CARE HOME ADULTS 18-65
Church Street Care Home 53 Church Street Eastwood Nottingham NG16 3HR Lead Inspector
Stephen Benson Key Unannounced Inspection 18th October 2006 9:30 Church Street Care Home DS0000008651.V316578.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 Church Street Care Home DS0000008651.V316578.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. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Church Street Care Home Address 53 Church Street Eastwood Nottingham NG16 3HR 01773 787446 01159 104267 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) N.C.H.A. Julia Faith Watkinson Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users shall be within category LD Date of last inspection 31st January 2006 Brief Description of the Service: 53 Church Street is a detached property standing in its own grounds close to the centre of Eastwood and its amenities. The home is registered to provide support and accommodation to five adults with a learning disability. Two residents are due to be leaving the project. They will be the first residents to leave the group since it opened 13 years ago. There is a large open plan dining room and living room and the kitchen is domestic in scale. There is no lift to the first floor, however there is an adapted bathroom on the ground floor for wheelchair users. The home was run as part of a joint scheme with the local health authority but is now solely managed by Nottingham Community Housing Association. The basic fee is £357 per week but this varies upon the benefits a resident is entitled to and prices are available when applying for a place. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit to the home since 1st April 2006 by The Commission for Social Care Inspection. Prior to the visit an analysis of the home was undertaken from information gathered over the last year. The inspection looked at key standards for younger adults. The site visit lasted for 4 ½ hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with staff. Only one resident was present during the inspection who was unable to comment, so this report does not contain any views expressed by residents. A discussion was had with the manager, deputy manager and staff on duty. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. A pre inspection questionnaire was completed and a survey forms sent to the home by The Commission for Social Care Inspection had been completed by a relative. What the service does well:
The home has had their first admission in many years recently. There was a Community Care Assessment on file and a relative had been involved in the admission process. The evidence shows that new residents are assessed before they come to live at the home. There are clear and detailed plans of care for the assistance residents need and they include promoting independence, privacy and dignity. The evidence shows that residents know their assessed needs and personal goals are reflected in their individual plan. Residents are given choices where they are able, although these are limited due to the level of residents’ abilities, and staff will use prior knowledge as to what residents prefer. The evidence shows that residents make decisions they are capable of about their lives with assistance as needed. There are limited opportunities for residents to take risks as apart of an independent lifestyle in order to promote their safety. The evidence shows that residents’ safety is considered as a priority when assessing risks as part of an independent lifestyle. All residents attend a local day centre where they can meet and mix with others and participate in appropriate activities. The evidence shows that residents are able to take part in age, peer and culturally appropriate activities. Residents use local facilities including the church, healthcare services, parks and shops. The evidence shows that residents are part of the local community. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 6 Residents are able to make choices they are able to, for example if they want to go to the day centre and the time they go to bed. The evidence shows that residents’ rights are respected in their daily lives. Residents are provided with personal support in private and staff time is available according to the help residents need. The evidence shows that residents receive personal support in the way they require. Residents have routine heath care checks and their well being is monitored. The arrangements for administering medication include safe storage and a record is made when any medication administered. The evidence shows that residents physical and emotional health needs are met. Staff have received training on the Adult Protection Procedures and these have been followed to ensure the protection of a resident. The evidence shows that residents are protected from abuse, neglect and self harm. Some areas of the home have been decorated and some new carpets laid. It is planned to replace the hall carpet shortly. Staff were sorting out pictures for the walls. The evidence shows that residents live in a homely, comfortable and safe environment. Staff do cleaning when residents are out at the day centre and have protective clothing provided. There is a separate laundry and the washing machine has a sluice facility. The home appeared clean, tidy and fresh. The evidence shows that the home is clean, pleasant and hygienic. The manager has worked at the home for a number of years and is currently working towards The Registered Managers Award. Staff felt the home was suitably manager. The evidence shows that residents benefit from a well run home. What has improved since the last inspection? What they could do better:
The home’s mini bus has not been available due to change in insurance arrangements, which has meant that residents have been restricted in where they can go. The home has a complaints procedure and a complaints book, however residents have not been supported to make a complaint regarding the mini bus. The evidence shows that residents are not provided with the support they need to access the complaints procedure. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 7 There are not any systems in place to seek the views of residents and their supporters on the running of the home. The provider is not carrying out monthly inspections of the home as required. The evidence shows that the views of residents do not influence the self monitoring, review and development by the home. Contracts are in place for servicing equipment, but some fire tests have not been carried out and no action has been taken where the fridge and freezer temperatures are shown as above the required safe temperatures. The evidence shows that the health, safety and welfare of residents are not being fully promoted and protected. 