty during the inspection said that any new service user always has the opportunity with their relatives to visit the home prior to being admitted. Copies of costed contracts are kept on service users files. Barnhill Road (11) DS0000025220.V283480.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): 6.7.8.9.10. The individualised care plans of each service user clearly evidence how the service users needs and goals are met on a daily basis. EVIDENCE: All service users in the home have a comprehensive and detailed individual care plan, which is formulated on admission to the home. The key-workers regulary review these documents. On the day of this inspection the monthly reviews were overdue and needed updating. Daily health records are documented on each shift for each service users, and this includes any critical incidences plus any visits from GPs, specialists, etc. Care plans are comprehensive and contain detailed information regarding the individual needs of the service users. Each service user has an Essential Lifestyle Plan ( E.L.P) which records service users individual choices and preferences interests and hobbies, social history, daily routines and documents what is important to the individual service user. On the day of this inspection the monthly reviews were overdue and needed updating. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 11 Personal and environmental risk assessments are completed for each service user Care plans show that service users and /or their relatives are involved in the care planning and review process. Full involvement of NHS and other healthcare professional agencies was clearly evident on all service user care plans examined. Barnhill Road (11) DS0000025220.V283480.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): 11.12.13.14.15.16.17. Service users are actively encouraged and supported by the staff team to participate as much as possible in age appropriate activities which enhances their quality of life. EVIDENCE: All three-service users have an Essential Lifestyle Plan, which details their individual interests hobbies and aspirations. The information in the E.L.P. and care plan forms the basis of the activities service users participate in. All three service users require the support of staff to participate in any social or leisure activities. During the winter months limited activities have taken place although staff said that the service users were still being taken to the “Light Room “ each Friday and shopping trips to the supermarket have continued. The senior support worker on duty said that the three service users had been taken to the Everyman Theatres pantomime in December. Staffing vacancies appear to be impacting on the number and variety of activities service users are currently able to take part in. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 13 On the day of the inspection staff were in the process of preparing a roast chicken dinner with a selection of vegetables. which at Barnhill is served in the evening. All three service users require staff support and assistance at mealtimes. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 14 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): 18.19.20.21. Medications are managed safely in accordance with the National Minimum Standards. The permanent staff has a good understanding of the service users’ support needs. This is evident from the positive relationships, which have been formed between the staff and service users. EVIDENCE: No current service user in the home self medicates, medications for service users are administered by the key-workers in the home. The protocols for the receipt, storage, disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). All three service users at the care home require the intervention of staff for all their personal support and health care needs. Staff spoken to during the inspection were fully aware of the personal support needs of the service users and how important it was that those needs should be met in a way that is sensitive to the service users preferences. It is a matter of concern that over recent months bank and agency staff have been used on a regular basis to cover the staff vacancies, this may lead to a Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 15 compromise in the standard and consistency of care provided to the service users who are unable to communicate verbally and all have specific and complex needs. There was evidence in the care plans that a number of health care professionals had recently been involved in reviewing the service users needs. Service users have an annual health check together with regular visits to the GP, dentist, optician and other healthcare professionals. Details of all planned visits are recorded. Information and advice given by healthcare professionals is also recorded. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 16 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. Barnhill has a comprehensive complaints system and appropriate checks are made on all staff to ensure the protection of service users. EVIDENCE: A clear complaints policy and procedure is available for both service users and their representatives. Included in this are contact details of the local CSCI. Office. The three service users are unable to communicate verbally but staff said that they were able to use non-verbal communication if they were unhappy. Relatives are sent a questionnaire annually to assess their satisfaction with the service provided. Personal finance for service users is recorded in individual accounts. All three service users accounts were reviewed as part of this inspection detailed and accurate recordings were kept. The amounts of money held were accurate and corresponded with the accounts kept and expenditure recorded and receipted. Since the last inspection there has been no progress made in accessing P.O.V.A training for all staff however the staff on duty demonstrated an understanding of adult protection issues and its implications for their practice. All staff at the home have had the appropriate C.R.B. checks to ensure that the service users are protected. No complaints have been received either by the Commission since the previous inspection. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 17 It is as a result of an external complaint to the service manager which led to the suspension and subsequent dismissal of the previous manager. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 18 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 standard of the environment within Barnhill Road is good, providing service users with an attractive and homely place to live. EVIDENCE: The home is situated in the Wavertree area of Liverpool and is close to shops and other amenities. The home is a three bedroom bungalow leased from Maritime Housing Association. The home is warm, comfortable and homely and on the day of the inspection odour free. Each service users bedroom is individualised to reflect their personal taste and preferences, all three service users bedrooms have tracking equipment to with individual slings to assist safe moving and handling. Since the last inspection profile beds have been serviced and repaired. