CARE HOME ADULTS 18-65
Breakaway Park Lane Aveley Essex RM15 4UB Lead Inspector
Mr Trevor Davey Unannounced Inspection 27 January 2006 09:45 Breakaway DS0000018070.V280660.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 Breakaway DS0000018070.V280660.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. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Breakaway Address Park Lane Aveley Essex RM15 4UB 01708 861520 NO FAX 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) East Living Limited Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service category: Care Home only. Service user categories: learning disability and physical disability. Maximum number of registered places: 4 (both sexes). Placements must be arranged to ensure that the two categories of service users (learning disability and physical disability), are not accommodated together in the home for the same period of short-term care. The home is to provide short-term care for periods of no longer than four weeks at a time. 02/09/05 5. Date of last inspection Brief Description of the Service: Breakaway is a detached property which has been adapted and refurbished as a care home to provide respite care for adults with a learning or physical disability. The accommodation includes for single bedrooms, a lounge and dining room, kitchen and shower facilities. A separate assisted bathing facility is also being installed. The accommodation and facilities have been specifically designed for disabled people. There is a large garden with a patio area to the rear of the property and off-road parking to the front. A vehicle with tail lift has been purchased for the home, which is used for the benefit of residents to give them easier access to the local community and surrounding areas. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place of one 27th January 2006 lasting 6.25 hours. The inspection process included discussions with the Acting Manager, two residents, two relatives and three staff. A tour of the premises took place and a sample of policies and records were inspected. Eighteen standards were covered and requirements are recommendations are listed in the report. What the service does well:
The management and staff team have worked well in establishing this newly registered service, which has been operating in providing respite care for the past nine months. Good communication has taken place with the Local Authority, parents and residents, which has improved as the service has continued to develop. Relatives spoken to were complementary of the input given by staff and of the positive impact experienced by residents as well as the respite relief provided to parents. Already, as a result of the positive interaction by the staff team, it has been possible to identify where some residents have progressed in their social skills leading, in one case, to a period of transition and an agreed placement in the community under a supported living arrangement. Staff spoken to were enthusiastic and enjoyed the opportunity of working with different residents who presented a variety of needs and challenges. The Registered Provider is committed to meeting identified training needs and staff had attended a number of courses and others arranged to ensure that all personnel are suitably equipped in a range of skills. Additionally, staff are encouraged to utilise their personal skills and previous work experience to enhance the quality of life for residents. The Home has been able to evidence good working relationship with parents where positive support has been provided. Albums of photographs had been prepared of leisure and recreational activities enjoyed by residents and copies are given to residents to take home after their respite stay. Individual person centred plans and risk assessments had been completed which included a comprehensive breakdown of the various areas of need and how these should be addressed. This system is still being developed to improve still further the recording systems and the effective practical use of information for the benefit of residents. Comment sheets on now issued to all residents/parents for completion after each period of respite stay and the Acting Manager is developing a Circle of Support involving parents and carers. Breakaway DS0000018070.V280660.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. Breakaway DS0000018070.V280660.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 Breakaway DS0000018070.V280660.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): 2 The needs and individual aspirations of prospective residents are assessed to determine the suitability of any intended placement as well as ensuring that the home can meet these needs. EVIDENCE: Preadmission assessments were available which included a wide range of detail including diagnosis, medical history, medication prescribed/side-effects, relationships and expectations. Members of staff spoken to confirmed that they had been involved with home visits together with the acting manager as part of the process in obtaining information which would assist the home in meeting the holistic needs of residents. A plan of care (person centred planning) had been completed as a result of this initial information and updated to reflect changes. Breakaway DS0000018070.V280660.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&9 The systems for resident consultation are good and where appropriate, this includes relatives who work together with the staff team, to see that goals are reflected in individual care plans accompanied by risk assessments. The review dates of some risk assessments had not been recorded or updated. EVIDENCE: The support plans sampled, set out clearly residents personal needs as described by them and how these were to be met by the staff team. Other information included activities enjoyed, medical needs, communication, budgeting behavioural issues and support required for mobility. Preferred routines were also recorded for mornings, night and sleep patterns and toileting as well as eating, drinking and dietary needs. Risk assessments were in place to cover specific assistance and the response required by staff and. Although some risk assessments had been updated to reflect changes, other dates had been omitted and it was not clear when the last review had taken place and whether the current assessment reflected the current needs and support required. Relatives spoken to expressed their appreciation of the respite care service provided by the home and of how well the staff team had been able to interact with residents resulting in improvements in social skills and communication. Daily log sheets had also been completed identifying
Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 10 meals, which had been eaten, and the staff who were on duty. Summary sheets are completed for each resident at the completion of their respite stay in the home. Breakaway DS0000018070.V280660.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): 13,15 & 16 The Home is able to demonstrate that residents are enabled to be part of the local community and to enjoy various leisure and daytime activities. Individual rights are respected to ensure that residents are able to make their own decisions regarding daily routines and of maintaining appropriate personal relationships. EVIDENCE: Information was available showing a variety of leisure activities and interests which residents were able to pursue during their stay at Breakaway. A collection of photographs had been prepared in albums, which showed residents cooking, bowling, visits to City Airport and to the London Eye as well as visits to shopping centres. The home now has its own specially adapted tail lift vehicle, which is used extensively for transporting residents around the area. Comments were also available which residents themselves had made to express how much they had enjoyed in-house activities and the level of support given by staff. The staff team have been creative in stimulating and benefiting residents by making use of their previous work experience and skills. This includes cooking, hairdressing, pedicure and facials. At the time of inspection, the majority of residents were able to pursue alternative daytime
Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 12 activities of their choice during their respite stay which parents were also happy for the home to arrange. There were no instances where residents’ rights were being infringed or were prevented from attending day activities or centres because of funding or transport difficulties. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 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): 18,19 & 20 Residents receive personal and healthcare support in the way they prefer and which is appropriate for their needs but individual protocols had not been agreed with healthcare professionals regarding clinical procedures. The Home has policies and procedures in place for the safe administration of medicines. EVIDENCE: Care records set out the personal support required by residents and how and when this is provided. From conversations with relatives, staff and the interaction observed with residents, needs were being met and supported appropriately. Staff were able to demonstrate their ability to communicate effectively with residents as well as using safe moving and handling techniques without exercising physical restraint. At the time of inspection, the acting manager advised the inspector that none of the current residents required clinical procedures. The majority of staff have attended training courses on administering rectal-diazepam but there must be individual protocols for this and any other clinical procedure e.g. peg feeding, when residents who require these procedures, are admitted to the home. This was highlighted in the previous inspection report and health care professionals must draw up an agreed protocol for staff involved specifying the procedures to be followed. The names of staff involved in the procedure must also be included as part of the protocols as well as the health care professional signing to confirm that the staff named, are competent to carry out the procedure. These protocols
Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 14 should be reviewed and documented by the health care professional concerned at least every year or sooner, if changes are necessary. The Inspector was advised that district nurses are very supportive and the occupational therapist will carry out assessments as required. All bedrooms have their own lockable cupboard for medication and when residents attended for respite care, they bring their own medication, which is booked in, and records are drawn up based on the details of prescriptions. Records had been signed each time medication had been administered and medication no longer required had been returned to the pharmacist and signed for. Arrangements are in place for local doctors to attend residents when required and to cover out of hours emergencies. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 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): 22 &23 There is an established complaints procedure of which residents are aware and a system is in place for residents to express their views. A policy and whistle blowing procedure for the protection of vulnerable adults is available and has been updated to include the correct procedures and agencies to be contacted should such an incident occur. EVIDENCE: One complaint has been received since the last inspection relating to moving and handling issues, staff training and experience. This was thoroughly investigated by the Registered Provider using their complaint procedures and a copy of the report and outcomes were submitted to the Commission for Social Care Inspection. Specific allegations made were not upheld but the Registered Provider has also taken the opportunity of reviewing procedures to ensure that at all times, residents needs are properly met in accordance with agreed policy and practice. A copy of the latest policy for the prevention of harm to vulnerable adults and whistle blowing procedures were in the home and staff has had P.O.V.A. training and were aware of the procedures, which should be followed where residents may be at risk of harm. A record of compliments and appreciation by residents, parents/carers of the service provided by the home, was also available. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 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): 27 Toilets and shower facilities have been provided with appropriate equipment for disabled people. At the time of inspection, an adjustable bathing facility was still not available and was in the process of being installed. This facility needs to be completed in order to fully meet the needs of residents who are admitted for respite care. EVIDENCE: Overall, accommodation, facilities and equipment have been provided to enable staff to meet the needs of residents. At the time of inspection, an adjustable bathing facility was in the process of being installed but there had been considerable delays in completing this work. Given the needs of the physically disabled people who are being admitted to the home, it is regarded as essential that this facility be made available for use as quickly as possible. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 17 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): 32,33 & 34 Residents are assisted by an effective staff team where individual and joint needs are met. A system was in place to ensure that thorough recruitment procedures were being followed for staff in order to support and protect residents. EVIDENCE: A staff rota was available and the deployment of staff and levels required, is determined according to the dependency needs and support required in respect of residents being admitted. Normally, there are three support workers plus the acting manager and had night, there are two staff awake and on duty. The acting manager advised the Inspector that a new post of deputy manager had been approved for the home. Staff spoken to, expressed how they felt highly motivated and enjoyed their work as well as finding their roles fulfilling as they interacted with residents. Staff also expressed satisfaction with the priority given to training and that they felt well supported by management and received regular supervision. Staff felt valued as well having the opportunity of utilising their previous work skills in the support provided to residents. As well as induction training, other courses had been completed dealing with sensory impairment, epilepsy, communication skills and certificates had also been awarded. Staff also confirmed that various levels of staff were provided depending on the support required by individual residents. Staff spoken to, had a good awareness of their roles and responsibilities and confirmed that care plans are discussed with residents. A wide selection of
Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 18 training courses had been completed by the staff team. The Registered Provider retains references of new staff in Central office and the acting manager gave evidence of e-mails, which had been received, by the home to indicate that completed references and recruitment checks had been completed. Although the Registered Provider retains information relating to Criminal Record Bureau checks, staff had made available copies of their own C. R. B. forms, which were being retained on staff files at the home. Proof of identification was also made available to the Inspector. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 The management of the home is effective and residents benefit from the service being offered. An application from the Registered Provider is still awaited by the C. S. C. I. for registration of the manager of the home. Procedures are in place for obtaining the views of residents and their relatives for the ongoing improvement and development of the service. The health, safety and welfare of residents are protected but Regulation 37 forms have not always been submitted as required. . EVIDENCE: It is understood that an application for the registration of the acting manager is in the process of being submitted to the Commission for Social Care Inspection. This needs to be processed as quickly as possible as the Home has been operating since July 2005. The acting manager has demonstrated his ability to create an effective staff team who are motivated and communicate effectively as well as supporting each other in meeting the needs and challenges of residents who come to stay in the home. The acting manager has identified improvements, which need to be made to the formats of care plans and risk assessments as well as other procedures in the home.
Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 20 Application is being made by the acting manager to study for NVQ 4 Registered Managers Award. As already mentioned in this report, residents and their families are given the opportunity of expressing their views, which are taken into account for improvements and future development of the home. Evidence was made available at the inspection of approvals obtained by the Building Control Officer regarding the Fire Officers consent to alterations to the fire precautions as a result of adaptations to the building. An incident occurred in the home in September 2005 regarding medication, which had not been administered, and notification was not given to the Commission for Social Care Inspection as required under Regulation 37. It is understood from the acting manager that N.H.S. Direct was contacted at the time as well as the On-Call Manager and parents of the resident concerned. The local doctor also gave advice. It is important that the C. S. C. I. is contacted by the Home regarding any event in the care home, which adversely affects the well-being, or safety of any service user as identified under Regulation 37 of the Care Homes Regulations. Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 21 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 3 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 2 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 3 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 2 x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 2 x 3 x x 2 x Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action 1 YA9 13 & 15 2 YA18 13 &14 3 YA27 23 (2) 4 YA42 37 The Registered Person shall 15/03/06 make arrangements to ensure that all care plans and risk assessments are regularly reviewed and updated to take account of any risks and hazards concerning residents. (Previous timescale of 31/10/05 not met). The Registered Person shall 31/03/06 make arrangements for health care professionals to include evidence of training given to staff and for protocols to be completed for any clinical procedures, which need to be carried out. (Previous timescale of 31/10/05 not met). The Registered Person shall 15/03/06 ensure there are provided at appropriate places on the premises, sufficient numbers of baths and shower facilities to meet residents needs. (Previous timescale of 31/10/05 not met). The Registered Person shall give 28/02/06 notice to the Commission for Social Care Inspection, without delay, of the occurrence of any event or incident in the care
DS0000018070.V280660.R01.S.doc Version 5.1 Page 23 Breakaway home, which adversely affects the well-being, or safety of any service user. 28/02/6 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. N/A Refer to Standard N/A Good Practice Recommendations N/A Breakaway DS0000018070.V280660.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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