CARE HOME ADULTS 18-65
Chapel Street Care Home 3-5 Chapel Street Kirkby In Ashfield Nottinghamshire NG17 8SY Lead Inspector
Joanna Carrington Key Unannounced Inspection 17th October 2006 10:00 Chapel Street Care Home DS0000008646.V293976.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 Chapel Street Care Home DS0000008646.V293976.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. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Chapel Street Care Home Address 3-5 Chapel Street Kirkby In Ashfield Nottinghamshire NG17 8SY 01623 757902 01623 720988 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) H4037@mencap.org.uk Royal Mencap Society Sarah Louise Hall Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: 3 - 5 Chapel Street provides accommodation for nine service users with a learning disabilities. The accommodation is not accessible to wheelchair users. It comprises two adapted joined houses with three floors, including a self contained flat. The home is situated in a residential area, with good access to local shops, pubs and transport. There is a garden to the rear of the property. The service users are encouraged to be as independent as possible with staff support, and all appear to be well integrated into the local community. The fees at the time of the inspection are £317.22 per week. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven hours on 16th October 2006. This was the home’s key inspection for this financial / inspection year. The main method of inspection was called ‘case tracking’ which meant selecting three service users and tracking the care and support they receive through checking their records, observation of care practice and discussion with them and with staff. Most service users were out at either their day centre or at work when the inspection took place. Altogether four service users and one staff member were spoken with. Staff records were looked at and a partial tour of the premises also took place in order to assess environmental standards. The acting manager was available for discussion and feedback throughout the inspection. The registered manager is currently on sick leave. What the service does well:
The service does well at ensuring that prospective service users will not move there until it can be determined that the home is suitable in meeting their needs. Information about the home is presented in a way that is accessible to prospective service users which means they can make an informed choice about whether to move to the home. There are care plans that cover all aspects of service users social, personal and healthcare needs, which provide detail on how to provide support and what individuals’ preferences are. The healthcare needs of service users are well met. Service users have annual heath checks and access to the GP when needed. The staff team are committed to promoting service users independence by supporting them to take acceptable and well- managed risks. Service users can make their own decisions on how they wish to live their lives and are also consulted over the running of the home. Service users have a good quality of life, with opportunities to access community facilities; go out to work or to day centre, clubs and to maintain contact with family and friends. Service users are treated with respect and their rights are upheld. On the whole, the staff team are trained and supported well, which helps ensure service users receive appropriate support and that their individual needs will be met. Monitoring and reviewing the quality of care is done well in the home. Service users are consulted and there are also audits, then ways to improve the service are identified and acted on. Chapel Street Care Home DS0000008646.V293976.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. Chapel Street Care Home DS0000008646.V293976.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 Chapel Street Care Home DS0000008646.V293976.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): 1 and 2 Quality in this outcome area is good. There is a good admissions procedure in place, which ensures the home is suitable in meeting prospective service users’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose is a very detailed document providing information to prospective service users and their representatives about the home. There are also pictures used which makes the information more accessible for service users. It is recommended that the document is reviewed and updated to ensure all information is current and correct. There have been no new admissions to the service since the last inspection. There was evidence on the files of all service users case tracked of the placing authority’s community care assessment, which is obtained prior to a new service user moving in so that it can be determined whether the home is suitable and to ensure they would be compatible with the existing service users. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good. There are good arrangements for planning how needs and choices are met and risk assessments are used effectively for the promotion of residents’ safety, independence and quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence on the care files seen that care plans are reviewed every six months and the key worker does a written monthly report also, to identify any issues or changes. All service users spoken with are aware who their key worker is and of their care plans but there was little evidence on care plans when service users have been involved in reviewing and developing new care plans and risk assessments. A recommendation is made in respect of this. There are good risk assessments in place for usual routines such as showering and bathing as well as risk assessments to enable service users to go out into the community independently, use public transport and also to do household tasks for example ironing safely. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 10 It was evident from discussion with service users and staff that service users are supported to make decisions about their own lives and also about the dayto-day running of the home. A service user spoken with explained how they have support but are ultimately in control of when they spend their own money and service users were observed being asked what they wanted for lunch. Service users spoken with all said they can choose when they wish to spend time alone or with others. There is access to independent advocacy services for service users that want assistance to exercise decisions by someone that does not work at the home. There are regular house meetings, which are written up in a format that service users understand. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. The rights and responsibilities of service users are respected and upheld, including the right to maintain and form relationships and to be a part of the local community. Service users are offered a healthy diet and enjoy their mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed interacting with residents in a respectful and meaningful manner and staff were observed knocking on residents’ bedroom doors to gain permission before entering. Service users spoken with reported that staff treat them with respect and a staff member spoken with gave excellent examples of how to maintain service users dignity and promote their rights. Service users spoken with talked about the activities they enjoy doing such as going to the pub, shopping and playing snooker. Records show that service users have opportunities to participate in activities they enjoy doing and have been supported to make steps in being able to do these activities independently.
Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 12 Some service users choose to go to day centre while couple of service users have work placements. There are also clubs in the evenings attended. For the service users case tracked there are care plans on their files on how to support them with their relationships. A staff member spoken with explained that service users will visit their relatives regularly and are able to phone their friends and relatives in private. This was confirmed by service users spoken with. A service user is currently in a relationship and has received support by an outside professional on issues around relationships and issues of sexuality and consent. Menu plans show that a variety of healthy, nutritious meals are offered to service users and each day a service user if they choose to, helps to prepare dinner. Service users were observed enjoying their meal together and service users were seen eating their preferred meal if they did not want the planned meal. It is recommended that in addition to the menu plan a record be kept of what meals and food individuals’ have eaten, in case of food poisoning and also to demonstrate choices are met. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Residents’ healthcare needs are met and residents receive personal support in they way they prefer and require. Some improvements to medicine management are necessary to ensure the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans show that the relevant specialist healthcare professionals such as psychiatrists, psychologists and community nurses are involved in residents care when necessary. Service users health is checked regularly. Appointment records show that service users go to the dentist and general well-person clinics every year. The weight of service users and healthcare conditions such as epilepsy are appropriately monitored. On the care files of service users case tracked there are care plans written in first person and also presented in pictures detailing what support is required with bathing and for example, washing hair, which include their individual preferences. “I like to have a bath every night at about 7pm”. Five different medicines were audited. Three of these medicines, which remain in their original boxes it was found that remaining quantities did not tally with
Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 14 the quantity stated on the Medication Administration Record (MAR) at the start of the cycle and what had been signed as administered. It was discovered that for two of these medicines the procedure in the home is to place the tablets in a cassette, which explained why the number of tablets were short. The quantity was still not correct however when these tablets were accounted for. In line with guidance from the Royal Pharmaceutical Society, secondary dispensing should be discouraged. One service user self-medicates and their medicines are placed into a cassette system by staff, to enable the resident to self-medicate safely. It is recommended that the pharmacy be consulted over whether they can dispense straight into the cassette thereby preventing secondary dispensing. A second MAR was issued for one service user for a medicine supplied after that cycle had began. The original MAR cross-referenced to the second MAR to ensure the medicine is administered and signed for but staff had forgotten to put lines through the second copy of two other medicines that are being signed as given on the original MAR. This has the potential to cause confusion and is unsafe practice. Two of the five medicines did not have clear instructions for administration on the label or on the MAR. It only states ‘as directed’. This does not ensure the medicine is being given as the GP has instructed. A requirement has been made in respect of medicine management. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. The Complaints Procedure ensures the concerns of service users are listened to and acted on. The local Safeguarding Adults procedures are not being followed, which does not help ensure service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Complaints Procedure is presented using pictures, which means it is accessible to service users. Service users spoken with confirmed they know how to complain and who to. There have been five complaints raised since the last inspection and records show a quick response to these complaints and a resolution. Records show that service users’ verbal complaints are taken seriously and responded using the Complaints Procedure, which is good practice. Since the last inspection there has been an investigation using the Safeguarding Adults procedures, following an allegation against a staff member. Social Services were involved at the time. An outcome form has not been sent to the Adult Protection Unit, which is required in accordance with the procedures. There were records seen that show there have been incidents between service users that have resulted in assault. The manager was unaware that Social Services need to be notified of these incidents so that the home does not make the sole decision on what action is necessary. It must be decided with Social Services, who take the lead role, what strategies need to be in place to minimise the risk to all service users.
Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 16 Most of these incidents have involved one particular service user. Triggers for challenging behaviour and how this behaviour is presented are listed comprehensively in their care file but there are no actual strategies in place on how staff should respond. The manager reported that the service user listens and responds to some staff but not others. This is one reason why a consistent approach is absolutely necessary. The manager reported that staff are not trained in challenging behaviour and appropriate techniques for defusing situations. Given previous incidents and the lack of confidence of some staff appropriate training must be identified and accessed. This is made a requirement in this report. Chapel Street Care Home DS0000008646.V293976.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 and 30 Quality in this outcome area is good. Service users live in a clean and homely environment but until work to address the high temperatures in the conservatory is completed an adequately comfortable environment is not achieved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On a tour of the premises it was evident that since the last inspection the requirements to replace floor coverings in bathrooms and replace stair carpet have now been complied with. The environment is clean and in communal areas furnishings are domestic in style. There is a homely feel. At the last two inspections it was identified that the conservatory, the main communal area gets very hot and uncomfortable. The original recommendation to replace ceiling blinds is not going to be acted on because it has been advised that this will not satisfactorily reduce the temperature. The intention is to have air conditioning installed and quotes are currently being obtained. Air conditioning will mean the conservatory will be comfortable for residents and staff to use all year round.
Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 18 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 and 36 Quality in this outcome area is good. Service users benefit from an effective and well supported, well trained staff team. Recruitment practice does not fully protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training records and certificates indicate that staff attend all mandatory and refresher training such as Food Hygiene and First Aid and also attend other relevant training courses such as epilepsy, diabetes, loss and bereavement and person-centred planning, to enable staff to meet the collective and individual needs of service users. More than fifty percent of the staff team are qualified with National Vocational Qualification (NVQ) level 3. Three staff files were selected, including the file of one staff member that has commenced employment since the last inspection. There was evidence on these files that regular supervision takes place. A staff member spoken with confirmed that he gets good support and good training. On two of the staff files there was evidence that the necessary recruitment checks have been carried out. There were two written references and Criminal Record Bureau checks. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 19 For the recently recruited staff member the date of issue on the Criminal Record Bureau check is after they commenced employment and no POVA First check was carried out. A requirement has made in respect of this. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 20 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 and 42 Quality in this outcome area is good. The health, safety and welfare of service users are promoted and protected. The home is well run and systems for monitoring the quality of care are in place, to ensure the home is run in the best interest of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is currently providing management cover at another Mencap service. There is a temporary manager in post and evidence found at this inspection indicates that the home is generally well run. The home receives a full service review from the provider Mencap every three years. On an annual basis service user surveys are distributed. These are presented with pictures so they are more accessible to adults with a learning disability. A manager from another Mencap home visits the service annually to chat with service users and audit care practice issues. The manager completes a ‘Service Improvement Plan’ as a result of quality monitoring and
Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 21 feedback. The provider also carries out monthly visits in accordance with Regulation 26 of the Care Home Regulations 2001. The registered manager must ensure that any accident in the care home, which results in a medical practitioner being called on is notified to the Commission in accordance with Regulation 37 of the Care Home Regulations 2001. There were some accident records seen where the paramedics have been contacted and / or service users have had to go to Accident and Emergency. The fire log shows that all necessary fire safety testing and drills have been carried out. The servicing of equipment and electrical and gas systems are all up to date. Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 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 Standard No Score 1 2 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 X 3 X 2 X 3 Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 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 YA20 Regulation 13 Requirement Ensure there are adequate arrangements in place for the recording, handling, safekeeping and safe administration of medicines received into the home. This refers to: 1. Ensure all medicines are administered as prescribed. (Quantities should tally with what has been signed as given) 2. Carry over any quantities of medicines onto current Medication Administration Records, to ensure all quantities are accounted for (or return to pharmacy) 3. Ensure Medication Administration Records are clear, to avoid confusion and error. Ensure there are specific instructions for the administration of medicines from the GP and that the pharmacy have copied onto the MAR and medicine labels these instructions correctly. Timescale for action 01/11/06 Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 24 2. YA23 13 3. 4. YA23 YA34 13 19 5. YA41 37 Ensure all incidents of abuse between service users are notified to Social Services in accordance with local Safeguarding Adults procedures. Identify and arrange appropriate training for staff in managing challenging behaviour. Ensure all necessary recruitment checks are returned before a staff member commences their employment. Ensure all notifications are made to the Commission, as specified under this regulation. 01/11/06 31/12/06 30/11/06 01/11/06 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. 2. 3. Refer to Standard YA6 YA17 YA20 Good Practice Recommendations Add more evidence on care plans and reviews that service users have been involved in this process. In addition to menu plans, make a record of what meals and food service users have actually eaten. For service user that self-medicates, negotiate with pharmacy on whether they can dispense into MDS or compliance aid (cassette) to avoid secondary dispensing in the home. Develop individualised procedures for responding to and managing the challenging behaviour of the named service user. Complete work to make conservatory comfortable communal space for service users and staff. 4. 5. YA23 YA24 Chapel Street Care Home DS0000008646.V293976.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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