CARE HOME ADULTS 18-65
Bath Road, 85 85 Bath Road Worcester Worcestershire WR5 3AE Lead Inspector
Mrs Yvonne South Unannounced Inspection 30th March 2006 14:00 Bath Road, 85 DS0000018626.V286418.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 Bath Road, 85 DS0000018626.V286418.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. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Bath Road, 85 Address 85 Bath Road Worcester Worcestershire WR5 3AE 01905 360439 01905 360447 home@bathroad85.fsnet.co.uk 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) Mr David George Broadbent Miss Josephine Mary Fowler Care Home 5 Category(ies) of Learning disability (5), Sensory impairment (5) registration, with number of places Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is for people with a learning disability who also have a hearing impairment. 28th October 2005 Date of last inspection Brief Description of the Service: 85 Bath Road is a large terraced house in Worcester, within walking distance of local amenities and the facilities of the city. The home provides accommodation in five single rooms for five younger adults with learning disabilities and profound hearing loss. Communal lounge, dining facilities, bathroom and toilet facilities are provided. Residents need to have good mobility to negotiate stairs to their bedrooms. The service aims to enable them to lead a normal life and gain fulfilment through support to develop skills in communication, social and daily living activities and to participate in further learning opportunities. The registered provider is Mr David Broadbent, who maintains a regular link with and oversight of the home and supervises the registered manager, Ms Josephine Fowler. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine inspection took place between 2pm and 5pm on a weekday. The inspector was assisted by an interpreter and spoke with the residents and staff. A partial tour of the home was conducted and some documents were seen. The focus was on the things that needed to be done after the last inspection. What the service does well:
The residents have lived in the home for many years. They a stable home and live together as a ‘family’. The staff group is stable and skilled in communication. They have a detailed knowledge of the residents’ abilities and individualities, which enables them to provide the support needed to assist in their development. Residents are able to participate in a wide variety of social events and community activities. The house is pleasantly decorated and furnished in a family manner. Each bedroom reflects the interests and tastes of the occupant. Medication is well managed and residents receive the health care they need. No complaints regarding the home and service have been received and the staff are able to identify when residents have concerns and are distressed. Suitable people are recruited who have the interest and ability to provide the residents with the support and care they need. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 6 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. Bath Road, 85 DS0000018626.V286418.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 Bath Road, 85 DS0000018626.V286418.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): EVIDENCE: These standards were not assessed during this inspection. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 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 Residents’ care plans contain the up to date information staff need so that they are able to communicate with the residents and provide the individual care they require. EVIDENCE: These standards were not assessed in full during this inspection. However compliance was checked with the requirements and recommendations made in the previous report. • It was required that residents’ plans must cover all aspects of care as set out in Standards 6 and 2.3, specifically this must include assessments of communication needs and strategies for communication support. A file was inspected that contained photographs of the resident demonstrating the communication signs that she used. These were clearly explained in the accompanying script. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 10 • It was required that residents’ plans must be reviewed at least 6monthly with recorded evidence to show this was done, and also to show that the views and wishes of service users and their representatives were noted and taken into account. The manager had developed a review format designed to provide the information required by the different placement authorities and meet the National Minimum Standard. This was about to be implemented. • It was recommended that where the home acts as appointee for service users’ finances the records maintained should be independently audited. This recommendation had not yet been actioned and will therefore be repeated. • It was recommended that it would be good practice to train all staff in risk assessment and risk management. The manager said that current training in this subject was obtained during health and safety training. She would seek additional courses to develop knowledge in risk assessment further. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed during this inspection. However the residents communicated with the inspector through the skills of the interpreter and it was apparent that they led full and varied lives, making choices and decisions that were respected. The staffs’ knowledge of the individuals and the rapport and interaction they had with them was impressive. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 12 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): 20 Residents receive their prescribed medication safely from trained and competent staff. Minor improvements are needed to the records and storage to further improve safety. EVIDENCE: The residents did not have the ability to manage their own medication or give their consent for others to do so on their behalf. However there was documentary evidence that discussions had taken place with interested parties including the residents’ doctors, and consent had been obtained from them. Records were maintained of the receipt, administration and disposal of medication. However it was noted that handwritten additions and amendments to the Medication Administration Records had not been double signed by the staff recorder and checker and some directions given by the doctor on the prescription were not clear and informative. For example when instructions read ‘as necessary’ or ‘as directed’ the doctor should be asked for more precise instructions. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 13 Medication was stored appropriately in a medication trolley. However key security needed to be improved. Tubs, bottles and tubes had not been dated when opened to aid stock control. There was not suitable storage for controlled drugs or a controlled drugs register. These drugs were not currently prescribed and had never been to date. None the less it was recommended that suitable storage and recording facilities be obtained as this could take time if needed. Staff had received training from Boots that met the requirements of the standard. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 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 residents are able to express unhappiness and concerns and be confident that the staff will respond appropriately. EVIDENCE: Comprehension of the complaints procedure by the residents was not possible because of the residents’ limited communication skills and ability. However the detailed knowledge that the staff had of each resident enabled them to identify when they were unhappy or concerned and all efforts were made to identify and address the cause. The home had a close relationship with relatives that also enabled concerns to be identified and addressed at an early stage. Staff had received training in the protection of vulnerable adults and had responded appropriately when issues arose. The manager said that refresher training was soon to be provided for all staff. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed during this inspection. However a partial tour of the home demonstrated that everywhere was clean. The décor was bright and attractive. Residents had participated in the choice of their bedroom décor and the rooms individually indicated their tastes, interests, and personalities. A recommendation that outstanding improvements should be completed had been met. A new carpet had been laid by the front door and the redecoration of toilets and bathrooms had been finished. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 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): 34 The recruitment procedure ensures suitable staff are appointed to provide the care and support the residents need. EVIDENCE: Staff records were seen for one person. They contained the relevant documents and information and these demonstrated there was an acceptable recruitment process. Although residents were not able to contribute directly to the recruitment process interviews took place in the home and interaction was observed. A recommendation that the registered manager should arrange for staff to receive training in Total Communication Methods had been partially met. The manager had undertaken the course and three staff were booked on the next one. The staff confirmed that they were happy in their work, had good access to training and were well managed. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed in full during this inspection. However the fire log contained evidence that systems and equipment were being regularly checked and staff were receiving appropriate training. A recommendation had been made that a copy of the report on the outcome of service users surveys, carried out as part of the quality assurance programme, should be provided to the Commission when completed. This had not been achieved. The manager said that the questionnaire that had been used needed to be developed further and take into account the individual communication skills and understanding of the residents. There was some discussion regarding staff involvement in this as a way of using learning from the Total Communication courses. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 18 A Quality Assurance System was on file and the manager was advised to implement this regardless of the impending changes in regulation expected this year. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X X X X X X Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 Handwritten additions and amendments to Medication Administration Sheets (MAR) must be signed by two staff to ensure accuracy. Containers of liquid medicines, creams and ointments must be dated when first opened to aid stock control. Security of the medication keys must be improved. Timescale for action 30/03/06 2 YA20 13 30/03/06 3 YA20 13 30/03/06 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 YA9 Good Practice Recommendations It would be good practice to train all staff in risk assessment and risk management. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 21 2 3 YA20 YA39 Suitable storage and a register should be available for controlled drugs when prescribed. A copy of the report on the outcome of service users surveys, carried out as part of the quality assurance programme, should be provided to the Commission when completed. Bath Road, 85 DS0000018626.V286418.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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