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. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents are assessed before they come to live at the home. EVIDENCE: The home has recently had a new resident admitted, which is the first one in sixteen years. There is currently another vacancy, which it is intended to fill. A Community Care Assessment was obtained for the new resident, which was seen on the file, and a relative was actively involved in providing information and supporting the admission process, which staff found very helpful and said they still ask the relative about things as they arise as they learn about his likes and dislikes. The manager said that not having had an admission for so long means they have not developed their practice and would use the recent admission as an opportunity to do so. In a survey forms sent out by The Commission for Social Care Inspection and completed by a relative’s satisfaction was expressed with the admission process. The manager said that anyone is welcome to apply for a place providing they fall within the registration category for the home. There are both male and female residents of a variety of ages at the home, all of whom are of white European origin. Church Street Care Home DS0000008651.V316578.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents assessed needs and personal goals are reflected in their individual plan. Residents’ make decisions they are capable of about their lives with assistance as needed. Residents’ safety is considered as a priority when assessing risks as part of an independent lifestyle. EVIDENCE: Care plans are prepared using a computerised system which staff have been trained to use. The home also prints off a copy and keep these in a file, the manager said these are easier and quicker for staff to refer to. Care plans seen were clear and detailed, and referred to promoting independence, privacy and dignity and care plans included details of resident’s gender, ethnic origin, religious beliefs and any disability. Staff input daily notes on the computer system.
Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 11 Files seen were very full and were not easy to use as there was no uniform system to them and no index of care plans to make reference easy. Staff were seen having difficulty to find a specific care plan. Much of the information held in the file could be archived keeping only current and relevant information in it. Staff said that they try to give residents as much choice as possible, but this can be limited and they often have to assist residents to make choices and they use information known about each resident. Staff gave an example of asking a resident whether they would like a drink of tea or coffee and they would always reply the last one said, so were looking at making a cup of each for them to choose. The manager said that where able residents will make choices, one resident has their own biscuit barrel thy can help themselves to biscuits from. Residents’ safety is always considered as a priority and as a result there are limited opportunities for residents to take risks as part of an independent lifestyle. Staff described one resident assisting to make a cup of tea, but not being able to use the kettle and the manager said residents can go into the garden provided the gates are closed as no one is able to go out unless accompanied. Church Street Care Home DS0000008651.V316578.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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in age, peer and culturally appropriate activities. Residents are part of the local community. Residents have appropriate personal and family relationships. Residents rights are respected in their daily lives. Residents are offered a healthy diet. EVIDENCE: Residents attend a local day centre, which also uses a local building that residents sometimes go to. Currently one resident is attending a college course. One resident requires additional support of a member of staff to enable them to attend the day centre. Staff said they have not been able to use the mini bus for several months due to changes in insurance arrangements. This has resulted in residents not
Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 13 being able to go out as frequently and limited places they can go to. Staff said one resident likes to use a swing and is taken to a local park. Staff said residents are taken for walks and go to local shops. One resident attends a local evening club. The manager said that some residents go to a local church and use local healthcare services. Some residents have relatives actively involved and another has a befriender. There is one resident who does not have a relationship outside of the home. Residents are supported to get up and be ready for their day time commitments, although they can chose not to go if they want and are able to stay at home if unwell. Staff said residents usually want to go to the day centre. Staff said that residents choose the time they want to go to bed and one resident likes to have a bath morning and evening. Staff know about residents preferred routines and support these. One resident returned from day centre and staff waited to see if he wanted to go to his room for a while or have a drink as it varies on how he feels. The manager said another resident likes to go for a walk when he comes home. The main meal is provided at the day centre and a lighter meal is had in the evening, however if a resident doesn’t have a main meal at lunchtime one is then provided in the evening. Residents have their meals when they choose and the manager said that it is rare for all resident to eat together. The manager said that any special diet for personal choice, religious or health reasons would be accommodated. Church Street Care Home DS0000008651.V316578.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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they require and with respect. Residents physical and emotional health needs are met. Residents are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Staff said that all residents require some support with their personal care and this is done in private. Each resident has his or her own room. The manager said that two residents require one to one staffing. Care plans detailed what support each resident requires. Residents attend routine health appointments in the local community where they are able to. Arrangements can be made for services to be bought into the home if they want. Staff said that on occasions residents do not cooperate with healthcare professionals and new appointments have to be made. Staff said it had been noted that morning that one resident appeared to be bruising easily and a doctor’s appointment is being made.