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 19 The trees at the side of the house overhang the rear garden this could prove to be a hazard if they were to break and snap off and are a potential health and safety risk and need to be pruned to reduce this risk. Fire and other safety certificates were in date and valid Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 20 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): 31.32.33.34.35.36. Staff morale is low at present however staff best possible care to the service users. EVIDENCE: are committed to providing the Staff morale at the home was low at the time of this inspection the dismissal of the registered manager at the end of November 2005 and staff vacancies are contributing to this. Staff on duty fully accepted that the action taken was appropriate and endorsed the action taken by C.I.C. It has however left the home short of a permanent manager this together with the longstanding support worker vacancy is having an impact on the overall health safety and welfare of service users and staff. Agency and bank staff are being used to fill the gaps in the rota caused by the staff vacancies. While every effort was being made to ensure that staff who “know” the service users are used this is not always possible and the consistency of care to the service users is compromised. C.I.C. has placed an advert in the local press for staff at all levels. A random selection of staff personnel files were viewed there has been no updating of mandatory or specialist training identified during the last inspection. The organisation has a 5 day corporate induction of the two new members of staff only one has attended the course. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 21 Three staff have completed N.V.Q. Level 2 and another two staff are working towards the award. The senior support worker who is currently overseeing the management of the home does not hold any formal qualifications but has many years experience working with the service user group. Staff are currently not having regular recorded supervision. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 22 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): 37.38.39.40.41.42.43. Management of the home has deteriorated since the last inspection This results in some practices that do not promote the health, safety and welfare of service users and staff. EVIDENCE: The Registered Manager has been dismissed since the last inspection, a senior support worker has been asked to manage the home until a new manager is appointed. `While the senior support worker has many years experience working with the three service users and was able to demonstrate an in depth knowledge of the service users and their individual needs. The senior support worker does not hold any formal qualifications and stated that they do not feel totally comfortable or competent in the acting up position. Both staff on duty at the time of the inspection said that the last few months had been difficult and that the staff group were attempting to look forward and develop new ideas to benefit the service users and how best they could all support each other through what had been an stressful time. A staff meeting Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 23 had been held on 1st February 2006.were ideas had been suggested and an action plan was being developed. The current staff vacancies are compromising the standard of management at the care home. All necessary certificates such as gas, electric and risk assessments were valid and in date. Service users risk assessments are also in completed and reviewed and updated regularly involving the service user and or their relatives. On the day of this inspection service users monthly reviews were in needs of up dating. No member of the staff group is currently having regular recorded supervision or appraisals. Quality assurance is undertaken in-house and via the company’s own audit process. The Operations Manager visits the home monthly and completes the Regulation 26 audit The next audit was due on 28th February 2006. Service user’s views and/or relatives involvement is sought as far as possible, and the results of audits are made available to interested parties, including the CSCI. Policies and procedures are reviewed regularly and updated. All records are kept in accordance with the Data Protection Act 1998, in a safe, limited access facility. Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 24 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 3 4 3 5 3 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 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 2 3 3 3 3 3 Barnhill Road (11) DS0000025220.V283480.R01.S.doc Version 5.1 Page 25 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 YA24 Regulation 23 Requirement The registered person shall ensure that the premises to be used as a care home are of sound construction and kept in a good state of repair externally and internally so that the home is safe and well maintained meets service users individual and collective needs in a comfortable and homely way;therefore the following repairs, replacements and redecoration work needs to be addressed;The trees at the side of the rear garden are overhanging and require pruning to limit the threat to the service users health safety and welfare. The registered person shall ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health safety and welfare of service users. The longstanding support worker and manager vacancy needs to be filled as soon as possible. DS0000025220.V283480.R01.S.doc Timescale for action 01/04/06 2. YA32 18 01/04/06 Barnhill Road (11) Version 5.1 Page 26 3 YA35 18 The registered person shall ensure that persons working at the care home receive training appropriate to the work they are to perform. A staff training audit identifying individual mandatory and specialist training needs to be completed and the relevant training made available. The registered person shall ensure that persons working at the care home are appropriately supervisied. Staff should receive regular recorded supervision at least six times a year. A person shall not manage a care home unless they have the necessary qualifications, skills and experience.which provides a an open positive and inclusive atmosphere. 01/04/06 4 YA36 18 01/04/06 4 YA37YA38 9 01/04/06 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. Refer to Standard YA23 Good Practice Recommendations The registered person should make adequate arrangements to ensure that the staff team update adult protection training. It is strongly recommended that the registered person maintains in respect of each member of staff a record of supervision sessions held 2. 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