CARE HOME ADULTS 18-65
Buckwood View 6 Buckwood View Off Gleadless Road Sheffield S14 1LX Lead Inspector
Shelagh Murphy Unannounced 27 July 2005. 10:20am 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. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Buckwood View Address 6 Buckwood View off Gleadless Road Sheffield S14 1LX 0114 253 0400 0114 253 1220 None Northern Counties Housing Association Limited 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) Mrs Michelle Taylor N - Care home with nursing 18 Category(ies) of LD - Learning Disability (18) registration, with number of places Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Minimum staffing levels must be maintained as stated in the documents entitled `Buckwood View Approved Staffing Levels` faxed to the NCSC on 8 April 2003. The five named wheelchair users can be admitted to the home at the time of first registration. No other persons whose main source of independent mobility is a wheelchair may be admitted. Nine specific service users over the age of 65, named on variation dated 11th August 2004, may reside at the home. 2. 3. Date of last inspection 9 November 2004 Brief Description of the Service: Buckwood View Nursing home was opened in April 2003. It was purpose built to meet the National Minimum Standards for care homes. Eighteen people with learning disabilities live at the service which is based in the community. Northern Counties Housing Association owns the care home. The care staff who work at the home are employed by the Sheffield Care Trust. There are six houses at the service, an office building and a day service base, which are all based on a small cul-de-sac. All of the houses have gardens to the rear. The home is based near to community facilities, shops and bus stops. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Shelagh Murphy carried out this unannounced inspection from 10:20 to 13:50 pm. Michelle Taylor, registered manager, from Sheffield Care Trust was present during the inspection. Opportunity was taken to make a tour of the premises, inspect a sample of records and policies and talk to staff and residents. The inspector had the opportunity to speak to all of the staff on duty. Two staff were interviewed. It was not possible to formally interview any of the residents, due to their high support needs but the inspector spoke to several residents informally. What the service does well:
The manager reported that all of the residents had person centred care plans. The individual plans checked contained the majority of the information required by the regulations, they were detailed and monitored on a quarterly basis. Some of the health care records needed updating but generally they were very comprehensive. Comprehensive risk assessments are in place for the resident’s case tracked to ensure that risks to residents were minimised. Overall, the home provides a lovely, homely environment for the residents who live there. The home was comfortable, generally well maintained, clean and free from odours. All of the residents bedrooms are well decorated, comfortable and reflected the individual’s needs and personalities. The staff showed respect for the residents. The relationships between the staff and residents were appropriate, friendly, informal and warm. All of the residents have either been on holidays with the staff or have plans to go later in the year. The staff team is very stable and most of the staff team have worked with the service users for many years, they therefore know the residents well and are able to provide a consistent service to them. The staff said they felt supported and were offered formal supervision on a regular basis. The majority of staff had completed annual appraisals with their line managers. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 6 The manager meets with the resident’s relatives on a regular basis, this group is called the, Friends of Buckwood View. At a recent meeting the manager had received very positive feedback about the service from the relatives group. What has improved since the last inspection? What they could do better: Two care plans were checked in detail, they were very comprehensive, however, there were a few issues, which needed to be addressed to ensure good practice. A record should be made of whether the individual residents or their relatives were involved in reviews and all medication review dates need to be recorded. The team leaders must also advise staff whether they are required to monitor the individual residents weight on a monthly basis, as this was not regularly recorded in the files checked. These actions will ensure that the resident’s needs are monitored and supported in an appropriate way. There were some planned activities in the home for the residents’, however, they need to be reviewed to ensure all of the residents have access to appropriate activities. The resident’s records regarding health care appointments need to be kept up to date to ensure that they are receiving appropriate health care at the frequency required. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 7 The medication was checked and found to be stored appropriately. The recording of medication administered was generally good, however, there were some occasions where staff had not signed for medication administered to the residents. This was brought to the team leaders attention immediately for action to be taken to address this as this could place residents at risk. The majority of the staff team had completed adult protection training in 2003, this will now need to be updated and newly recruited staff will need to be included in the these training opportunities. All of the resident’s rooms, which have en-suite showers, need to be checked and as appropriate to meet the resident’s needs, a shower door needs to be fitted. This is because the staff said that they experienced problems with the bathroom floors flooding and becoming slippy, this could pose a risk to residents and staff from falling. The fire doors at the entrance to house 11 are not at present enabling easy access to wheelchair users. Staff said that it was very awkward to open the heavy doors and push the residents in wheelchairs through at the same time. Action needs to be taken to enable appropriate access as this could pose a risk of injury to service users and staff. Overall the environment within the houses was well decorated, comfortable, homely and well maintained. There were some minor maintenance issues found during the inspection. These included:- the dining room furniture in house 7 needed to be repaired or replaced, as it looked scratched, stained and damaged. In several of the houses the kitchen cabinet doors were slipping off their hinges and will need to be repaired. In House 15 the lounge and hallway carpet was stained and needed to be cleaned or replaced. 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. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 8 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 Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 9 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) 2. The manager said that none of the current residents had needs assessments as they had moved from another Sheffield Care Trust nursing home straight in to this home. EVIDENCE: Not applicable. