Inspection on 27/04/05 for Blackfriars

This inspection was carried out on 27th April 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Blackfriars 18/09/07

Blackfriars 18/05/06

Blackfriars 29/09/05

Blackfriars 11/01/05

Blackfriars 06/09/04

Blackfriars 25/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Blackfriars 12-14 Blackfriars Oswestry Shropshire SY11 2DU Lead Inspector Michael Moloney Unannounced 27 April 2005 15:00 th 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 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 Stationary 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. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Blackfriars Address 12-14 Blackfriars, Oswestry, Shropshire, SY11 2DU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01691 670671 01691 670671 MacIntyre Care Mrs Jane Anita Humphreys Care Home 4 (4) Category(ies) of Learning Disabilities registration, with number of places Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 11th January 2005 Brief Description of the Service: 12-14 Blackfriars is part of the MacIntyre Care Services organisation and is registered with the Commission for Social Care Inspection to provide a home to four people with learning disabilities. It is situated in a very pleasant area of Oswestry, close to all amenities and the property is in keeping with the local neighbourhood.Jane Humphries is the registered manager and has NVQ 4 in care and management. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 3.00 and lasted for two and a quarter hours. The inspection was carried out by talking with the service users, observing activity within the home, looking at records and case tracking. The nature of the needs and disabilities of some of the service users concerned made ascertaining their views by direct means difficult. Therefore the views of the staff had to be relied on to a great extent. However, observation confirmed that those service users were calm and relaxed in their company approaching them freely when the need arose. What the service does well: 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 7 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 standard(s) EVIDENCE: There have been no new service users admitted to this home for some time. A full assessment of these standards may be more appropriate at a future inspection. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 8 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 standard(s) 6, 7 and 9 The service user plans are comprehensive and updated at appropriate intervals ensuring that the individuals’ needs are met. Where possible service users are consulted and do make decisions about their lives. EVIDENCE: The care plans and the assessments of activities contained the information that would enable staff to work towards the service users’ goals. Given the range of needs and the dependency levels of the service users these had, of necessity, involved very little direct input from some of the individuals concerned. However, some of the service users made it clear that they could express their views and that they had been asked for them before the plans were agreed and the staff confirmed that this did, indeed, happen. These plans had been reviewed by staff on a regular basis. In talking to and watching the service users it was obvious that they were encouraged to make as many decisions for themselves as possible and their records showed when they should not for safety reasons. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 9 Various elements identified within the Individual Plans had also been risk assessed and these documents were regularly reviewed protecting the safety of the individual concerned. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 10 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 standard(s) 12, 13, 15, 16 and 17. Residents are helped and encouraged to keep in contact with their friends and make good use of the local facilities. The home provides good quality food in appropriate quantities. EVIDENCE: Three of the service users attend a local day centre on a regular basis and they were all enthusiastic about it. The fourth person is based at home but goes out to a variety of activities arranged for her by the staff making sure they all have a good range of occupational activities. Talking with both the service users and the staff it was clear that they use the local facilities as much as is possible. Service users talked about doing the weekly shopping with the staff, shopping for their own belongings and going to the bank with the staff to withdraw their own cash and generally maintaining links within the local community. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 11 Friends outside the home are obviously encouraged. One of the service users spoke of her newly appointed advocate with whom she obviously has a good relationship as all of them seemed to have with the staff on duty. The evening meal was prepared during the visit and looked very appetising. All of the service users were emphatic that the meals that they were given were of a very high standard and that they had chosen what would be included on the menu. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 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 standard(s) 18, 19 and 20 The healthcare needs of the service users are met. EVIDENCE: The service users care plans clearly showed how each individual should be approached and how different types of help should be given. When personal support was needed the person concerned was discreetly taken to a bathroom or their room making certain that their personal care needs are met whilst their dignity is maintained. Numerous entries in the home’s diary and the individuals records that were confirmed by either the staff or the service users showed that the help of various healthcare professionals was obtained when necessary. The storage and recording of medication was looked at and was seen to be in order. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 13 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 standard(s) 22 and 23 The service users are protected from abuse and the staff enable their views to be taken into account despite the nature of their disabilities. EVIDENCE: The home has received no allegations of abuse or complaints. The home had a copy of the local policies and procedures for the protection of vulnerable adults as well as a copy of their own complaints procedure both being part of the systems that ensures that the service users are listened to and protected from abuse, neglect and self-harm. Although the level of the disabilities of the service users means that they are unlikely to be able to access these formal policies, observation of the staff interacting with them and communicating between themselves indicated that they, the staff, would be aware of any dissatisfaction expressed by a service user and it was seen that a whistle blowing policy is available to be used. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 14 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 standard(s) 24 and 30 The standard of the environment is good providing service users with an attractive and homely place to live. EVIDENCE: The home has a new kitchen and laundry that contain new furnishings and equipment. Now that the laundry is separate from the kitchen this makes it easier to avoid cross infection. The staff also said that they are receiving further infection control training which will also help towards this. The rest of the house and gardens are all well maintained and the furnishings were also in good condition. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The home ensures that enough staff are available to carry out the service user plans. EVIDENCE: Looking at the staffing rota and talking to the staff on duty confirmed that enough staff are on duty at all times to meet the needs of the service users. The newer member of staff on duty said that she is currently working towards achieving her NVQ3 in supporting people and the other member of staff had already achieved hers showing that they have the skills necessary to meet the service users needs. Those staff also have regular supervision meetings with the manager although on this occasion it was not possible to check that all of the staff do. Further discussions around training and supervision will take place at a future date when the manager is available. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The premises are run and maintained in a safe manner. EVIDENCE: The home has carried out a fire risk assessment and the records showed that the procedures it identifies are carried out to reduce the risk of injury to service users from fire. Bath and shower temperatures are also monitored to avoid the service users scalding themselves and fridge and freezer temperatures are also monitored to make sure that the service users are given food that is in good condition. The home has also carried out a number of other risk assessments to ensure that the activities in which the service users become involved are carried out as safely as possible. Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 4 Standard No 11 12 13 14 15 Blackfriars x 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x Version 1.20 Page 18 E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 19 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Blackfriars E56 S20685 Blackfriars V224618 UAI 270405 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn, Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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