No residents are able to self medicate. There are appropriate storage arrangements for medicines and a record is made when each dose is administered. Staff said that if a resident refuses their medication this is recorded and they try to give it to them again later.
Church Street Care Home DS0000008651.V316578.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are not provided with the support they need to access the complaints procedure. Systems are in place to protect residents from abuse, neglect and self harm. EVIDENCE: The home has a complaints procedure and a book to record any complaint in. The manager said that no recent complaints have been made, however it was identified that residents were unhappy at the loss of the use of the mini bus. Residents do not have sufficient understanding to access the complaints procedure without support and ways of providing this support are needed. Staff said that they thought a relative did raise a concern about the lack of transport with a service manager. Staff were aware of the Adult Protection Procedures and have received training in these. The procedures were followed to ensure that a resident was fully protected from another and this was recorded in the resident’s care plan. The manager said that any form of abuse or discrimination would not be accepted and would be dealt with by following the Adult Protection Procedures. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment, but is not suitable for wheelchair users. The home is clean, pleasant and hygienic. EVIDENCE: The home has recently been decorated in some areas and some new carpeting provided, however the hallway carpet is also in need of replacement, which the manager said will be done shortly. Staff were seen sorting out pictures to hang on the walls. The manager said that repairs are carried out promptly by the housing association. The building is not suitable for wheelchair users as there is restricted access on the ground floor and none on the first. There is one resident who uses a wheelchair, but the manager said she would not envisage any more residents who use a wheelchair coming to the home. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 17 Staff are currently preparing a sensory room upstairs, which they said residents enjoy elsewhere, however the resident who uses a wheelchair will not be able to access this. Staff share in doing the laundry and cleaning and have appropriate protective clothing available. There is a sluice programme on the washing machine and the manager said consideration is being given to fitting a sluice. Residents will assist with some cleaning, although this is extremely limited due to their abilities. Church Street Care Home DS0000008651.V316578.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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff. Residents are supported and protected by the home’s recruitment policy and practices. Residents individual and joint needs are met by appropriately trained staff. EVIDENCE: There are a minimum of two support staff on duty at all times with additional staff coming in at key times identified and to take residents out. Staff said that there is usually only two staff on in the mornings, which can be difficult due to the amount needing to be done. Recruitment and training were previously managed through the local health authority. Future recruitment will be undertaken by Nottingham Community Housing Association where they place block advertisements to recruit staff to all vacancies within their projects. The manager said that all the required checks and tests will be carried out. Training is now being organised by Nottingham Community Housing Association and this includes all mandatory training. The manager said it is a transitional time and the new systems need time to take hold. Some staff have completed National Vocational Qualifications level 2 and more will be doing so when a new assessor has been identified.
Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 19 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home. The views of residents do not influence the self monitoring, review and development by the home. The health, safety and welfare of residents are not being fully promoted and protected. EVIDENCE: The manager has been in post for a number of years and is currently working towards The Registered Manager’s Award. Staff said everyone works together and the home is suitably run, although there could be some improvement with communication. The home does not have any system for seeking views of residents and their supporters on the running of the home. The manager said this had been discussed at a meeting the previous day and they will be looking at doing this.
Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 20 A requirement was set at the last inspection for the provider to undertake monthly unannounced visits to the home. These have not happened and the requirement is repeated in this report and must be complied with or The Commission for Social Care Inspection will consider taking legal action. The manager said that there are contracts in place for the servicing of equipment and the required safety checks and tests are carried out. The fire log showed weekly tests are usually carried out, but there were occasional gaps when this had been missed. The manager said Nottingham Community Housing Association undertake some health and safety checks including testing water storage and portable electrical appliances. A record is made of fridge and freezer temperatures each day, however the temperatures recorded varied greatly and no action has been taken to identify the cause of this. Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 21 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 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 3 X 3 X 2 X X 2 X Church Street Care Home DS0000008651.V316578.R01.S.doc Version 5.2 Page 22 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 YA22 Regulation 22 Requirement The registered person must ensure that residents are supported to access the complaints procedure if appropriate The registered person must ensure that a system for seeking the views of residents and their supporters is introduced The registered person must ensure monthly unannounced visits to the home are undertaken and a report prepared of the visit REPEATED REQUIREMENT The registered person must ensure that the health, safety and welfare of residents are protected Timescale for action 10/11/06 2 YA39 24 01/01/07 3 YA39 26 01/12/06 4 YA42 12 24/11/06 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. Refer to Standard YA6 Good Practice Recommendations The registered person should organise care plans so they are easier to refer to.
DS0000008651.V316578.R01.S.doc Version 5.2 Page 23 Church Street Care Home 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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