CARE HOME ADULTS 18-65
Butterfly`s 1 Bromley Road Colchester Essex CO4 3JE Lead Inspector
Neal Wolton-Harragan Key Unannounced Inspection 26th June 2007 10:30 Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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 Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Butterfly`s Address 1 Bromley Road Colchester Essex CO4 3JE 01206 861482 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) Mrs Julie Elizabeth Webster Mr Manus Webster Mrs Caroline Joseph Care Home 9 Category(ies) of Learning disability (9), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 9 persons) Persons of either sex, under the age of 65 years, who require care by reason of a learning disability who may also have mental health needs (not to exceed 3 persons) The total number of service users accommodated in the home must not exceed 9 persons Mr Manus Webster will not take part in running, or have any other operational interest in the business of providing residential care within the care home 7th June 2006 Date of last inspection Brief Description of the Service: Butterfly’s is a small home, registered to meet the needs of up to 6 younger adults with learning disabilities. Situated on the outskirts of Colchester, the bungalow has been extended and remodelled to offer six single en-suite bedrooms as well as sufficient communal space. The home is on principal public transport routes for easy access to central Colchester and is within walking distance of local shops. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report follows a key inspection of Butterfly’s that included an unannounced visit to the service on June 26th 2007 as well as subsequent fieldwork. The judgements made within this report are based upon evidence found on the inspection visit along with information submitted by the service and feedback from service users, staff and other parties since the previous inspection. Mrs Caroline Joseph, the Registered Manager of Butterfly’s was available throughout the inspection visit and contributed fully to the inspection process. Mrs Julie Webster, the Home’s owner was at Butterfly’s during the afternoon and was available for feedback. During this inspection, 28 of the 43 applicable standards were looked at; 26 of which were met and 2 were nearly met resulting in 2 statutory requirements. During the visit to Butterfly’s, people living at the home and staff were spoken with. All were positive about the home and the people living there appeared at ease and were happy to talk to the Inspector. Interactions between staff and the people living at Butterfly’s observed during this inspection were positive. The visit to Butterfly’s included an environmental tour of the home, discussions with people living at the home, staff and the home manager, as well as the opportunity to look at records of how people living at Butterfly’s were supported and how the staff were recruited and trained. What the service does well:
As at the previous inspection, Butterfly’s continues to offer a high standard of care to those living at the home, with a range of meaningful activities on offer. Butterfly’s has a well-trained staff team that works well to support the people living at the home. Butterfly’s was well managed and people living there spoke well of the home and were comfortable with the Manager and the care staff on duty. Every person living at Butterfly’s had their own bedroom and each person’s bedroom was furnished and decorated to their own taste. The communal areas were well decorated and provide sufficient shared space for in-house activities. All people living at butterfly’s had planned programmes of activities throughout the week and had good access to community facilities. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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 Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive needs assessments are completed before a person moves into Butterfly’s and people can ‘test drive’ the home to be certain it will be able to meet their needs. EVIDENCE: There had been three new admissions to the home since the previous inspection. Individual care records showed that thorough assessments were undertaken to ascertain all the needs of individuals before a place has offered to them that butterflies. These assessments included input from the service user, care manager, relatives and other services (either residential or day care), forming the basis of the individuals initial care plan and contributing to the on-going process of assessment within the home. Individual care records also contained care package summaries and contracts of residence. Discussions with care staff and the Manager, as well as the examination of service user records, gave evidence that prospective service users were given the opportunity to visit the home before they made the decision to stay and Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 9 were able to have a phased introduction to Butterfly’s that included short daytime visits and overnight stays. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is robust, showing evidence of contributions by individuals through discussions at reviews. People were supported to take risks as part of an independent lifestyle. People living at the home were consulted on all aspects of life at the home through regular meetings and discussions. EVIDENCE: The individual plans and care records examined as part of this inspection showed that those living at butterfly’s contributed to their construction and to their ongoing review. The care plans reflected the individuality of the person and the uniqueness of each person’s needs. Conversations with carers showed that there was an understanding of the issues within the individual plans of care and that these were followed and there were regular meaningful entries in daily records that showed needs were being met. Care plans were regularly reviewed to ensure their effectiveness and people living at the home had their
Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 11 needs and aspirations reassessed at appropriate intervals to ensure their individual plans reflected the true needs. Discussions were people at the home showed there was a process of active and responsive consultation at butterfly’s in relation to the day-to-day running of the home. There were records of resident meetings regarding a range of subjects including activities, trips and menus and these discussions formed the basis for planning and developments at Butterfly’s. There were comprehensive risk assessments conducted for each person living are butterflies along with clear risk management plans to ensure individuals were supported to take risks as part of an independent lifestyle. These included environmental risks for both inside and outside the home as well as risks that may have been encountered while undertaking planned activities. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Butterfly’s were able to take part in a wide range of activities tailored to their individual needs and preferences and were active members of their local community. Rights of individuals were respected and relationships were positive for those living at Butterfly’s. EVIDENCE: Individual care records sampled showed that each person living at Butterfly’s had a detailed weekly programme of activities both inside and outside of the home. These activities included work, education and leisure type activities. People spoken with on the day of inspection stated that they used community facilities as part of their daily lives and enjoyed the activities on offer. Discussion with people living and working at Butterflys, as well as the examination of records, showed that peoples rights were respected and
Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 13 appropriate personal relationships supported. The observation of interactions between those living at the home and care staff showed evidence of relationships that were built on mutual respect and trust. Staff were seen to knock on doors before entering a persons private room and the way peopel talked to each other showed that dignity and respect was upheld. Visitors were welcome at the home at any time and people living at Butterflys were able to receive guests in private if they wished. The examination of records and discussions with the home’s manager provided evidence of those living at Butterfly’s receiving a healthy diet. Menus were developed through discussions with service users and service users were encouraged to take part in meal preparation and in shopping for foodstuffs. Meals were said to be unhurried and an opportunity for people to socialise and discuss their day. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users received personal support in the way they preferred and required and physical and emotional health needs were met. People were protected by the home’s medication policies and procedures. EVIDENCE: People spoken with were happy with the way they were supported and this was reflected within the care plans examined. Care plans identified individual needs as well as the person’s preferences for how these needs could be met. Care plans were well detailed; regularly monitored and formal reviews were held at six-month intervals. As noted at previous inspections, care records showed an ongoing process of assessment, to take account of the changing needs of individuals, and the services of healthcare professionals - such as community nurses, speech and language therapists or psychologists - were accessed as necessary and there was good liaison with the school attended by the youngest person living at the Butterfly’s.
Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 15 No service users retained their own medications at this inspection; all medications were kept within a locked cabinet in the home’s office. This decision was taken following thorough risk assessment for each person and was regularly reviewed. All medication records examined were appropriately maintained and the home’s medication policies and procedures provided protection to the people living at Butterfly’s. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Butterfly’s could expect their views to be listened to and acted upon. There were robust arrangements in place to afford protection for those living at the home from abuse, neglect and self-harm. EVIDENCE: The home had a robust complaints procedure and this was also presented in a manner that was easy for service users to understand. The adult protection policies and procedures were adequate to protect service users from abuse and, where service users presented with behaviours likely to cause self-harm, these behaviours were identified within their care plans and management strategies devised. Discussions with people living at the home showed evidence of a feeling that if a person had a concern it would be listened to and acted upon. People living at Butterfly’s were very positive about the approachability of the staff and management and this was also shown by there interactions. There have been no formal complaints about the services at Butterfly’s since the last inspection nor have there been any Safeguarding referrals. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Butterfly’s is a clean, comfortable, homely and safe place to live in. EVIDENCE: An environmental tour of the home showed that service users lived in a homely, comfortable and safe environment and that individual bedrooms suited service users’ needs and lifestyles and promoted independence. All rooms had en-suite toilet facilities. Many areas of the home had been redecorated since the last inspection and the dining room had been moved to the conservatory to provide additional lounge space. There were sufficient shared spaces throughout the home, and within its grounds, to complement and supplement service users’ individual rooms. There remains an intention to remodel the lounge through the removal
Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 18 of a central arch and a chimneybreast, to provide additional space for the service users. The bungalow next door, which was completed but unoccupied at the time of the previous inspection had three people living in at this visit. People living here lived largely separately to those in the main house although there was interaction between the two people regularly got together for meals and activities. All areas of the home were clean and hygienic. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Carers at Butterfly’s were appropriately trained and skilled to meet the individual and group needs of those living at the home. Staff recruitment practices afforded support and protection to those living at Butterfly’s. People living at the home did not benefit from sufficient support and supervision of staff. EVIDENCE: Examination of staff records, as well as discussions with the Registered Manager and staff, gave evidence that care staff were qualified and competent. Records showed that all required pre-employment checks were undertaken and documentation was collected to ensure the protection of those living at Butterfly’s. Staff were employed in sufficient numbers to meet the needs of the service users and were well trained with access to induction to Skills for Care standards and regular on going development opportunities. Staff spoken with on the day of inspection stated that training was regularly made available and
Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 20 the home’s Manager fully supported staff in meeting their training needs. Two carers were hoping to commence similar programmes in the near future. Staff were observed as caring and professional and interactions between carers and those living at Butterfly’s were positive and encouraged independence for the individual. Observation of interactions showed carers worked as an effective staff team. The examination of staff records showed that there was some formal support and supervision of care staff although this was insufficient to ensure staff development needs were being fully met or that any concerns regarding carers’ performance would be identified or addressed. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Butterflies benefited from competent management of the home and could feel confident that their views underpinned developments. The health, safety and welfare of people living and working at Butterfly’s were promoted and protected although the safeguarding of the rights and best interests of those living at Butterfly’s could not always be assured by the application of the home’s record keeping policies and procedures. EVIDENCE: People spoken with on the day of this inspection visit were positive about the management style adopted in the home and staff felt able to raise concerns with, or make requests to, the Manager. Mrs Joseph, the Registered Manager, Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 22 showed a good understanding of management issues and had completed the NVQ level 4 in Management and Care. There were records of regular meetings for those living at Butterfly’s to be able to contribute to how the home was run on a day-to-day basis and a formal quality assurance process was in place. Records examined showed that the health, safety and welfare of service users, staff and visitors was protected and promoted. Control valves restricted water temperatures with hot water being delivered at around 43 degrees Celsius. There were regular checks of the fire alarm system and records of routine gas and electrical safety checks. While the home’s record keeping policies and procedures largely protected the rights and best interests of those living at Butterfly’s, not all the individual care records examined contained photographs of the person. Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 23 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 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 YA36 Regulation 13, 18 Requirement The home must ensure that persons working at the home are appropriately supervised to ensure staff development needs are fully met and that any concerns regarding carers’ performance are identified and addressed. The home must ensure that all records required in respect of individuals are adequately maintained to ensure that adequate protection and support is afforded to all those living at the Home. This refers specifically to the inclusion of photographs within individual care records. The previous timescale of 01/08/06 was not met. Timescale for action 01/11/07 1. YA41 17(1)(a), Schedule 3 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Butterfly`s Refer to Good Practice Recommendations
DS0000064355.V347111.R01.S.doc Version 5.2 Page 25 Standard Butterfly`s DS0000064355.V347111.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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