CARE HOME ADULTS 18-65
Collinson Court 56 Longton Road Trentham Stoke-on-trent Staffordshire ST4 Lead Inspector
Ms Wendy Jones Unannounced Inspection 21 December 2005 10:50 Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 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 Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 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. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Collinson Court Address 56 Longton Road Trentham Stoke-on-trent Staffordshire ST4 01782 658156 01782 643103 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) Autism Tascc Services Limited Ms Karenann Williams Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th June 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 users’ primary diagnosis must be learning disabilities although they may have a dual diagnosis of a mental health condition. The property provides ground floor accommodation divided into four areas, each with its own entrance. These consist of two four-person apartments, two single-person flats, a staff office, training area, activity room and gym. Each apartment and flat has its own garden area and the gardens to the rear of the property are secure. The home is located off the main Trentham to Longton road; it provides off-road parking and shared drive access. The building is single-storey, providing access to wheelchair users. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on 21st December 2005 and feedback was given to the manager on 22nd December. Information for the inspection was provided from discussions with staff; from inspection of the environment, records, and other relevant documents; from interaction and conversation with service users and discussion with the regional manager. What the service does well: What has improved since the last inspection?
The recruitment drive undertaken by the service have been successful in attracting new care staff. Certificated medication training had taken place for all staff responsible for the administration of medication. Relevant information regarding the purpose and effects of medication was available.
Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 6 Staff had received training in recognising and reporting abuse. All fire safety issues highlighted at previous inspections and following discussion with fire safety officers. Some redecoration and refurbishment has occurred, improving the environment for service users. 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. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 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 Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 The home’s Statement of Purpose and Service User Guide are excellent, providing service users and prospective service users with details of the services the home provides, enabling an informed decision about admission to be made. EVIDENCE: A Statement of Purpose and Service User Guide had been completed, giving the necessary information to enable service users and their supporters to make a decision about moving into the home. The aims and objectives and service philosophy are included in both documents. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 There was a clear and consistent care planning system in place to provide staff with the information they need to meet service users’ needs. There was concern that care plans and risk assessments had not been followed in all instances. EVIDENCE: Care plans and risk assessments were explicit, subject to very regular reviews and reflected the assessments of service user needs. Monthly summaries of care plans were provided. 24-hour plans were excellent, giving detailed accounts of the daily routines and preferences of each individual. Following discussion with staff and the manager of the home and from the information seen in records of staff meetings, there was concern expressed that care plans were not properly followed, which would have a direct impact on the behaviour of service users. This was felt to be an issue particularly with one service user whose behaviour had deteriorated.
Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 10 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): 12, 15, 16. The standard and frequency of activity in and out of the home for some service users had increased, providing more opportunities to engage in social and leisure activities. EVIDENCE: The service provided an activity room where table-top activities could take place. One service user enjoyed riding a bicycle in the grounds of the home. A small gymnasium also provided service users with an opportunity to participate in exercise on a one-to-one basis. Hobbies and interests are facilitated in each of the apartments and flats and recorded as part of the activity plans of individuals. A sample of service users’ records showed that activity plans were in place. The service employed day care workers to supplement the support workers and to provide more opportunities for service users to engage in activities in and out of the home. Records showed that service users were supported to maintain contact with relatives and friends.
Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 11 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): 18,19, 20 The health needs of service users were met with evidence of good multidisciplinary working taking place, although further efforts to seek specialist support should be pursued for the benefit of service users. EVIDENCE: Staff were observed interacting appropriately with service users, and there appeared to be positive relationships between service users and staff in the flats/apartments visited. There was evidence that the service had been involved in multi-disciplinary working and assessments over a period of time, although it was reported that recently there had been limited involvement with psychology services due to resource issues for that service. A consultant held very regular meetings at the home to discuss individual service users’ progress and health care needs. In a psychology report dated 07/03/05 a recommendation was made for training in Behavioural therapy for staff. It was disappointing to note this had not occurred and of particular concern, given the reported behavioural management difficulties presented by some service users. Medication was appropriately stored. Records showed that protocols were in place for the administration of as-required medication, and administration records had been signed at the time of administration for all other medication.
Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 12 There was evidence of regular reviews of medication with the consultant psychiatrist. A sample of medication records were inspected to establish the frequency of administration of as-required medication. One service user had reportedly exhibited very unsettled and challenging behaviour for a period of time. A sample of 20 days’ records were reviewed. During that time there were 10 incidents recorded, 8 occasions when aggressive behaviour had occurred and 6 occasions when as-required medication had been given. The records indicated that during the periods of aggression, staff had been assaulted and injuries had occurred. A review of medication had occurred in September and a decrease in incidents was evident, with 7 occurring in the following month and no as-required medication, compared to 12 incidents and 7 occasions in the previous month where as-required medication had been given. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: These standards were not inspected during this visit. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 14 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): 24, 27, 30 The standard of the environment within this home is good, providing service users with an attractive and homely place to live. Areas for action had been identified at previous inspections. EVIDENCE: This inspection did not include a detailed inspection of the home, but it was pleasing to note that there had been some significant improvements in the appearance of apartments 1 and 2 and flat 1, through refurbishment and redecoration. A request for a change to the boundary fencing between two of the apartments had been discussed with the Commission for Social Care Inspection since the last inspection - the reason for the request was to help reduce the anxiety of one service user. Quotes had been sought but due to difficulties with suppliers the fencing had not been replaced, it was hoped that this matter could be resolved. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 15 There were a number of outstanding environmental issues that had been subject to requirements of previous inspections, these included: lack of a visitor toilet, lack of suitable laundry facilities, lack of suitable sluicing facilities. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 16 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): 33, 35, 36 The staff morale in this home is low and although sickness levels had improved there was an atmosphere of uncertainty, caused by two of the senior staff leaving, the lack of a manager and a lack of autism training. EVIDENCE: Staff vacancies included: a cook, a DSF, one full-time team leader, one fulltime and one part-time support worker. Staff numbers on the day of the visit included: Apartment 1, 5x 7.30am-2.30pm 1x 7.30am-10pm 2x 2.30pm-10om Flat 1, 2x 7.30am-2.30pm 1x 9am-4.30pm 2x 2.30pm-10pm, 1 of whom doing the sleep-over Apartment 2, 3x 7.30am-2.30pm 2x 2.20pm-10pm Flat 2, 1x 9am-4.30pm
Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 17 There were also 3 waking night staff, 9.30pm-8am. A number of service users were allocated and funded for 1:1 staffing - in apartment 1, one service user was funded for 15 hours and another funded for 10 hours. In flat 1 the service user was funded for 2:1 staffing in the home and 3:1 outside the home. Records of staff meetings were seen and it was noted that, in the comments for apartment 1, discussion included staff not following care plans and generally not adhering properly to the routines that had been established in the unit. This was of particular concern, given a number of incidents that had recently been reported to the Commission for Social Care Inspection. Meetings were recorded for 27/09/05 and 18/11/05. Records of meetings for apartment 2 showed that meetings had occurred on 20/05/05 and 06/07/04 and it was recommended that more frequent meetings would be of benefit. Supervision of staff had occurred, and a new supervision and appraisal system was to be introduced in 2006. There was a need to ensure that staff who have the responsibility to supervise staff have received the training and feel competent to do so. A requirement was also made in relation to the provision of Autism training for new staff. A staff hand-over was observed during which staff were given an account of the events of the shift and any matters to be actioned during the next shift. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 18 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): 39, 42, 43 The manager had provided leadership and worked hard to promote the service and achieve the standards expected. The health and safety of service users had been compromised by risk assessments not being followed. EVIDENCE: Monthly reports on the conduct of the service had been copied to Commission for Social Care Inspection as required by regulation. Since the last inspection the service has been successful in acquiring recognition and accreditation from the Autistic Society. The care manager was leaving the service on the day after this inspection visit; she had tendered her notice in June 2005. It was reported that efforts to recruit a suitable replacement had been unsuccessful. It was of concern that Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 19 the Commission for Social Care Inspection had not been informed in writing of arrangements for the ongoing management of the service. During the visit staff were in discussion about salaries. One member of staff had not been paid correctly for a few months and there were examples of other staff having 37.5, 42 and 30 hour deficits. It was reported that an event beyond the control of the organisation’s office for salaries ability to operate had resulted in some salary errors. These matters were discussed with the regional manager for her attention and action, and assurances were given that the matter would be resolved. Two reportable events had occurred with one service user, where it appeared that risk assessments and care plans had not been followed. The potential consequences of these events was significant and a requirement of this report is for these events to be investigated. On another occasion a member of staff had sustained a fracture during an incident with a service user who was exhibiting challenging behaviour. It was reported that an investigation into the accident would be carried out and the outcome should be made available to Commission for Social Care Inspection. Fire drill records showed that night staff had not been involved in recent drills. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 20 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 3 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 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 2 36 2 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 X 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 3 X x X 3 X X 1 1 Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 21 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 YA42 Regulation 37 Requirement Timescale for action 21/02/06 2. 3. 4. YA24 YA42 YA30 5. YA37 6. 7. YA43 YA35 8. YA33 The outcome of the investigation into the reportable incidents must be provided to the CSCI 23 (2) The service must provide a visitor WC.(Previous time scale 26/04/05, 21/07/05) 23(4) All staff including night staff must be involved in fire drills 23(2)(k),16(2)(f)(j) The service must provide more suitable laundry and sluicing facilities.(Previous time scale 21/03/05, 21/07/05) 9 Provide formal notification of the management arrangements for the service when the current manager leaves on 22nd December 2005. 12 Resolve the issues causing staff discord relating to incorrect salary payments. 18 Ensure that all staff have received the training necessary to meet the needs of service users. 18 The service must provide appropriate staffing to
DS0000008324.V274784.R01.S.doc 21/04/06 21/02/06 21/04/06 21/01/06 21/01/06 21/03/06 21/02/06 Collinson Court Version 5.1 Page 22 9 YA19 12 accommodate the deficit in hours created by the cook vacancy. (Previous time scale 30/06/05) Access behavioural 21/03/06 specialist input for the service user identified and supply staff with support in managing the challenging behaviours presented. 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 YA36 YA36 Good Practice Recommendations Staff responsible for the supervision of staff should be trained to do so. More frequent staff meetings should be arranged. Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Collinson Court DS0000008324.V274784.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
