CARE HOME ADULTS 18-65
Collinson Court 56 Longton Road Trentham Stoke on Trent Staffordshire, ST4 8NA Lead Inspector
Wendy Jones Unannounced Monday 20 June 2005 3.50pm The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Collinson Court Address 56 Longton Road Trentham Stoke on Trent Staffordshire ST4 8NA 01782 658156 01782 643103 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Autism Tascc Services Limited Ms Karenann Williams Care Home 10 10 10 Category(ies) of LD registration, with number MD of places Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20 December 2005 Brief Description of the Service: Collinson court is a purpose built care home, registered to provide accommodation for 10 adults. The home provides a specialist service to people with an autistic spectrum disorder, service user primary diagnosis must be Learning disabilities they can have a dual diagnosis of a mental health condition. The property provides ground floor accommodation divided into four areas each with it’s own entrance. These consist of two four person apartments, two single person flats and staff office/training area. Each apartment and flat has it’s own garden area the gardens to the rear of the property are secure.The home is located off the main Trentham to Longton road, it provided off road parking and shared drive access. The building is single storey providing access to wheelchair users. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on 20th June 2005, the inspection methodology, included inspection of staff rota’s; care records, medication records; records of staff meetings; communication documentation; daily records; fire safety documentation; discussion with staff; observation of service users and service user/staff interactions; participation and involvement in an evening meal; inspection of the physical environment in flat 1 and apartment 2 and the exterior of the home. What the service does well:
The service provides specialist care for service users with a learning disabilities, have Autistic Spectrum Disorders and who present behaviours that are considered challenging. The records provided staff with detailed assessments and information they required to meet the needs of service users. Care plans were very regularly reviewed with evidence of changes to plans if necessary. Risk assessments were comprehensive. The dietary requirements of service users were known by staff and catered for. The health and personal care needs of service user were adequately met, there was evidence of regular health related appointments and consultation with specialist health professionals. The systems for the storing, receiving and returning of medication were satisfactory. There was explicit information available regarding the purpose and effects of medication, in addition the preferred method of administering medication for each service user was recorded. The service has a complaints procedure that had been produced in a userfriendly format for the benefit of service users. Procedures were also in place for the protection of Vulnerable Adults. Staff meetings were recorded regularly and systems were in place for the induction and supervision of staff. Staff morale was high. The service has made every effort to ensure the accommodation is well maintained and provided in a homely and comfortable manner given the constraints of the service and the dependency of service users. Some areas of the home were of a very high standard. All areas of the home were clean and hygienic.
Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Ensure that protocols for as required medication are available for staff to follow, ensure that all staff have been involved with at least annual fire training and that night staff receive fire drills. Monitor and report the recorded high fridge temperatures in apartment 2, and ensure that, while there is a cook vacancy this does not impact on the care staff hours or affect service users. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 7 The service could provide an alternative to the main meal at all meal times and ensure that service users are able to make an informed choice. Ensure that staff have the documentary information they require to safely administer as required medication and ensure that all staff responsible for the administration of medication had undertaken certificated training. Provide a record of staff training that gives an overview of training received and required including when updates are due. The manager must ensure that any allegations of service user abuse are properly reported and investigated. The outstanding environmental and fire safety matters highlighted at previous inspection and monitoring visits must be addressed within the time scales given. Ensure that service users lifestyles are not compromised by the staffing deficits created by the cook vacancy. Ensure that staff are fully familiar with the organisations policy relating to staff expenses when accompanying service users on community visits. 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. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x Not inspected. This standard will be reviewed at forthcoming inspections. EVIDENCE: Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,9. The standard of care planning was good, providing essential information regarding the care service users required. Risk assessments were detailed ensuring the safety and well being of service users. EVIDENCE: Care records contained very good information relating to the assessment of need. Social and personal histories were documented; a 24 hour plan gave detailed information regarding service users daily routines and the support they required to meet their personal care needs. Care plans were in place for each identified area of need; records showed that they were subject to regular reviews. Risk assessments had been completed for each assessed area of risk, staff were familiar with the action required to reduce risk. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 Dietary needs of service users were catered for with a balanced and varied selection of food available that meets service users dietary needs. EVIDENCE: Service users were provided with a balanced diet, individual dietary needs were recorded and known to staff. It was not established at this inspection how service users were involved in menu planning and choice of meals. A choice of main meal should be provided at all meal times. The evening meal in Apartment 2 was observed during this inspection meals were well presented and of adequate portion size. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20. The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the administration of medication were generally good with evidence of some very good practice. Information regarding the administration of as required medication was in most instances inadequate, potentially placing service users at risk. EVIDENCE: There was evidence of frequent health monitoring and appropriate action taken to address any health issues identified. Specialist health input was accessed very regularly. Reviews of health and medication needs were carried out with a Consultant Psychiatrist. The service operates the NOMAD cassette system to safely administer medication. Medication records were appropriately maintained, the medication file contained evidence of staff signatures and initials, copies of medication administration procedures. Records showed that medication was handed and signed over at the end of each shift and that the systems in place for stock control were effective, including records of received and returned medication.
Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 13 There was very explicit information on file regarding service users preferred method of taking medication, and how this could be managed in a sensitive and supportive manner. Protocols for the administration of as required anti psychotic or anxiolytic medication were missing from the medication file. It was reported that they had been taken to the G.P. for signing, before the 10th June 2005. It was of concern that the protocols were not available to staff for this period of time, or that a copy had not been retained on file until such time as they were agreed and signed by the prescribing health professional. Protocols for the administration of as required rectal diazepam were in place. It was confirmed that two staff were enrolled on a distance-learning administration of medication course, and that training and up dates in the administration of Rectal Diazepam were planned for July 2005. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. Procedures for the protection of service users were in place, further efforts were required to ensure the protection of service users. EVIDENCE: A complaints procedure was displayed in the home and had been produced in a format that was considered to be user friendly. Records of complaints were not available during this visit. The Commission for Social Care Inspection had received no complaints since the last inspection. The service has policies and procedures in place for the protection of vulnerable adults. Since the last inspection any event that affected the well being of service users had been appropriately reported to the CSCI, Social workers and families. Incidents of service user on service user assault had reduced, efforts were being made through behavioural management strategies and staff intervention to reduce this occurrence further. This has been of significant concern and the subject of previous inspection visits. It was of concern that records of staff meetings indicated that an incident of shouting at service users had been reported to senior staff in the home. This matter was discussed. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 15 Records showed that staff had been reminded that this behaviour was not acceptable. The manager was contacted following the inspection to act on and investigate these matters. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,28,30. Recent investment has improved the appearance of areas of this home creating a comfortable and safe environment for those living there. The completion of outstanding works will further improve the service provided for the safety and well being of service users. EVIDENCE: The service is provided in a purpose built single storey property, in a residential area of Trentham. The accommodation is in 4 areas, 2 single person flats and 2, four person apartments. Additional room is provided in an area used to accommodate a gym, an activities and a training room; a staff sleep in room also provides an area where relatives can meet in private. Each of the 4 flats/apartments has it’s own garden area for the benefit of service users. Car park space is available on the shared driveway leading from the main road to the home. At the last inspection and subsequent monitoring visits a number of environmental matters were discussed. The organisation has confirmed it’s
Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 17 commitment to compliance with the requirements made and while the original time scales have not in all instances been met, there was evidence of a planned programme of works to address the matters to the satisfaction of the CSCI and Fire Safety Officers. This inspection included observation of Apartment 2 and 1, of the single person flats. Apartment 2 provided accommodation for up to 4 service users; at the time of the inspection there were 3 service users in residency. The open plan lounge/dining room in apartment 2 had been re-carpeted since the last inspection. The lounge had two, two seat sofas, a number of bean bags were also used, a television and television unit and a cabinet for the storage of records. The dining area had two tables and seating, secured to the floor. Service users had access to a pleasant garden/patio area, with suitable garden furniture, flowers in planters Flat 1, provided single person accommodation, a significant improvement in the environment was noted since the last inspection. The environment was generally more homely, with comfortable furnishings, evidence of accessories and coordinating fabrics. A new floor had been fitted in the bedroom and shower unit. A specialist mattress had been provided to provide the service user with more comfortable sleeping arrangements. Staff had made considerable efforts to ensure that the environment was appropriately maintained including repainting and retouching walls when damage had occurred. It was accepted that to maintain the environment to an acceptable standard will require on going commitment by staff and the organisation. Fridge temperatures in the main kitchen were recorded daily, a sample of fridge temperatures in the training kitchen in apartment 2 were recorded and noted to be in excess of the recommended range, for May and for most of June 2005. This matter was discussed with the manager during the verbal feedback given on 21st June 2005. The service was clean and free from offensive odours. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Some staff turnover and sickness had disrupted consistency of care to service users. Staff moral was improved since the last inspection, resulting in an enthusiastic approach. EVIDENCE: Staffing levels were recorded as follows, The manager had been on duty from 7.30am-3pm, a team leader from 7.30am-3pm (stayed until approx 6pm). Apartment 1:- 2 staff 7.30am-3pm, 1 staff 7.30-10pm, 2 staff 3-10pm, a sleep in staff and waking night staff. Apartment 2:- 1 staff 7.30am-3pm, 1x 9am-3pm, 2x 3pm-10pm, 1 waking night staff. Flat 1:- 1 x7.30-3pm, 1x 7.30-10pm, 1x 3pm-10pm, 1 waking night staff. Flat 2:- 1x 9am-4.30pm. One staff was off sick for all the week, and three other shifts had been lost to sickness in the week of the inspection. There was a staff vacancy for a cook that had occurred some time ago. The responsibility for catering for the main meal of the day was undertaken by one
Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 19 of the senior staff in apartment 1, reducing the staffing levels in this area. While acceptable in the short term, to address an unexpected staff absence, this situation must not continue for long periods of time. The service is required to provide appropriate staffing to accommodate the deficit in hours created by the cook vacancy. Since the last inspection the service had recruited two activity assistants (DFS), unfortunately both were on annual leave. Staff confirmed that service users engagement in activities had improved significantly since the last inspection. 3 staff were spoken to individually and two others were included in general discussion regarding the service. It was reported that staff training was provided by the organisation but access to training records was not possible during this visit. The service is required to provide evidence that statutory training is up to date, such training includes, health and safety, fire training, infection control, manual handling, first aid and basic food hygiene, and that all staff have received such training as required to meet the needs of service users, for example CPI, epilepsy, Autism awareness, communication training. Staff reported that some were undertaking a distance-learning course relating to the safe administration of medication; arrangements were in place for staff to receive training or updates in the administration of Rectal Diazepam. CPI training had been provided in June 06. Records of staff meetings evidenced that they were held regularly, meetings were held for each of the staff teams, separate meetings had been arranged for the Activity staff. Staff supervisions were also recorded regularly. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41,42 The health and safety of services users was promoted through satisfactory application of policies and procedures. EVIDENCE: From discussion it was apparent that staff were not fully familiar with the organisations policy relating to staff expenses, when accompanying service users on community visits. It was recommendend that this matter is addressed. Fire safety checks were recorded, servicing documentation was up to date, insurance certificates were displayed, Health and Safety audits had been carried out, recommendations were being acted upon. Fire drills had occurred and were recorded regularly, it was recommended that a record of staff who attend a drill is recorded and a requirement that night staff are involved in fire drills. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 x x 4 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x 2 x 3 Standard No 11 12 13 14 15 16 17 x x x x x x 3 Standard No 31 32 33 34 35 36 Score x x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Collinson Court Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x 2 2 x E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement Timescale for action 21/09/05 2. 3. YA24 YA24 4. YA30 5. 6. 7. 8. YA24 ya33 YA17 YA17 All staff responsible for the administration of medication must undertake a certificated course that meet the guidance for administration of medication in care homes.(previous time scale 21/03/05) 23 (2) The service must provide a visitor wc.(previous time scale 26/04/05) 23(4) All fire safety matters identified must be addressed following consultation with fire safety officers.(previous time scale ongoing) 23(2)(k), The service must provide more 16(2)(f)(j) suitable laundry and sluicing facilities.(previous time scale 21/03/05) 23 (2) The service must provide a visitor wc.(previous time scale 26/04/05) 18 The responsible person must provide evidence that staff have undertaken mandatory training. 13 Ensure that fridge temperatures are maintained within the recommended levels. 13 The responsible person must ensure that staff have written information regarding the
E51 E09 S8324 Collinson Court V234544 Stage 4.doc 21/07/05 21/07/05 21/07/05 21/07/05 21/07/05 24 hours 30/06/05 Collinson Court Version 1.30 Page 23 9. 10. YA23 YA33 13 18 11. YA42 13,23(4) administration of as required medication. The registered person must 05/07/05 investigate the alleged verbal abuse. The service must provide 30/06/05 appropriate staffing to accommodate the deficit in hours created by the cook vacancy. The service must ensure that 28/06/05 night staff are involved in fire drills. 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. 4. Refer to Standard YA41 YA17 YA42 Good Practice Recommendations Ensure that staff have access to and understand the organisations policy relating to staff expenses, when accompanying service users on community visits. Ensure that service users are able to make an informed choice of main meal at each meal time. Record the names of staff who have attended fire drills. Collinson Court E51 E09 S8324 Collinson Court V234544 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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