CARE HOME ADULTS 18-65
Boscobel 1 Preston Road Southport Merseyside PR9 9EG Lead Inspector
Miss Orla Murphy Unannounced Inspection 11th October 2005 09:30 Boscobel DS0000005357.V258682.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 Boscobel DS0000005357.V258682.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. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Boscobel Address 1 Preston Road Southport Merseyside PR9 9EG 01704 537611 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 Derek Ellison Mrs M Ellison Mrs Marjorie Ismay Care Home 20 Category(ies) of Learning disability (20) registration, with number of places Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 20 LD One named out of category service user, Physical Disability (PD), as defined in letter dated 19/04/90. 9th March 2005 Date of last inspection Brief Description of the Service: Boscobel provides personal care and accommodation for up to 20 adults with a learning disability, one of whom also has a physical disability. The home is owned by private individuals, Mr & Mrs Ellison and is managed by Mrs M Ismay. The property is a detached four-storey house in a wide, tree-lined street. There is ample parking available outside the home and some on its grounds. Accommodation is available on three floors. There is a large garden to the rear of the property. The home has close access to public transport links to Southport town centre, Lancashire & Liverpool. Southport town centre is approximately ten minutes bus journey from the area. The Promenade is also nearby. There are local shops & facilities nearby, with a wider range available in the town centre. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspection was unannounced and neither residents nor staff knew the Inspector was coming. The last inspection report was examined and some requirements needed to be followed up on this visit. The Inspection was the first in the home’s required visits, which are 2 inspection visits per year. 8 residents and three staff were spoken to at the inspection. Two residents were “case tracked”. Case tracking means that the Inspector concentrates on the care given and experiences of one or more residents to get an idea of what is like to live there and how that person’s needs are being met. Case tracking also shows the inspector where needs aren’t being met. A variety of records (care plans, medical notes, complaints records, assessments, reviews, medication sheets, meeting minutes, menus, timetables, risk assessments and significant events) were examined. What the service does well:
Boscobel Management and staff have always responded well to the minimum standards and advice to raise standards. The service continues to do well in areas such as resident consultation and involvement. Historically, this was an area that the home did not do well, but great improvements have been made since 2002, and residents meetings are now very empowering for those that live there. Staff discuss day-to-day issues with residents at these meetings but they also involve residents in policy issues, informing them of issues in care and the home’s management which affect them. The result is that residents are very informed, for example, about complaints, what to do if they are worried about abuse, managing money and health & safety. Staff have involved residents in making their own DVD’s (for friends & family) and other projects. Residents have continued to say in all inspections that they really enjoy living at Boscobel. There is a very positive atmosphere in the home and staff have been observed always being patient, kind and positive with residents. Staff supervisions have been introduced and are being continued. Each resident has an Essential Lifestyle Plan, which are positive, and user led. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 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. Boscobel DS0000005357.V258682.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 Boscobel DS0000005357.V258682.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): 2 and 4. Resident’s needs are assessed fully. Prospective residents visit the home over a period of time, prior to deciding to move in. EVIDENCE: Many of the current residents have lived at the Home for a number of years. Current procedure is a gradual process of moving in which was discussed with and confirmed by the 2 residents case tracked. One of the residents case tracked had moved in earlier this year. Before moving in, he had a process of visits to the home to view it, to meet other residents, to join a meal and to stay overnight. Records seen confirmed this. Assessments of both residents were detailed and informative. The 8 residents spoken to stated they were very satisfied living in the home. The atmosphere in the home is always relaxed, jovial and positive during visits as it was on this occasion. Boscobel DS0000005357.V258682.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 and 7. Residents all have essential lifestyle plans, which records their needs and wishes. Residents are encouraged and supported to make decisions about their lives. EVIDENCE: Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 Page 10 The 2 residents case tracked said they felt staff met their needs. Essential Lifestyle Plans are very positive and identify the specific work needed to help a resident succeed. These Plans give lots of information about each residents goals, likes/dislikes, things they are good at, things they need help with, what makes them angry or sad and what makes them happy. It tells staff, from the resident’s point of view, how best to care for them and help them. Daily records were detailed and linked to the Essential plans. Activities assessments are in place but many were repetitive and staff say don’t reflect all activities. Staff must record all resident’s activities to show the support provided. This was identified through records and chats with staff and residents. The Home continues to work very well in consulting and including residents in important day-to-day and management issues. This is apparent from discussions and resident’s excellent knowledge on how to complain, what to do if they are worried about abuse etc. Minutes were not all available but residents were able to talk about all meetings. Minutes must be collated and held centrally as evidence. Only one resident case tracked was aware of the general aims of their plan and the support required from staff. The other resident case tracked could talk about what help they get from staff and stated “ Its good, I like it here”. Boscobel DS0000005357.V258682.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 and 15. Resident’s access to activities has improved and developed but needs to continue its improvement in external opportunities. Resident’s family and friends are encouraged to visit and be involved, and personal relationships are supported. EVIDENCE: Many of the current resident group have lived at the Home for several years. Many are not in a position to have structured day occupations due to age or health considerations. The 2 residents case tracked have their own structured routine & occupation, which they said they were satisfied with. Staff have developed structured internal activities over the past few years as well as improving external opportunities but examination of the activities log shows more external opportunities need to be introduced. The Manager reported positive relationships with visitors/relatives/representatives. The Home has a visitors’ book, which was satisfactory. All residents spoken to said that relatives and friends visit and they don’t feel there are problems with this. One said staff were flexible and helpful in helping her to visit relatives. Staff appeared to have relaxed and comfortable relationships with residents and both approached each other with ease throughout the inspection.
Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 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): 18 & 20 Resident’s plans detail the support they need and how they prefer to receive it. Medication administration is satisfactory and all residents are assessed as to their ability to self medicate. EVIDENCE: Residents are supported to attend to their healthcare needs. The Essential Plans and assessments of the 2 residents case tracked recorded the support each resident needs for health and personal care. Both confirmed that staff help them when they need it and staff go to health appointments with them. Records were in place for all healthcare appointments and their outcome. Treatment was also recorded. The medication administration was satisfactory and both residents have risk assessments/statements about their ability to self medicate. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 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 the following standard(s): 23 Residents are aware of and protected from abuse. EVIDENCE: All staff have now attended Protection Of Vulnerable Adults (POVA) training, which was recorded. Residents have monthly meetings where, amongst other topics, they discuss important issues such as Abuse, Fire Safety and complaints procedures. These plus other topics are rotated so residents are reminded regularly about what to do. This was very evident when talking to residents. They are fully aware of abuse, what is right and wrong, that they should always tell someone they trust if they are afraid, worried or being hurt. One of the residents case tracked said, “ We talked about abuse in the meetings and I know its wrong for anyone to hurt me or make me scared. I’d tell ***** (staff) or you (Inspector) straight away because it would have to be stopped.” They also said, “ Some people wouldn’t be able to tell someone but if I saw it I’d tell”. This shows how staff have worked hard to empower residents and how the identification of abuse is not just left with staff but residents are informed enough to be confident and speak up. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 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 the following standard(s): 30 Most areas of the home were clean and hygienic but some more support is needed. EVIDENCE: The bedroom of one of the residents case tracked was very dusty in certain areas. The resident keeps the area herself with support but it is obvious that more detailed supervision is needed for dusting etc. The window in that bedroom must be repaired. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 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 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 & 36 Most staff files are fully up to date and checked, which protects residents. Staff supervision is in place providing guidance and support. EVIDENCE: A number of staff files were seen and checked for references, identification, Criminal Record Bureau (CRB) check and proof of qualifications/training. One staff file was incomplete and must be brought up to date. All others were fully complete & satisfactory. Staff supervision has been introduced and the records seen were positive and constructive. This must be continued and a minimum of 6-recorded sessions a year held with each staff member. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 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 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): 42 Health & Safety systems are up to date and protect residents and staff. EVIDENCE: Fire Safety, Electrical & gas safety checks and training are all up to date. Staff are attending a rolling update of Manual Handling, First Aid, Food Hygiene and Fire Safety training as seen on individual files and in the training plan. Residents meetings discuss Fire awareness regularly at meetings. Drills are carried out and concerns noted but again, due to regularly discussing fire safety residents are very aware of what to do if there was a fire. Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 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. 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 3 X 3 X Standard No 22 23 Score X 4 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 4 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 2 LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 2 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Boscobel Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000005357.V258682.R01.S.doc Version 5.0 Page 18 No 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 3 4 5 Standard YA12 YA30 YA34 YA36 YA24 Regulation 12 16 18 18 24 Requirement Residents must have more opportunity to access external activities. More support must be provided for those who clean their own rooms. The staff file identified must be completed with all required checks/documents. Staff must have 6 supervision sessions per annum. The window identified must be repaired. Timescale for action 01/02/06 11/11/05 11/11/05 01/02/06 11/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Boscobel DS0000005357.V258682.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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