CARE HOME ADULTS 18-65
Chestnut Street, 59 59 Chestnut Street Southport Merseyside PR8 6QP Lead Inspector
Mr Paul Kenyon Unannounced Inspection 24th November 2005 16:30 Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 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 Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 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. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chestnut Street, 59 Address 59 Chestnut Street Southport Merseyside PR8 6QP 01704 539505 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) Speciality Care (Rest Homes) Limited Mrs Greta Morphet Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 3 LD Date of last inspection 28th February 2005 Brief Description of the Service: 59 Chestnut Street is a registered care home offering support to three individuals with learning disabilities. The home provides term time accommodation for students who attend Arden College, a local educational resource that specialises in the provision of life skills to individuals with a learning disability with a view to promoting future independent living. Greta Morphet is the Manager of the service. Arden College is a subsidiary of Speciality Care, a private organisation. The home is located in a residential area of Southport, close to local amenities and transport links. The home is a semi-detached property that has not been specifically adapted for the purpose of the service. The home consists of a ground floor, which contains a kitchen, dining room and a lounge to the front. All bedrooms are located on the upper floors with two rooms on the first floor and a further one on the second floor. A bathroom is available with toilet as well as a staff sleep-in room/office on the top floor. The home is not suitable as accommodation for students with a physical disability at present. Students are able to access all parts of the home. As a result, no adaptations are required at present. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection to be held at 59 Chestnut Street this inspection year. The inspection took two and a half hours and took place during the early evening. The management team had been informed in advance of the date of the inspection but staff in the home had not. The notice given of the inspection reflected the need to ensure that students living at the address would be available to give their views of the service they receive. Service users living at 59 Chestnut Street are referred to as students in this report given that the address provides term-time accommodation while they attend the local specialised college. The inspection included a tour of the premises as well as an examination of a number of records to evidence that the standards measured for this inspection had been met. The main part of the inspection included detailed discussions with two students about their experiences with the third student offering views towards the end of the visit. The nature of the accommodation is such that students generally only use the service for approximately two years before they move on. As a result, students living at 59 Chestnut Street at present were not there at the last inspection in February 2005. What the service does well:
The service is god at ensuring that assessment information about students is retained within the home. This assessment information includes assessments by external agencies as well as a trial assessment period carried out by the organisation as a whole. The service is good at having a clear system of care planning, which is reinforced by daily records, weekly tutorials and reviews on a monthly basis by the unit manager. The service is good at producing risk assessments that are dated and provide information about the level of risk involved in students pursuing everyday activities. These risk assessments cover general areas of risk that could be posed by the environment as well as risk that is linked to the individual needs of students. The service is good at providing students with information about local facilities within the community and enabling them to be involved in community
Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 6 activities. The service has now provided students with supervised access to the Internet within the house itself. The service has secure storage for medication and systems to ensure that all received and disposed medications are correctly accounted for. In the main the service ensures that any complaints students have are listened to through the holding of weekly tutorials as well as joint student/staff meetings. The service is good at ensuring that students feel safe and are protected from abuse. This is reinforced by staff training in abuse awareness and policies in respect of action to be taken if allegations of abuse are made. Comments from students were significant at this inspection in measuring standards. Comments included: ‘I know Southport well now’ ‘I think the place is OK’ ‘I feel safe’ ‘They help me if I need to go to the Doctors’ ‘Staff keep me busy’ ‘I feel safe but sometimes the three of us do not get on but that is because there are three of us living here and that is normal’ ‘I can now go to college on my own, I was nervous at first but afterwards I realised it was great and I felt good about it’ Interactions with staff and students were noted. These are positive and it is clear that students are empowered in a number of areas and are able to take part to contribute to the routines of the house. These included cooking, cleaning, doing their laundry, answering the door and answering the telephone. Staff remain a key point of reference for students and interact in a positive, friendly, informal and guiding fashion. What has improved since the last inspection?
