Inspection on 13/02/06 for Blunt Street (9)

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 Adequate. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blunt Street (9) 23/12/08

Blunt Street (9) 19/12/07

Blunt Street (9) 11/01/07

Blunt Street (9) 06/09/05

Blunt Street (9) 14/02/05

Blunt Street (9) 12/08/04

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 Blunt Street (9) Stanley Common Ilkeston Derbyshire DE7 6FZ Lead Inspector Anthony Barker Unannounced Inspection 13th February 2006 1:25 Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Blunt Street (9) Address Stanley Common Ilkeston Derbyshire DE7 6FZ (0115) 9323508 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) None United Response Christine Coates Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four (4) persons (of either sex) in the category adults with learning disabilities / adults with physical disabilities. 6th September 2005 Date of last inspection Brief Description of the Service: 9 Blunt Street is a detached house in a small village development. Service users are provided with adequate accommodation and single rooms. There is a reasonably-sized rear garden. The Home offers personal and social care to people with a severe learning disability with associated conditions that include autism, sensory and physical disability and challenging behaviour. Activities are planned to meet individual needs. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The time spent on this inspection was 5.00 hours and was a routine unannounced inspection. The last inspection took place in September 2005 and was an unannounced inspection. The Manager and the Senior Support Worker with Additional Responsibilities (SSWAR) were spoken to, records were inspected and there was a tour of the premises. One service user’s records were examined as part of the case tracking method. The focus of this inspection was on progress made on the requirements and recommendations made, and those standards not assessed, at the last two inspections. What the service does well: What has improved since the last inspection? What they could do better: All records maintained in respect of each service user must be signed and care plan documentation must be maintained at the Home for inspection at any time. Records must be kept up-to-date and administration records for medicines must be properly and completely maintained. Damaged items and others in need of maintainance, identified in this report, must be repaired or replaced. 50 of staff must achieve a National Vocational Qualification (NVQ) to level 2 or above. Staff must receive training in mandatory topics and be provided with top-up training at least every three years - excepting fire training which must be more frequent. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 6 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. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not assessed at this inspection. EVIDENCE: Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&7 Service users were benefiting from an improvement in care planning documentation although further work is necessary. They were being enabled to make decisions about their lives, with assistance. EVIDENCE: One service user’s care plan was examined as part of the case tracking process. A new care plan format was in use and, although not yet fully completed, it provided a useful holistic individual plan. Not all the entries in the ‘Action’ column were worded as actions and this was discussed with the Manager. It was noted that care plan review meetings were being held every six months, approximately. The minutes from the most recent review meeting were being typed at the United Response Area Office, the Manager reported. Service users’ personal files had been rationalised from three to one per service user making it easier for staff to access information. ‘Monthly Summary Sheets’ had been introduced in December 2005 and the December 2005 document for the case-tracked service user was examined. This had no signature from the staff member. The January summary had been completed, the SSWAR said, but was not on file. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 10 The Manager described the potential for active staff involvement with service users in the area of decision-making. There was evidence of service users being enabled to make decisions, aided by staff knowledge of their individual needs. The Manager gave examples of community settings – one in a supermarket and one in a leisure centre – where pro-active measures had been taken, based on knowledge of individual needs, to re-introduce a service user to an activity that would elicit individual choices and decisions. Techniques had been developed to enable staff to understand the expression of preferences and choices. This included the use of written symbols and photographs. Also, the case-tracked service user had a ‘communication file’ comprising laminated photographs of personal items that he could point to. This was also used as a distraction during times of challenging behaviour or boredom. One service user had perspex screens on his bedroom windows to prevent him from throwing objects through the window. There was still no evidence of any statement in the care plan/risk assessment regarding restricted access to his window. Other aspects of standard 9 were not assessed on this occasion. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Service users were able to take part in valued activities and were part of the local community. Staff supported them to maintain family links and provided opportunities for socialising with peers. Service users’ rights and responsibilities, in their daily lives, were being recognised and respected. They were being offered a healthy diet. EVIDENCE: Each of the service users had a mix of day services and ‘personal days’ spent at, and around, the Home. Day services comprised either external United Response day service provision or a local authority day centre or was based on or around the Home. The Manager gave examples of service users showing, by their behaviour, that they had been involved in valued and fulfilling activities. Shift plans were examined and these showed that service users were involved in a range of community-based activities. Examples provided by the Manager included involvement at local shops, supermarkets and a local public house – where service users were well known and their personal names were used. The local publican had arranged a Christmas meal for them. