CARE HOME ADULTS 18-65
Connect Community 19-21 Park Road Moseley Birmingham West Midlands B13 8AB Lead Inspector
Jill Brown Unannounced Inspection 22nd March 2006 09:30 Connect Community DS0000016863.V287230.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 Connect Community DS0000016863.V287230.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. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Connect Community Address 19-21 Park Road Moseley Birmingham West Midlands B13 8AB 0121 449 2204 0121 449 6124 admin@connecttc.org 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) Connect Therapeutic Community Limited Ms Carol Ann Gordon Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. That the home can provide care and accommodation for up to 10 service users of either gender between the ages of 18-65 years of age suffering with a mental health problem (MD). That the manager completes the Registered Managers Award by December 2006. 14th October 2005 Date of last inspection Brief Description of the Service: The home is situated south of the city centre and lies close to a frequent bus service into Birmingham. The property is part of a large Victorian terrace, and is similar in appearance to others on the road. The building has been adapted throughout its history and has several corridors, stairways and changes of level inside. There are two front doors, only one of which is in general use, and this is accessed via a walled and gated front. There is a garden to the rear of the property, which contains a greenhouse, some lawned and flower areas and a laundry. Office spaces, lounges, therapy rooms, a kitchen and dining room are found on the ground floor. There is a mixture of double and single rooms on the first and second floor. Toilet and bathing facilities are communal. Connect provides care and support for up to ten people with mental health issues. The mission statement for Connect states. We are a therapeutic community providing high quality residential and non-residential psychotherapy for clients and support services to professionals working with them. Using Transactional Analysis as our main framework, we provide therapy for psychological, emotional or behavioural problems in order to promote life long, sustainable improvement to that individuals quality of life. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken on the morning of a day in March and lasted just over two hours. Connect had an announced inspection in October 2005 where the most of the core standards were assessed. It is recommended that the announced report be read in conjunction with this report. One service user file and two staff files were inspected. Service users were around the building at the time of the inspection and appeared well. What the service does well:
Thorough assessments of potential service users are carried out prior to admission. These assessments include information from associated health and social care professionals. Service users spend time at Connect prior to admission and are able to make the decision about whether it can help them. Service users have a therapeutic and care plan, as well as a plan derived from the Care Programme Approach (CPA) meeting. These plans are reviewed. Service users were undertaking leisure activities and where appropriate attended education courses. One resident had achieved a number of certificates whilst being at Connect. Service users maintain skills of managing both cooking and domestic, service users devise a rota to ensure this happens. There is a good supply of food and arrangements were made to meet service users dietary needs. The building was clean and fresh at the time of the inspection. Appropriate checks were made for before staff were employed at the home. Staff were given support according to their experience and qualifications. All staff receive clinical support. There is a meeting on a weekly basis with staff and service users at which concerns, requests for support and praise can be aired and this is recorded. Connect have an annual audit from Community for Communities and undergoes peer audits with other communities. This safeguards practises within Connect. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Connect Community DS0000016863.V287230.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 Connect Community DS0000016863.V287230.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): 2, 4 Arrangements for assessment and trial stays at Connect were good. This enables service users to be clear about the service the community offers. EVIDENCE: Before being admitted into Connect, service users have a thorough assessment over several months and also spend some time usually about three days at Connect before the decision is made to offer a place. The assessments include information from other sources such as social care and medical assessments. Highlighted in these assessments is a history of service users’ risk behaviour and plans are made to minimise these risks and these are called ‘structures’ at Connect. Connect does not take service users on an emergency basis without a full assessment. This assessment process was found on the newest admission to Connect. Service User’s are admitted as part of a care programme approach (CPA) to meeting the service users needs. Connect Community DS0000016863.V287230.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 The service user has a therapeutic plan and a care programme approach plan in place on admission. A care plan is worked on after admission to determine service user’s personal goals. EVIDENCE: The service user file sampled had evidence of a therapeutic plan. A care plan had not yet been developed but a plan had been commissioned by the CPA meeting. General restrictions in freedoms were outlined in Connect’s Statement of Purpose and an explanation given. Connect also had rules for communal living and individual safety of service users. These rules were revised through the meetings with service users in Connect. Individual service users had structures as part of their care plan that changed as service users needs and risk level changed. Therapeutic plans were reviewed on a monthly basis. Connect Community DS0000016863.V287230.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): 11, 12, 17 Opportunities for external leisure and personal development were arranged when the service user could enjoy these. The arrangements for meals and food were good and responded to service users individual need. EVIDENCE: Service users seen during the inspection were engaged in the upkeep of the cleanliness of the community. One service user was assisted to undertake a leisure activity within the safety levels of their difficulty. One service user had recorded achievements in education and this was recognised by the whole community. One service user had since left Connect as a resident and was being supported to adjust to life outside of Connect. Service users planned meals to be provided and were responsible for the preparation of food. Meal times were a key time at Connect where service users meet and eat with staff. At these points service users’ well being is checked and as this is part of
Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 11 the therapeutic programme. Meal times are set. Food is available at other times although service users make choices such as for the biscuits to be locked away to assist service users’ diets. Connect had good supplies of food, some food was brought in by the service users and other was ordered as needed. Service users were aware of the need for food to be rotated, fridge temperatures were kept and for food to be dated in the fridge. It was clear from the food in stock that a wide range of fresh, frozen, dried and canned food was available. Service users were aware of other service users dietary requirements and for example food without salt was available. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 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 the following standard(s): 20 The arrangements for the administration of medication were good and responded to the safety needs of the service user. EVIDENCE: Connect had implemented the recommendations on medication of the last inspection ensuring that two people checked medication and the numbers of medication were written on the MAR. It was recorded that where safe service users were assisted to become selfmedicating especially prior to leaving the community. Connect Community DS0000016863.V287230.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 on this occasion. Connect Community DS0000016863.V287230.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): 30 The community’s environment was clean and fresh on the day of the inspection and showed the efforts of the service users. EVIDENCE: A full tour of Connect was not completed but the areas of Connect that were seen were clean and hygienic. The kitchen was in good order. Service users take responsibility for the upkeep of communal areas and Connect has a rota of domestic chores. None of the service users have physical care needs. The emphasis is on service users maintaining domestic skills and motivation for living outside of the community. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 15 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, 34, 35, 36 Connects arrangements for the recruitment of staff were satisfactory and this protects service users. Further improvements on supervision of staff to ensure clarity in any performance issues. EVIDENCE: Connect was staffed with two staff from 8am until 11pm with a sleep in member of staff being available. This was acceptable level with the current service users. The requirement to ensure enough staff was available to ensure that service users were able to undertake activities was not inspected on this occasion. The employment records for two new staff were seen. Connect had a formalised recruitment process that can be seen within the staff records. References were checked and Criminal Record Bureau (CRB) checks were completed. The storage of and completion of records were subject to further guidance from CRB and copies of the guidance were to be obtained to ensure full compliance. Connect has undertaken training with staff except for gaining disability training. The registered manager had found difficulty arranging this with a disabled trainer. It was agreed for this to be pursued from a mental health trainer.
Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 16 Connect had presented a framework of training to replace NVQ 2 for staff as being more suitable for staff in this type of service and this is being progressed by the community. Staff employed either have varying levels of skills and experience prior to working at Connect and clinical support is given to all staff. Connect had started to look at staff supervision in addition to clinical support and had undertaken a number of appraisals as beginning to this process. Recorded supervision other than the clinical practice was needed to ensure the employer responsibilities and to assist with maintaining the confidentiality for service users. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 17 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): 37, 39, 43 Connect had appropriate audits of its service and took into account service users views. Management of Connect was satisfactory with issues being acted upon and this protects service users. EVIDENCE: The manager had become a registered manager with the Commission since the last inspection and was undertaking the Registered Managers Award (RMA). There is a condition of registration that this award is completed by the 30 December 2006. The service users had a routine weekly meeting with the staff of Connector discuss any issues. The records of this meeting showed a range of issues. The meeting was used for example for the service users asking support to achieve something, to praise individual service user’s achievement, difficulty with reception on the TV, and requests for new bed and for a service user to challenge a structure on behaviour. Outcomes of the discussions were recorded. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 18 Connect has an annual audit by Community of Communities and this looks all areas of the service’s performance. Unfortunately the audit available was for 2004 as the 2005 audit had been delayed to the beginning of 2006 and the report had not yet arrived. There was also evidence that Connect is involved with peer audits of other communities in the country. The manager of Connect reported that Connect has had a five-year wiring certificate but this was not available on the inspection and there was evidence of the water quality had been tested. A West Midlands Fire Service inspection had been undertaken since the Commission’s last inspection and Connect had acted on the small number of requirements made at that visit. Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 19 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 3 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 X 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X 2 X 3 X X X 2 Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 20 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 YA33 Regulation 18(1a) Requirement The registered manager must ensure that the staffing levels reflect the service users need for support in outside activities. (This aspect of the standard was not assessed on this occasion) Staff at Connect must undertake disability awareness training. (This remained outstanding since 31/01/06) The Commission and Connect must continue to work on the proposal for training to replace NVQ2 care training to make it relevant to the service. All staff must have, in addition to specialist supervision, recorded supervision at least 6 times a year that reviews performance, training and development. (This requirement was outstanding since the 31/05/05) The registered manager must complete the Registered Managers Award by December 2006. The registered manager must ensure that a copy of the five year wiring certificate be sent to the Commission by
DS0000016863.V287230.R01.S.doc Timescale for action 31/05/06 2 YA35 18(1c)(i) 31/05/06 3 YA35 18(1c)(i) 31/07/06 4 YA36 18(2) 31/07/06 5 YA37 10(2) 31/12/06 6 YA43 23(2)(b) 30/04/06 Connect Community Version 5.1 Page 21 7 YA43 13(4)(c) The registered manager must ensure that a copy of the Legionella certificate be sent to the Commission by 30/04/06 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 YA5 Good Practice Recommendations It is recommended that the contract Connect has developed be adjusted to reflect practice when placements break down. (This was not inspected on this occasion and was brought forward) Connect Community DS0000016863.V287230.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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