The requirements at the last inspection have all been met. The service has ensured that all students are aware of the content of their plans of care given that all students have now signed to confirm that they are aware of the contents of the plan. Their awareness of care plans is also confirmed through the use of weekly tutorial sessions. Areas surrounding the goals that have
Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 7 been set for students as well as their own personal goals are recorded on a weekly basis and include reference to how students consider they are progressing. The service now ensures that risk assessments are dated and a date is set for future review. The service now ensures that all medications that are received by the service are recorded and any disposed medication is also included in these records. The service has now included information for staff in respect of whistle blowing. Information is now on prominent display for staff providing information on how they can contact the Commission for Social Care Inspection to express any concern they have about care practice and how the regulator can be seen as an external agency to investigate concerns if they arise. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 9 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 Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The assessment processes within the organisation enable the aspirations and wishes of students to be assessed and made known to the staff team. EVIDENCE: Assessment information relating to all three students was examined. All tree have lived in other service connected to the college during their education. Despite the fact that assessment information had been gathered during their stay within the college, assessment information was readily available for staff in 59 Chestnut Street to refer to. The funding authority through the learning skills council produces assessment information. In turn an application is made to Arden College with whom all three students are educated. Once received a decision is made about the suitability of the placement. In addition to this, records suggested the college undertakes an assessment for a six-week period when further information about the student is gained. Refusals to admit students can occur according to the residential manager yet given that all three current students have gone through this process in other service with the same organisation, it has been concluded that their needs can be met by the college. Assessment information generates those needs that are unique to that individual. Information covers their educational needs as well as their needs in relation to daily living such as behavioural issues, levels of personal care and emotional support they may need.
Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 11 Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Students are aware of the existence of care plans and have the opportunity to influence these on a weekly and monthly basis. Students are enabled to take risks in order that independence is gained. EVIDENCE: All three care plans were examined. These refer to educational needs as well as those needs that reflect issues of daily living within any residential placement. These are included within care plans as a whole. Evidence suggested that these reflect initial assessments. Evidence was also present to suggest that students agreed with the content of each plan given that they had signed them. Care plans are reviewed in a number of ways. The staff team maintains a daily record of progress. Students also maintain their own diaries and these were available for inspection. A weekly tutorial session is held between the college’s tutor as well as the unit manager and this is recorded. This provides a weekly review of how needs are being met and whether plans of care are progressing or need to be altered. As a matter of course, the unit manager provided evidence of his own particular reviews, which occur on a monthly basis.
Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 13 Risk assessments are available outlining the risk involved in aspects of daily living within the house as well as in the wider community through activities based there. All have been dated and a review date set for September 2006. These risk assessment were general and referred to potential hazards in the home but in all cases, assessments were available outlining risks tat are associate with the individual student themselves. On student stated that he was now independently accessing the local college and another work placement; ‘I felt nervous at first but realised I felt great about it’. This was included in this person’s risk assessment. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 Students are provided with information about their local community and are encouraged in some cases to access this independently but with consideration of risk. A recommendation is raised in respect of transport availability. EVIDENCE: Students conformed that they knew the local community facilities; ‘I know Southport well’, ‘I need some help but know the main places in the town’ and ‘I was born here’. Activities tend to be less structured in the evening and at weekends given that all students undergo a structured programme of routines in the home linked to their needs and in college linked to education issues. That night all students were going to go ten-pin bowling. An issue arise from students about transport. They felt that sometimes they were limited because transport made available by the organisation for staff was not always available. A car had been made available fir that night’s activities but in response to this observation by students, a recommendation is made in respect of this. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 The health needs of students are taken into account and acted upon. Medication systems are safe. EVIDENCE: Records suggested that no students have any enduring health problems. Students confirmed that ‘if we have a health problem, staff will take us to the Doctors or wherever’. Records confirmed that a recent visit had been arranged for one person to confirm this. Records include an indication of the health need, dates of the appointment and the outcomes involved. A requirement at the last inspection outlined the need for all received medication to be recorded. This had been done given that records had been commenced when three other students had been in the home up to last summer. All their medications received had been recorded. No students living at the address at present are on medication and therefore these records are not used. A locked medication cabinet is available and there are records relating to received and disposed medications. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Students do not feel that they have been provided with clear information about how they can make a complaint. Students are protected from abuse and harm. EVIDENCE: A complaints procedure is available as well as one, which is considered to be in a more appropriate format for students and their needs. The main complaints procedure was shown to students who felt that it was not readily easy to understand. This procedure does include reference to the Commission For Social Care Inspection. The unit manager explained to students that a more readily accessible procedure was available in the dining area. One student stated that he did not know it was there. As a result, it is required that this complaint is reinforced to students. A complaints record is available and included a complaint from a relative of a student who has since left the service. This showed evidence that the complaint had been investigated and an outcome reached. No complaints about the service have been received by the Commission for Social Care Inspection. Training records confirmed that all staff had received abuse awareness training. A procedure is available but has only been signed by one out of the three permanent staff. Given that all staff have received training, it is recommended at this point that the two other members of staff sign the policy to confirm they know of its existence and to reinforce the training they have been given. Students stated that they feel safe. One student commented on the daily life of the home and while he felt safe stated that sometimes ‘the three of them don’t get on’ yet ‘this is normal when you are all living together’. The comments did not suggest that his safety had been compromised and essentially he felt ‘safe’
Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 17 Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards in this section were measured during this inspection. EVIDENCE: Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 Students are protected by procedures used to recruit the current staff team. EVIDENCE: Personnel files relating to all three permanent staff were examined. These staff work in the home almost without change although there is some need to alter this following annual leave. All files included a minimum of two references, information to confirm the person’s identity and evidence of a criminal records check. In all cases a copy of job descriptions were available as well as a medical declaration statement. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The health, safety and welfare of students are staff are not fully promoted. EVIDENCE: Training records suggested that staff had received all mandatory training with the exception of some training that was compulsory or related to the needs of the service. All staff have received fire training, all have food hygiene certificates, all have had training in health and safety and the control of substances hazardous to health. Not all staff had manual handling training or first aid training. The latter is important given that staff work on their own reflecting the needs of students. Infection control training must be provided to two staff given that infection control issues need to be taken into account when laundry is being done. This is because the washing machine is in the kitchen and clothes that need to be washed may come into contact with food preparation areas. Other health and safety systems are in place to ensure the safety of all connected with the house. Fire detection systems are checked regularly and labels on fire fighting equipment suggested that these had been recently
Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 21 serviced. Fire drills take place and are recorded. Three have occurred since September 2005 and students confirmed that these had happened. A fire risk assessment dating from 2005 was also available. Health and safety checks take place weekly. These include measuring water temperatures, refrigerator/freezer temperatures and the general state of the fixtures and fittings. Where items need to be repaired, a system for repairs is in place. The inspection took place during the early evening by which time it was dark. The level of students’ involvement in household routines is significant. This includes emptying bins into the bin outside. For this students and staff need to use the back door to get to the main bin. This is unlit and poses a potential accident threat to students and staff alike with trip hazards being present. It is required that a light is installed to the exterior of the building providing light to this area. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 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 3 X X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chestnut Street, 59 Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000005270.V266807.R01.S.doc Version 5.0 Page 23 NO 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 2 Standard YA22 YA42 Regulation 22 23 Requirement Timescale for action 31/12/05 3 YA42 13 The complaint procedure must be reinforced to students External lighting to the rear must 15/12/05 be provided to ensure the safety of students and staff during the hours of darkness All staff must receive infection 31/01/06 control and manual handling training 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 Refer to Standard YA13 YA23 Good Practice Recommendations Transport provided by the organisation should be made more available in line with students’ wishes Two members of the staff team should sign the protection of vulnerable adults procedure to reinforce the training in this area that they have already received. Chestnut Street, 59 DS0000005270.V266807.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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