Inspection on 31/05/05 for Burden Road (43)

This inspection was carried out on 31st May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

Burden Road (43) 05/06/08

Burden Road (43) 17/07/07

Burden Road (43) 28/09/06

Burden Road (43) 09/12/05

Burden Road (43) 06/01/05

Burden Road (43) 16/06/04

Burden Road (43) 31/01/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 43 Burden Road 43 Burden Road Moreton Wirral CH46 6BG Lead Inspector Inger Moynihan Unannounced 31 May 2005 10 am 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. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 43 Burden Road Address 43 Burden Road, Moreton, wirral, CH46 6BG 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) 0151 678 9962 Community Integrated Care Susan Aldrid (acting manager) Care Home Only 3 Category(ies) of LD - Learning Disability registration, with number of places 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are no conditions attached to the registration of this service. Date of last inspection 19 January 2005 Brief Description of the Service: 43 Burden is a residential care home providing 24 hour personal care and accommodation to three service users with a learning disability. This service is owned and managed by Community Integrated Care. The home is located in a residential area close to Moreton town centre which has a large selection of shops, pubs, a post office and other town amenities. The home is a two story detached house with bedroom accommodation on both floors; all bedrooms are single occupancy. Toilets are located on both floors with a bath and shower on the ground floor. The communal facilities comprise of a lounge, dining room and kitchen. Smoking is not permitted in the home. The home has its own transport allowing service users to access community facilities easily 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took five hours over two days and was the statutory unannounced inspection for the service. A tour of the premises took place and service users’ records were inspected. Three staff were spoken to and all service users were observed during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Improvements need to be made to the medication procedures and the way in which service users health and safety is promoted in the home. The registered person needs to ensure a documented complaints procedure is in place and all staff are aware of who they can contact in the event of them wishing to make complaint. A range of relevant training has been provided for the staff team to ensure they know how to look after the service users in accordance with their needs. Because the home does not have a registered manager, further management support must be provided to the acting manager and staff team to assist them with the management of the home the care of service users. To ensure service users safety and welfare, more thorough quality assurance systems must be implemented. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 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. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 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 standard(s) 2 and 3 Service users care needs had been assessed which enabled the staff team to know how to look after the service users in accordance with their needs. EVIDENCE: Documentation was in place to demonstrate that a comprehensive assessment of service users’ care needs had been carried out. All of this information had been reviewed and was up-to-date. A member of the care staff explained that a broad range of social activities were provided to cater for service users’ social needs and a minibus has been purchased by the service users to allow them to get out in about more easily. These activities included daytrips out, pub lunches, trips to the cinema and local shops etc. Activities are also provided within the home which include relaxation music, a sensory night and a foot spa. Although a summer holiday was not being provided this year, additional daytrips out would be arranged. Service users’ physical needs are met by accessing a range of relevant health care professionals. A record of when service users had attended healthcare appointments had not always been maintained which could result in important parts of a service users care being missed and them being left vulnerable to the risk of harm. The registered person must ensure detailed records are kept in respect of each service users healthcare needs. At the time of the inspection the dining room was also being used as a bedroom for one of the service users as their care needs had changed and they 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 9 were unable to access their bedroom by the stairs. The CSCI agreed last year that this situation could continue for a period of assessment but that action must be taken to find appropriate accommodation for the service user as this effectively reduces the communal living space for other service users and does not provide adequate or appropriate care for this specific service user. To date no progress has been made on this matter and the inspector remains extremely concerned that the registered person has not yet resolve this issue. In light of this the registered person is required to write to the CSCI outlining the action being taken to address this matter. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.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) 6,7, 9 and 10 The care needs of each service user had been recorded and provided staff with information on how to look after the service users properly. This information also enabled the staff to know how to support the service users in any decision making. A range of risk assessments had been completed to ensure service users safety and welfare. Information relating to service users is only shared with relevant people and always held in confidence to respect service users privacy. EVIDENCE: Documentation was in place to demonstrate that a comprehensive care plan had been drawn up from the information gathered during the assessment process. The care plans outlined how the staff should provide the necessary care to each of the service users and enabled them to keep up-to-date with their daily care needs and general welfare. A member of the care staff explained to the inspector how service users are encouraged to make decisions about their lives but because of their disability, the staff team also make decisions for them. He went on to say that most of the staff have worked at the home for many years and have got to know the service users’ particular preferences and ways of communicating. Documentation was in place to demonstrate that an up-to-date risk assessment had been carried out in 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 11 respect of different aspects of the service users life. Carrying out this risk assessment ensures service users are encouraged to take risks as part of an independent lifestyle, but at the same time ensures their safety and welfare. Information relating to service users was stored securely and only shared with relevant people. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 12 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 and 17 A range social activities are provided and include the use of community facilities. This ensures service users are provided with a stimulating and interesting environment. It was not possible to establish whether a healthy diet was provided for the service users, as past menus were not available for inspection. EVIDENCE: Currently none of the service users attend college or are in paid employment. Links with the community are maintained through the use of healthcare and social facilities. This ensures service users participate in normal community life and they are not segregated because of their disability. A record of service users dietary requirements, likes and dislikes had been made. Special diets are provided when required and service users are regularly taking out to cafes and pubs for their meals. The inspector was not able to establish whether a nutritious and balanced diet was provided as only one weeks menu was available. In order to address this standard the registered person must ensure a record of service users’ dietary intake is maintained. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.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. Service users are provided with the personal care they require in order to ensure they maintain good physical and emotional well being. Improvements need to be made the way in which service users medication is maintained. EVIDENCE: Each of the service users requires some degree of help with their personal care and the staff spoken to demonstrate an understanding of the importance of maintaining service users’ privacy and dignity in this area. Through discussion with staff, the inspector established that service users’ healthcare is monitored on a regular basis with a record of any specific issues being made. This monitoring and recording ensures service users enjoy good health and quality of life. A medication administration procedure was available for staff guidance and all staff have recently been provided with appropriate training around the safekeeping and administration and service users’ medication. The inspector noticed the key to the medication cabinet was not stored securely and that a large amount of paracetamol and co-codamol was being kept. The acting manager confirmed she was not sure how much of this excess medication was held in stock. Good practice indicates that only the required amount of medication should be held within any care home and that a 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 14 record of this is must be maintained. In light of this the registered person must ensure that excessive amounts of medication are not kept in stock and if additional medication is required, an accurate record is kept of the amount of medication in place. At the last inspection issues of concern were raised around the way in which medication was being administered and stored and the inspector was given assurances by the registered person that these matters were resolved. However, this is clearly not the case. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.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 Staff demonstrated and understanding of the action they should take in the event of them receiving a complaint although they were not entirely which agencies they should contact if they wished to make a complaint. Staff demonstrated an understanding of issues relating to the protection of vulnerable people from abuse and neglect. EVIDENCE: The CSCI had not received any complaints about this service and a member of staff confirmed that no complaints had been received by the home. The complaints procedure was not available for inspection. To ensure all relevant parties can raise concerns about the standard of care provided at the home, a documented complaints procedure must be made available. Upon discussion with a member of staff it was clear they understood what action to take in the event of them receiving complaint however they were not aware that the CSCI could be contacted for this purpose The registered person is required to ensure all staff are clear on who they may contact in the event of them wishing to make complaint about the standard of care provided. The inspector was informed that all staff have been provided with training on the protection of vulnerable adults from abuse about 18 months ago. The member of staff spoken to during the inspection was clear on the action they would take in the event of them suspecting or knowing an incident of abuse had occurred. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 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 standard(s) 24 and 30 This standard and furnishing within the home is comfortable which provides a homely environment for service users to live. The communal living space has been reduced as the dining-room is also being used as a bedroom. This situation is unacceptable and this reduces the amount of communal space for all service users. EVIDENCE: The premises are in keeping with the local community and are comfortable and free from offensive smells. On the day of the inspection the home was warm and clean with good light levels throughout. Service users have their own bedrooms which had been personalised with their own belongings. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The CIC organisation has provided staff with a range of appropriate training to ensure they know how to look after the service users in accordance with their particular needs. EVIDENCE: Documentation was in place to demonstrate that staff had undertaken a range of training relevant to the care of the service users and a rolling programme of training has been drawn up. The member of staff who takes responsibility for promoting health and safety within the home stated he had completed a fourday health and safety training course last year but expressed the need for further training in this area. The staff rota submitted on the day of the inspection indicated the staff were evenly deployed across the week and the staffing levels exceeded those stipulated by the registering authority. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 18 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) 37, 39 and 42 The acting manager and staff team are working hard to promote the welfare of the service users, however further management input is required to support the staff in their role. The promotion of service users health safety was promoted, however staff are not carrying out all of the necessary checks and service users being left at the risk of harm. EVIDENCE: There is currently no registered manager at 43 burden Road. Ms Susan Oldrid has agreed to act as manager of the home until this post can be filled. The post of registered manager has been vacant now for over a year and the inspector has raised concerns with Mr Charles Eggleston, responsible individual, about the length of time it is taking to recruit a person for this position. This issue will be addressed outside of this inspection as it is important there are clear leadership and management systems within the home. While it must be noted that Ms Oldrid is clearly working very hard to manage the home and care for the service users in accordance with good practice, it is the inspectors opinion that further management support is 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 19 required for the staff team. In light of this, the registered person is required to write to the CSCI to outline what action is being taken to address this issue. Steps had been taken to ensure the service users health and safety by way of electrical safety checks, fire safety checks, the disposal of clinical waste and the training of staff in health and safety. However the following issues were raised: • • • • • • • • Staff had not been provided with fire safety training since February 2004 kitchen knives were not stored securely despite this issue being raised at the last inspection the keys to the medication cabinet were not stored securely despite this issue being raised at the last inspection the water from the washing machine was ‘backing up’ into the bath on the ground floor body creams were not stored securely the first-aid kit which contained two pairs of scissors was not stored securely service user fire safety risk assessments had not been carried out staff had raised concerns within the organisation about the about the length of time it had taken for a bedroom door to be repaired. Eventually the door was repaired but this was only after a service user had sustained an injury. This evidence demonstrates the home is lacking in quality assurance systems which need to be addressed as a matter of priority by the registered person. At the last inspection the inspector raised serious concerns about the way in which service users health and safety was promoted in the home. At this time the registered person wrote to the CSCI and gave an assurance that this matter would be addressed straightaway. It is evident that this matter has not been resolved and again the registered person is required to write to the CSCI outlining the action that will be taken to address these issues. This matter will also be addressed outside of the inspection. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 20 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 1 x x Standard No 22 23 ENVIRONMENT Score 1 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x x 2 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 43 Burden Road Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score 1 x 1 x x 1 x F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 21 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. Standard 3 Regulation 15 Requirement Thise registered person is required to ensure a record of all aspects of service users healthcare is maintained. The registered person is required to write to the CSCI to update them on the action being taken to find alternative accommodation for the service user who is currently sleeping in the lounge. The registered person is required to demonstrate that sufficient, adequate, suitable, wholesome and nutritious food is provided for the service users. In this instance that a record of the weekly menus is made available for inspection. The registered person is required to ensure arrangements are in place for the safekeeping of medicines received into the home. In this instance that the keys to the medication cabinet are held by member of staff at all times and that excessive amounts of medication are not held in stock. Also is that a record is in place of all medication held. F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Timescale for action 2 June 2005 1 August 2005 2. 3 12 3. 17 16 1 August 2005 4. 20 13 2 June 2005 43 Burden Road Version 1.40 Page 22 5. 22 22 6. 37 8 7. 37 12 8. 42 13 9. 42 13 10. 42 13 11. 42 13 12. 42 13 13. 42 13 The registered person is required to ensure a documented complaints procedure is available for inspection and that all staff are aware of who they can contact in the event of them wishing to make a complaint about the standard of care provided. The registered person is required to write to the CSCI with regard to the action being taken to propose a manager for this service. The registered person is required to write to the CSCI and inform it of the action being taken to further support the staff team in role. The registered person is required to write to the CSCI to inform it of the action being taken to address the issues relating to health and safety within the home. The registered person is required is to ensure all staff are provided with fire safety training in accordance with the fire departments regulations. The registered person is required to ensure all kitchen knives, body creams and scissors are held securely. The registered person is required to ensure the service users health and safety is not affected by the water from the washing machine which is currently backing up into the bath on the ground floor. The registered person is required to ensure fire safety risk assessments are carried out with each service user. The registered person is required to ensure service users safety and welfare particularly in F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc 1 August 2005 1 August 2005 1 August 2005 1 August 2005 1 August 2005 2 June 2005 2 June 2005 1 August 2005 2 June 2005 Page 23 43 Burden Road Version 1.40 relation to any repairs that are required around the building. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations There are no recommendations resulting fromt this inspection. 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Liverpool Office 3rd Floor, 10 Duke Street Liverpool L1 5AS 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 43 Burden Road F52 F02 S18971 43 Burden Road V230411 310505 Stage 4.doc Version 1.40 Page 25 - 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!