CARE HOME ADULTS 18-65
Coppice & Oakside Shipley Common Lane Off Heanor Road Ilkeston, Derbyshire DE7 8TS Lead Inspector
Brian Marks Unannounced 20 April 2005 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. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Coppice & Oakside Address Shipley Common Lane Off Heanor Road Ilkeston Derby DE7 8TS 0115 944 3690 0115 944 3690 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) United Health Marion Atherton Care Home 10 Category(ies) of Learning Disability - 10 registration, with number of places Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 28 November 2004 Brief Description of the Service: Coppice and Oakside is a purpose built home offering 10 places for adults with a severe learning disability, set in 2 bungalows linked at the rear through the enclosed garden areas. The physical environment of the home was designed to a high standard, and is spacious and comfortable. The majority of the current resident group were admitted as part of the closure of Aston Hall Hospital, near Derby, and all had spent long periods living in an institutional environment. The range of abilities demonstrated by the 2 groups of service users is quite different, with the 4 residents in Oakside being more independent and having higher communication and self-help skills. Because of the levels of disability in the resident group, the home offers an intensive package of support on a 24 hour basis, and staffing levels are accordingly very high. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 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 visit that took place at the home over half a day. Additionally time was spent in preparation for the visit, looking at previous reports and other documents and, after the visit, in telephone calls to 2 care managers from Social Services who are involved with residents at the home. Apart from examining documents, care files and records, time was spent looking around the 2 buildings that make up the home and speaking to 5 staff who were on duty and to the manager. The 4 residents at Oakside all made some comments about care at the home, but the residents at Coppice were not able to do this. They were observed throughout the visit being cared for by staff. What the service does well: What has improved since the last inspection?
Improvements have continued to be made to the look of the home and corridors and lounges have been redecorated, as have some of the bedrooms. Improvements have been made to some of the residents’ care plans so that staff can care for them in safer and more consistent ways. Unnecessary documents have been taken out of the files and the descriptions of what needs
Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 6 to be done by staff have been reduced in order to make them easier to understand. When new staff are recruited the home is required by law to obtain information about people who want to work at the home, to ensure that they are safe to look after the residents and will not harm them. The amount of information has recently increased and the home managers are doing everything that they should to ensure increased safety. The systems of ensuring good standards of health and safety around the home have been brought up to date, particularly in relation to fire safety equipment, which has all been properly serviced. 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. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 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 standard(s) 2 Residents’ needs were met through a system of assessment, carried out both before and after coming to the home, that formed the basis of the way staff cared for them in consistent and individual ways. Some of the care plans had been recently revised to improve the ways in which staff helped residents with their lives. EVIDENCE: Information received from previous inspections and from the examination of case files indicated that residents had extensive assessments of their requirements carried out before they came to the home, although none had come to the home recently. The case files examined also had documents from the care managers who became involved after the residents had settled at the home, indicating that the difficulties faced by the residents had continued to be examined. One file examined indicated that staff at the home had revised the programme of help within the past six months. The file contained a set of assessments of important problems, the actions to be taken (care plans) and ‘risk assessments’ of some sections where particular difficulties were being faced. All of these documents are individual to the resident concerned. Documents in the other case files looked at did not indicate that this process of revision had fully occurred.
Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 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 standard(s) 6, 7 and 9 Detailed individual care plans have been developed at the home so that consistent patterns of support can be given and the welfare and safety of residents maintained. These included a system of identification and management of risk areas that also contribute to overall safety of residents. Most residents have poor verbal communication skills and staff have developed individual ways of understanding what they want from their lives at the home. The residents who are able to speak out are encouraged to involve themselves with their care and staff are very good at carefully listening to what they want. EVIDENCE: Examination of case files indicated that residents have a plan of care, which included aspects of personal and health care specific to the individual concerned. New staff, in particular, commented that these documents helped them get a clear picture of the residents and showed them how to provide consistent and individual help. The manager confirmed that a process of revising and reducing the amount of documentation held within these files had been started since the last inspection. Within the documentation there are clear indications that the care plans had been reviewed regularly by the home’s staff, but not all had involved recent reviews with care managers and other key
Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 10 people. Resident welfare is potentially put at risk by staff acting on information that is not current. The residents of Coppice have great difficulty with verbal communication, and staff were observed making use of a number of ways of understanding individual characters, such as simple verbal prompts and gestures. For example, staff described how some residents enjoyed quiet places whilst others liked the bustling crowds of the town centre staff; finding this out involved an element of ‘trial and error’. Newly appointed staff described how they had been helped to gradually learn about the residents by working alongside more experienced staff and not being left working alone. Those residents that could make verbal indications of their wishes were encouraged to do so and these were recorded in their files. In particular, this was confirmed by the talking to the residents in Oakside. Some elements of the care plans include risk assessments, which indicate key areas of concern and ways in which staff can minimise or eliminate any problems. This was carried out to ensure individuals did not come to harm, and to guide staff in safe ways of working. Examples of the problem areas covered included difficult behaviours, falling because of poor walking ability and sudden recent weight loss. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 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) 12, 15 1nd 16 Because of the capability of the group of people who lived at this home Standard 12 only applies to one who attended a local college. This was particularly good for him because he was with people his own age. Residents were encouraged to keep in contact with their families. EVIDENCE: All of the people living at this home are disabled by a learning disability and have no interest or capability in paid employment. One regularly attends a local college and the programme was laid out in his care file. Staff said that he particularly enjoyed and benefited from the social environment during his attendance and being with people of his age own group. Two of the residents of Oakside also attended a local special day centre. Indoor activities within the home remained a major part of the day for the service users and a variety of activities were observed during the inspection. Staff stated that these were aimed at sensory stimulation and improving communication. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 12 Records and individual files examined indicated that people living at the home were encouraged to maintain family links and this had been achieved with varying success. A family member of one resident was present during the inspection and he reported that he visited every day and had very good relations with staff at the home and was happy with the lifestyle his daughter enjoyed. Friendships within the group of people living at the home were discussed with staff as a number had shared an institutional life before coming to the home. Access to a local social club for disabled people had been encouraged to help the development of friendships outside the home. Examination of daily programmes indicated that they were not over structured and staff were keen to emphasise that residents were, for example, able to get up at any time during the morning if they didn’t have any outside appointments; this was observed during the inspection. At all times during the inspection staff were respectful in their communication with residents and privacy of service users was respected by the closing of doors, particularly bathrooms. Some residents continued to spend periods of time alone in their rooms. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 13 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) 18, 19 and 20 Problems with residents’ health and personal care are well managed by the staff at the home and they are able to get the assistance of outside professionals when they need it. They are also able to obtain special equipment for certain individual residents, which is used to make their lives easier. The administration of medicines by staff is well organised. EVIDENCE: Information in individual care plans indicates how staff at the home would care for and support residents; additionally the care managers spoken to said how well staff did this and how they all used the same approaches. Specialist equipment and furniture that had been supplied to individuals was seen in use and in bedrooms. Records indicated that staff had been instructed in their use and resident lives were made easier. Records also showed how outside professionals were able to help residents; a physiotherapist, and a psychologist are currently involved with the residents whose files were looked. Staff said that they assist them to work more effectively. Some of the residents have complex health problems and staff are assisted by the local GP practice to deal with these; these include epilepsy and difficult behaviours as well as 1 service user who had had a recent sudden weight loss. The care managers spoken to were positive about the ways in which staff at
Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 14 the home deal with health related problems. Records on individual files indicated regular contact with the dentist and optician. There are no residents who manage their own medicines and systems operated by staff at the home were satisfactory. A new member of staff spoken described how she had been allowed to gradually take on responsibility for giving out medicines to residents, but always under supervision. Staff also receive formal instruction from the home’s pharmacist to ensure that they are carrying out this task safely. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home has robust policies and procedures in place to protect the residents from harm and these have recently linked well with the Statutory Procedures to practically demonstrate the manager and staff’s commitment to safety in this area. EVIDENCE: Policies and procedures for protecting from harm are well established at the home but levels of training on the subject have not been maintained to match the numbers of new staff regularly joining the team; it is covered in a very broad sense during induction to the home and for those staff getting training in a National Vocational Qualification (NVQ). There have been 2 incidents involving the home’s residents during the past 12 months that involved the Statutory Procedures being put into operation, involving the local Social Services Department. Staff were subject to investigation and disciplinary procedures in one of these incidents, and the management and staff of the home were seen to act swiftly in order to protect the residents. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 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) 24and 30 The home is equipped, furnished and maintained to a high standard and offers homely and spacious facilities for residents to enjoy. This is both a valued and valuing environment in which to live and work. EVIDENCE: The home was built specifically for this group of residents, and its corridors and rooms are large. It was supplied with a good range of equipment, furniture and fittings of a style that could be expected in an ordinary domestic setting. Security against both intruders coming in, and residents going into unsafe places or wandering off, is covered by a keypad system in Coppice, and a routinely-locked front door in Oakside. The home is near the town centre of Ilkeston and the home’s transport offers good access to local amenities. The improvement programme of the home has been continued and 1 of the bedrooms visited had been recently redecorated. The home continued to benefit from the services of a maintenance person who ensures that all repairs are completed quickly and who is also responsible for a number of health and safety activities. The domestic assistant on duty described the cleaning programme for the home and also how problems of incontinence were managed. Both bungalows
Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 17 have well-equipped and maintained laundries, with care staff responsible for the personal laundry and bedding of residents. Standards of cleanliness and hygiene were high at the time of the inspection Because of the high standard of the environment of the home these 2 standards are scored as 4. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 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) 32, 33, 35 and 36 The home is well staffed with experienced, skilled and knowledgeable people who are supported to work effectively by management and the staff peer group. EVIDENCE: Records on staff files showed that 9 care staff had completed or were completing an NVQ qualification at a minimum of level 2, but this is not at the required proportion of 50 of staff. There is a mix of well established and newly appointed staff at the home and the staff spoken to described how they had been encouraged to support one another and work together. All of them were very committed to their work at the home and high levels of job satisfaction were talked about. They all talked about the residents as individuals with different needs and were able to describe clearly the activities that took place to care for the individuals selected for discussion. Information from the staff rota indicated numbers of staff on duty in excess of the required standard. There has continued to be a regular turnover, and 2 of those on duty during the inspection were appointed since the beginning of 2005. The manager had chosen to limit the use of agency staff on daytime shifts and rely on existing staff taking extra shifts; they were more effective
Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 19 with care for residents and offered more consistency. The staff meet together on a regular basis and those meetings were recorded. Staff stated that had enjoyed regular access to training and development opportunities, although discussion with the manager indicated that some important areas had not been covered in relation to key health and safety subjects (see next section). Recently appointed staff said that they had been introduced to the home in a helpful way, although the manager confirmed that this had not been done within nationally agreed guidelines of the Learning Disability Award Framework (LDAF), as the NMS recommended. Staff said that were given good levels of support that helped them carry out their work properly. They said that the manager or senior staff were always available and that because they always worked with someone else within the home they never felt that they had been left to resolve difficulties by themselves. One experienced member of staff said that she had been allowed to take increasing amounts of responsibility and that this had given her confidence in her work with residents. However, the manager had not introduced a formal system of 1-to-1 meetings with staff and remained unconvinced of the best way to introduce this within the home, having unsuccessfully tried a number of different approaches. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 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) 37, 39 and 42 The manager is a qualified nurse and has a broad range of skills, knowledge and experience relevant to working with the people who live at this home. Safety of the home had been improved through the servicing of fire safety equipment and specific aspects of staff training, but the latter process is not yet complete. EVIDENCE: The manager is a nurse with a learning disability qualification and has extensive experience of a working with people with this type of difficulty. The manager is currently completing a Registered Manager’s course (NVQ4) with a local training outlet. The manager confirmed that she had not been able to arrange training in relation to fire safety for staff, due to problems with the training agencies; this was a requirement of the last inspection. Not all staff, particularly those recently appointed had received training in all of the important aspects of health and safety practices but the manager is qualified to train in safe moving
Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 21 and handling techniques and this subject is well covered in the staff group. As mentioned before in this report the maintenances person has a number of responsibilities in relation to health and safety at the home and from the records examined, all aspects of routine servicing of fire safety equipment had been carried out, as required at the last inspection. Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 4 x x x x x 4 Standard No 11 12 13 14 15 16 17 x 3 x x 3 3 x Standard No 31 32 33 34 35 36 Score x 2 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Coppice & Oakside Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 23 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. 2. Standard YA6 YA23 Regulation 15(2) 13(6), 18(1) 18(1), 19(5) 9(2) Requirement All residents care plans must be reviewed with outside agencies at leats every six months. All staff must receive training in their responsibilities in relation to the protection of vulnerable adults. The target of 50 of all care staff achieving an NVQ at a minimum of level 2 by the due date. The registered manager of the home must achive an NVQ in management and care at level 4 by the due date. All staff must receive training in relation to the fire safety of the home at least annually for day staff and twice a year for night staff. (Previous timescale of 30.11.04 not met). All staff must receive instruction in food hygiene and infection control. Timescale for action 30 June 2005 Ongoing 3. YA32 31 December 2005 31 December 2005 30 June 2005 4. YA37 5. YA42 18(1), 23(4) 6. YA42 13(3), 18(1) Ongoing Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 24 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 YA23 YA35 Good Practice Recommendations The manager should attend the Social Services briefing in relation to the abuse of vulnerable adults. Any training provided to staff, including induction and foundation training, should be provided to all newly appointed staff in line with Learning Disability Award Framework (LDAF) standards. The registered person should structure staff training needs into individual plans that reflects the care activities carried on at the home. The manager must develop a formal 1-to-1 system of supervision for all staff. To assist with this develoment she should participate in training to enable different models to be evaluated for the home. 3. 4. YA35 YA36 Coppice & Oakside C02 C52 S19965 Coppice Oakside V222774 200405 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection South Point, Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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