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 10 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 and 9. All of the residents had care plans, those checked were very detailed, however, there were some records, which needed to be updated to ensure the resident’s needs were monitored. Risk assessments to minimise any risks associated with the tenants lifestyles and the environment had been devised and had been regularly reviewed. EVIDENCE: Two of the residents care plans contained the majority of the information required by the regulations, were detailed and monitored on a quarterly basis. However, there were a few issues, which needed to be addressed to ensure good practice. These included a record should be made of whether the individual residents or their relatives were involved in reviews and all medication review dates need to be recorded. The team leaders must also advise staff whether they are required to monitor the individual residents weight on a monthly basis, as this was not regularly recorded in the files checked. These actions will ensure that the resident’s individual needs are monitored and supported in an appropriate way. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 and 17. All residents have some opportunities to access age, peer and culturally appropriate activities to meet their needs. Some resident’s regularly accessed leisure activities. They were also supported to access other community facilities, such as shops, pubs and local parks etc. The resident’s were supported to have appropriate relationships with their peers and relatives. Residents are offered a well-balanced and nutritious diet, which meets their needs and personal preferences. EVIDENCE: There are several regular planned activities organised at the home on a weekly basis. A member of staff at the home is responsible for co-ordinating the service users leisure and daily activities. She reported that there were regular planned activities available at the home including, wheelchair aerobics and art therapy and a luncheon club, Agewell luncheon group, which is open to other people with a learning disability in the community.
Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 12 The staff reported that other activities were planned for residents on an ad-hoc basis, these included trips out shopping to the pub and for meals, theatre trips and trips to local parks and the countryside. However, there were no central records of this, which made it difficult to measure their frequency. The manager had reported that the relatives group had requested more planned outings/activities for the residents and this was being considered with the staff team. The staff reported that they have access to a minibus and a car to support the resident’s mobility/transport needs to access the community. The staff and several residents reported that they had been on holiday to destinations including Disneyland, Great Yarmouth and Wales. Another holiday was planned for later in the year to the Gran-Canaries. Several residents told the inspector that they are, supported by staff to phone and visit their relatives. There was evidence in the care plans checked that relatives and other supporters are Menu guidelines were available to advise staff about appropriate nutritional content. From this information staff planned menus with the residents around their individual preferences. Details of the resident’s preferences and special needs were recorded in the care plans checked and staff made a record of the menus taken on a daily basis. Some residents needed to have soft diets and assessments for these had been carried out by appropriate professionals and were recorded on care plans. One resident required, Peg Feeding, and there was evidence that the, staff had received training and were supported by a district nurse. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 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 standard(s) 18, 19 and 20. Residents had person centred plans, which identified in detail how personal support should be offered to each individual. Included in this information was how residents physical and emotional needs should be met, some of the records relating to the residents physical needs required updating to ensure these needs are met. The medication at the home was stored appropriately and safely, there were however, some anomalies in the recording of medication administered to residents, which could pose a potential risk and therefore must be addressed. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 14 EVIDENCE: Resident’s personal support needs and emotional needs were recorded in the individual plans checked and were very comprehensive. The records of the resident’s physical needs, regarding health care appointments need to be kept up to date to ensure that they are receiving appropriate health care at the frequency required. None of the residents are able to self medicate and therefore are reliant on nursing staff for this. The medication was checked and found to be stored appropriately. The recording of medication administered was generally good, however, there were some occasions where staff had not signed for medication administered to the residents. This was brought to the team leaders attention immediately for action to be taken to address this as this could potentially place residents at risk. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 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 standard(s) 22 and 23. The home had a formal complaints procedure. The residents who were able to verbalise their concerns to staff, knew how to make complaints. The residents who had high support needs may need more support from relatives and key workers to advocate on their behalf. Procedures were in place to protect the residents from abuse, neglect and selfharm. Staff had received some awareness training in the management of challenging behaviour and adult protection issues and this will now need to be updated. EVIDENCE: There was a formal complaints procedure in place at the service, which met the regulations. The procedure promoted the rights and wellbeing of the residents. Records of all complaints were kept. The manager said that the complaints procedures had been devised in accessible formats to meet the resident’s needs. The manager said that none of the residents had made complaints at the home over the last six months. The staff reported that they felt confident that the management would listen to the residents and relative’s views and support them to take appropriate action if they had any concerns or complaints. The home had adult protection procedures, which met the regulations. The residents spoken to said they felt happy at the home. The manager said that no allegations of abuse had been made over the past year. The staff said that they did not use restraint techniques or sanctions with any of the residents who lived at the service and therefore there were no risk assessments on these issues.
Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 16 Several staff reported that they had completed some training regarding adult protection procedures. Training records showed that all except two newly recruited staff had been offered training in 2003, therefore this training will now need to be updated. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 17 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, 25, 27 and 30. Overall, the home provides a lovely, homely environment for the residents who live there. The home was comfortable, generally well maintained, clean and free from odours. A few minor issues were noted and will need attention. The resident’s bedrooms were clean, free from odour and had been personalised by being decorated and furnished to their individual needs and taste. The bathrooms and toilets in the home generally met the resident’s needs, the residents en-suite shower rooms posed a slipping risks to staff and resident’s and therefore needed attention to address the issue. The home was very clean and the laundry areas were all appropriately equipped to meet the needs of the residents. EVIDENCE: All of the residents bedrooms were well decorated, comfortable and reflected the individual’s needs and personalities.
Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 18 The central heating system had been repaired, the manager reported there have been no problems with the system January 2005. The drains at the home have been cleaned and this ensures that rain water can safely drain away to prevent flooding at the home. The gardens were attractive and tidy, they are now maintained on a regular basis to ensure the grounds are safe for the residents and staff. The resident’s bedrooms were checked and found to be clean and tidy, they were all individually decorated and furnished to reflect the resident’s tastes. All of the resident’s rooms, which have en-suite showers, need to be checked and as appropriate, a shower door needs to be fitted. This is because the staff said that they experienced problems with the bathroom floors flooding and becoming slippy, this could pose a risk to residents and staff from falling. The fire doors at the entrance to house 11 were not enabling easy access to wheelchair users. Staff said that it was very awkward to open the heavy doors and push the residents in wheelchairs through at the same time. Action needs to be taken to enable appropriate access as this could pose a risk of injury to service users and staff. Overall the environment within the houses was good, it was well decorated, comfortable, clean, homely and well maintained. There were some minor maintenance issues found during the inspection. These included:- the dining room furniture in house 7 needed to be repaired or replaced, as it looked scratched, stained and damaged. In several of the houses the kitchen cabinet doors were slipping off their hinges and will need to be repaired. In House 15 the lounge and hallway carpet was stained and need to be cleaned or replaced. The laundry rooms in each house were found to be appropriately equipped, safe and met the resident’s needs. Staff reported they had been supplied with appropriate protective equipment. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 19 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 and 36. There is a stable staff team at the home, who reported they are well supported and supervised by the managers. The staff work effectively as a team and offer a high standard of care and support to the residents. EVIDENCE: The manager has completed the NVQ4 management award to develop her management skills and the deputy manager is presently working towards this award. The inspector observed respectful, appropriate, warm and informal interactions between the staff and residents. The staff spoke of empowering residents to make choices appropriate to their abilities. All of the residents had named key-workers who supported them. One resident said she liked the staff and especially her key-worker. Two staff reported that they were happy at work and enjoyed working with the residents. Another resident told the inspector they liked the staff who worked in their home and especially enjoyed outings with their key-worker. The staff team is very stable and most of the staff team have worked with the service users for many years, they therefore know the residents very well and are able to provide a consistent service to them.
Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 20 The staff said they felt supported and were offered formal supervision on a regular basis. Records to confirm this were checked and the majority of staff had completed annual appraisals with their line managers. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 21 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) N/A None of these standards were checked during this inspection. EVIDENCE: Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 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 N/A x x x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x 2 x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 2 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Buckwood View Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The residents care plans must be checked to ensure they all contain relevant information to meet the regulations. Leisure activities for the residents must be reviewed to ensure their individual needs are met. Residents health care needs must be recorded accurately as appropriate. All medication administration must be recorded accurately. All staff must recive adult protection training. The home must be kept well maintainerd at all times. Minor maintenance issues identified in this report must be addressed. The resident ensuite showers must be checked and as appropriate doors must be supplied to prevent the risk of slipping. Timescale for action 31.10.05 2. YA14 16 31.12.05 3. 4. 5. 6. YA19 YA20 YA23 YA24 12 13 18 23 30.9.05 27.7.05 31.3.06 31.12.05 7. YA27 23 31.12.05 8. 9. Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 24 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 None Good Practice Recommendations Buckwood View J55 S41058 Buckwood View V204848 27.7.05 UI Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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