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 12 Each service user had family involvement to varying degrees and there were some friendships with individuals in the local community. There were increasing opportunities for socialising with other United Response service users on evenings and weekends, the Manager reported. For example, a ‘Valentines Disco’ had been arranged at United Response day services on the evening of this inspection to which service users from this Home, as well as other local United response service users, were invited. Also, the Home’s staff had organised a sports day at a local leisure centre on a recent Saturday afternoon to which all local United Response service users had been invited. This was to become a regular fortnightly occurrence. Three of the service users had individual bank accounts although they were unable to understand bank statements. Staff opened this type of mail but more personal mail, such as greetings cards, were given to service users to open. There was a house cleaning rota in operation that, the Manager said, was not rigidly adhered to. There was evidence of routines, within the Home, promoting the independence of service users. For instance, they were encouraged to put away their own personal laundry. The Manager described how one service user makes her own decision when she wants to be on her own and will use her bedroom – in which she has items providing visual stimuli - for this purpose. A varied and nutritious three-week rolling menu was seen. This included meals eaten out and ‘theme nights’ at the Home. The evening meal was taken between 6 and 6.30pm and there was differing involvement by service users in its preparation. Food stocks were assessed and found to be a good level. One of the service user’s drawings was displayed on a kitchen wall. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 Service users were receiving support in the way they preferred and required. They were benefiting from an improvement in the administration and recording of medicines although there were still some issues to address. EVIDENCE: The Manager spoke of the need to improve service users’ ability to communicate with particular emphasis on communicating to staff reasons for frustration that may lead to challenging behaviour. One service user’s ‘communication file’ has already been mentioned in this report. Some staff had received Makaton (sign language) training and, recently, ‘communication evenings’ had commenced at the local United Response office for both staff and service users. Makaton bingo was part of this session. ‘Involvement Support Profile’ and ‘Support Plans’ for one service user were examined and these gave good insight into his individual needs and preferences and the routines that were important to him. The Manager gave examples of the flexibility of routines that included: changing activities to suit the weather and service user preferences, flexible mealtimes, and bedtimes being different for each service user. For the two female service users there was always a female member of waking night staff on duty, the Manager stated. She added that she was aiming to increase the male staffing establishment to take account of male service users’ needs. During this inspection staff behaviour was noted as being positive and patient and service user-focussed. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 14 The Record of Health Checks for the case-tracked service user had no entries since 2004. Other aspects of standard 19 were not assessed on this occasion. The Manager described a sound system for the passing of medication, on a monthly basis, to the respective day services attended by service users. The ‘Medication Signing Sheet’, used to record medication administered at day services, was examined as well as a record of medication ‘booked’ in/out from day services and the pharmacy. The Home’s own medicine records were examined and these were satisfactory except that handwritten entries had not been signed, dated or countersigned. There were no photographs of service users filed with the medicine records and staff specimen signature list. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users were not being fully protected from abuse due to inadequate staff training. EVIDENCE: Staff training records showed that, although most staff had received SCIP training, this was still not being kept up to date. Also, there were three members of staff who had not attended any Adult Protection training course. Other aspects of standard 23 were not assessed on this occasion. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 16 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 & 26 Service users were benefiting from improvements to the Home’s environment – although further work was necessary. EVIDENCE: A number of environmental improvements to the premises had been made since the last inspection: • bathroom tiles had been replaced and a window blind fitted, • perspex screens on one service user’s bedroom windows had been secured, • ceiling light fittings in the lounge had been replaced, • the dining room was being fitted with sound-deadening material, • the hall and landing carpets had been replaced by an attractive cushion flooring, • one service user’s privacy and dignity needs were now met by means of curtains and translucent window covering, • one bedroom had been re-decorated, • pictures were displayed on lounge walls – there was an ongoing move to create a homely environment. Additional items needing attention were… • painted window frames were peeling in the bathroom – the Manager spoke of triple glazed upvc windows being fitted, Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 17 • one bedroom still had a ceiling damaged by water and a carpet in poor condition, • a kitchen ceiling light fitting was broken. The Manager stated that outstanding maintenance issues would be addressed by the end of February 2006. There were several photo-collages in the Home. One was in the bedroom of a service user who had helped create it. This and one other bedroom were nicely personalised. There was good environmental evidence of staff taking a pro-active line to meeting service users’ needs and taking account of their personal preferences. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 18 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): 32, 34, 35 & 36 Service users were not being supported by an adequately qualified staff group. They were being fully protected by the Home’s recruitment procedures and their needs were being met by staff who were generally well-trained, although not consistently on all topics. The staff group was being fully supported and supervised. EVIDENCE: A third of the staff group held a qualification to at least National Vocational Qualification (NVQ) in Care at level 2. A further third of the staff group were undertaking this qualifying training and will have completed within six months, the Manager stated. The Manager added that the current staff group were motivated to achieve NVQ level 2 – an improvement on the situation found at the last inspection. The file of a member of staff appointed in December 2005 was examined. This showed that good practice had been followed in her recruitment. The staff group’s training matrix indicated, as at the last inspection, that not all staff had been provided with training on four mandatory subject areas within the past three years. Two relief staff had not been provided with fire training for some years. However, there was evidence of progress on staff training, since the last inspection, and the Manager appeared to be taking an active position on this. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 19 It was noted that the Home was on-track to achieve the required frequency of formal staff supervision sessions. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 20 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): 39 & 42 Service users’ needs were generally underpinning the Home’s services. Their health, safety and welfare were being protected. EVIDENCE: The Home’s quality assurance measures included… • regular review of care plans, • regular visits by line managers, • annual observational visits from a member of the United Response Practice Development Team – whose assessment is discussed with the Manager and her line managers, • a Quality Assurance Manual, • a comprehensive Service Plan, • ‘The way we work’ training, when the values of the Home and United Response are explored. There were no surveys of opinion from service user representatives or other interested parties. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 21 There was evidence of fire drills taking place, on average, every other month. These were mainly day-time drills but the Manager explained that two night drills a year were also included, for added safety. The lock on the cleaning materials cupboard had been replaced. Refrigerator and freezer temperatures were being recorded daily. Other health & safety aspects were satisfactory. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 3 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Blunt Street (9) Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000019939.V273809.R01.S.doc Version 5.0 Page 23 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 2 Standard YA6 YA6 Timescale for action 17 All records maintained in respect 01/04/06 of each service user must be signed. 15(2b) Service users’ care plan 01/04/06 17(3) documentation must be maintained at the Home for inspection at any time. 17(3)(a) The manager must ensure that 01/04/06 records are kept up-todate.(Previous timescale was 31/3/05). 13(2) The registered person must 01/04/06 ensure that administration records for medicines are properly and completely maintained.(Previous timescale was 30/8/04). This must include the signing, dating and countersigning of all handwritten records. 23(2)(b) Damaged items and others in 01/05/06 need of maintainance, identified in this report, must be repaired or replaced.(Previous timescale was 01/02/06). 23(2)(b) The kitchen ceiling light fitting 01/05/06 must be repaired. 18(1)(a)(c) 50 of staff must achieve a 01/09/06 National Vocational Qualification (NVQ) to level 2 or above. DS0000019939.V273809.R01.S.doc Version 5.0 Page 24 Regulation Requirement 3 YA19 4 YA20 5 YA24 6 7 YA24 YA32 Blunt Street (9) 8 YA35 18.1(c)(i) Staff must receive training in mandatory topics and be provided with top-up training at least every three years excepting fire training which must be more frequent. (Previous timescale was 01/02/06). 01/06/06 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 2 3 4 Refer to Standard YA6 YA9 YA20 YA39 Good Practice Recommendations Service users’ care plans should set out in detail the action which needs to be taken by staff to ensure individuals’ needs are met. The manager should ensure that risk assessments are in place for restrictions on service users.(This was a recommendation from 14/2/05) Photographs of service users should be filed with the medicine records and a staff specimen signature list drawn up. The registered persons should consider surveys of opinion from service user representatives and other interested parties. Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI Blunt Street (9) DS0000019939.V273809.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!