CARE HOME ADULTS 18-65
Creative Support 7 Sidney Road Blackley Manchester M9 8AT Lead Inspector
Steve O`Connor Key Unannounced Inspection 17th July 2006 12:00 Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Creative Support Address 7 Sidney Road Blackley Manchester M9 8AT 0161 205 7314 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) Creative Support Ltd Mary Carter Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of seven (7) service users in the category of MD (Mental disorder, excluding learning disability or dementia) of either sex. Three (3) named service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age) may be accommodated within the overall number of registered places. Two of the seven places are situated in 19 Allen Roberts Close, which backs onto 7 Sidney Road. These two places are for service users moving towards independent living. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 8th November 2005 Date of last inspection Brief Description of the Service: The home is managed by Creative Support and is based at 7 Sidney Road and 19 Alan Roberts Close (neighbouring properties) that operate as a single scheme offering 24 hour care and accommodation to five people in the core house (Sidney Road) and two in the cluster house (Alan Roberts Close). The primary needs of the people living at the home relate to their long-term mental health. The scheme is situated in the Blackley area of North Manchester, within close proximity to public transport, shops, parks, churches and a local market. Both properties are sited on residential streets. There is parking available at both properties and each has a well-maintained rear garden. In Sidney Road bedroom accommodation is spread over the three floors. All bedrooms are single with hand washbasins and the ground floor bedroom has an en-suite bathroom. Communal space is provided in both properties along with kitchen and laundry facilities. Information provided by the home showed that the fee charged was £355.98 per week. Details about the home and its services can be provided on request from the home. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the home was last inspected in November 2005. This information includes an Action Plan sent in response to that inspection report and a pre-inspection questionnaire (PIQ) completed by the home and submitted in June 2006. Additional information such as questionnaires sent to people living at the home and about incidents that have affected the people living there was also used to write the report. A visit was made to the home without telling them that an inspector was coming. Time was spent talking to people who stay at the home, staff on duty and the Manager. Staff were observed in how they work with people. Documents and files relating to people and how the home is run were also seen and a tour of the building was made. The visit was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used alongside other information passed to the CSCI to make a decision on the quality of the service and to decide what action and how much work the CSCI needs to do with the home in the future In the last inspection report four areas were identified where the home needed to make improvements and four recommendations regarding improved working practices were identified. The home had taken action to address all the areas of work identified. What the service does well: The home makes sure that before a new person comes to live at the home, they have received all the information they need to make the decision of whether they can support the person and how that person may have an impact on the people already living at the home. Examples were seen of assessments from occupational therapists, mental health specialists and the information that the home finds out when they meet with people before they come to live at the home. By doing all this and getting the right information the home can show that they have considered whether the home can provide the support the person needs and also how this may affect the other people living at the home. Each person who lives at the home has a named member of staff who works with them to find out exactly what help the person needs and the best way to give that help. They also work together to find out what the person wants to
Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 6 achieve, the activities they enjoy and what will make their lives better and more enjoyable. The persons’ care plan is a written document that reflects all these areas of work and how to help people in staying well and healthy. The information put together by the person and the keyworker focuses on how the person wants to be helped. It tells what the person likes and does not like, about their history and the major events that have affected their lives. It reads very much like a personal story written in the words of the person telling others about them and how they want to be helped and not how the home thinks it should be done. The home has continued to work with people in finding out what they like to do to enjoy themselves and have fun. People are encouraged to celebrate their birthdays and other events and there are lots of photos around the home of different events and trips. An area of work that the home has developed is that they have recognised just how important peoples diet and appetite is in maintaining their emotional and mental health and wellbeing. Each person has a meal plan that not only records the meals that they have but also how they were feeling at the time and information about their appetite. The home has found that this information helps in recognising any changes to a persons’ health. This is especially important if a person finds it difficult to express how they are feeling. An example was see where a change in a persons meal choices and appetite was recognised and found they had an illness which may not have been picked up as soon as it was. The home also recognise that for people who have experienced long term mental health problems and may have experienced long periods of time in hospital environments that meals and mealtimes are an essential part of their daily routines. The home has introduced new ways of involving people in this area including introducing peoples own recipes, regular meetings where people talk about the menus and their food preferences and to help people decide what they want the home has developed a menu book with photographs of the meals. The home are commended for the work they have done in this area and is seen as an example of good practice. The home has a good understanding of people’s general and mental health needs and know how to recognise and respond when a person begins to show signs of ill health. The home has also shown that it can change and adapt to support people if their general health does change and has provided aids and equipment and sought guidance from the healthcare professionals to do this. An example of this was shown where the home has supported a person to cope with their health issues. This also involved working together with all the people living at the home to support the person’s changing needs. Because the health problem affects the their daily life it was important that other people were
Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 7 made aware of the problem. The person gave their permission to talk to everyone about how they can help in making sure that they stay healthy. This was a good example where everyone cooperated and worked together in a way that treated people with respect and dignity. Being able to find out if the service being provided is of a good enough standard and helps people in the best possible way is something that the home takes seriously. The manager carries out regular checks through talking to people and other professions who come into contact with the home about the service they receive. In addition, the home has recently carried out a full check on how it feels it has met the standards that the CSCI use to inspect and judge the quality of service care homes are providing. In this way the home is trying to look closely at what it does and whether or not it can improve in certain areas and so offer a better service to the people living at the home. 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. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are clearly assessed and identified before they come to live at the home. EVIDENCE: The home has a referral, allocation and admissions policy and procedure. The system for admissions was clear and would involve the person, their families and the purchaser of the service at all times. Since the last inspection in November 2005 two new people had come to live at the home. Pre-admission assessments and information had been provided by the relevant purchasing authority. Each person also had a comprehensive assessment carried out by the home before they came to live at the home and this was updated and reviewed to reflect a person’s needs. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ goals and support needs are clearly identified and changes reflected in their care plans. People are supported to make decisions and choices about their lives and risk they may face are identified and supported. EVIDENCE: Examples of people’s care plans were seen and showed that the home had continued the progress seen in the last two inspection reports. Care plans contained clear and identified goals and needs, the information in the care plans was detailed and focused on the person and their support. Changes to peoples’ support needs had been reflected through the care planning review process. People are encouraged and supported to make decisions and choices about their day-to-day lives. They are consulted about what meals they want and what activities they are interested in. People have the chance to get together every month and discuss issues affecting them and the home. The home also
Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 11 operates a keyworker system where a named staff member takes on specific responsibilities with a person and supports them in helping to make informed choices and decisions. The home works with people in identifying areas of risk that may affect their lives and opportunities to do the things they want to do. If something is found that could present a risk to the persons’ health or choice of lifestyle then the home will work with them and other relevant people to come up with a way of lessening that risk. It is recommended that the home makes sure that all identified risks have a clear action plan and guidance in how to reduce the effects of that risk. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People were offered and supported to take part in activities that they enjoy. They are encouraged and supported to maintain links with family and friends and routines of the home were relaxed and informal. The home supports and offers people a healthy and balanced diet. EVIDENCE: People are encouraged and supported to take part in activities within the home and the community that they enjoy and value. People have regular meetings to talk about the activities that they would like to try and go on. The activities that people enjoy are recorded in their care plans and a record of the activities they are offered was being maintained. People are encouraged to maintain continued links with family and friends. Visitors are welcome and people spend time away from the home with their families.
Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 13 The routines of the house are based around peoples’ own needs and their ability to take part in household tasks. People have their own door keys if they wish and this does not present a risk. Letters are given direct to people who will ask for help if needed. Mealtimes were an important part of the peoples’ routines and social interaction. People enjoyed the meals and range of choices offered. Information on people’s nutritional needs and likes/dislikes was clear and detailed. Regular meetings were held to discuss the meals and what people enjoyed or wanted changing. There was a good selection of fresh ingredients, fruit and vegetables with very few processed foods used. The recommendation that a clear record of the meals people have had been implemented. The home had identified that food, the meals people had and their appetite had a clear link with changes in their health and particularly their mental and emotional wellbeing. They had used this connection and the information kept on peoples’ diet to recognise changes in mental health and taken the actions needed to help the person. This work is commended as an example of good practice. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home supports and encourages people to maintain their personal and healthcare needs. The medication administration system was accurate and followed correctly so maintaining peoples health and wellbeing in a safe way. EVIDENCE: The home continues to support people to maintain their personal, general and mental healthcare needs. Changes in personal or healthcare needs are clearly reflected through peoples’ care plans and advice and input has been gained from specialist healthcare providers when needed. Monitoring systems needed to support a persons’ health were being maintained. The medication administration system was checked and found that Medication Administration Records were accurate, there was a clear auditing and monitoring system in place and staff who administer medication had received the appropriate training. These action met the requirements issued in the previous inspection report. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are aware of their rights to raise concerns and worries with the home and systems are in place to protect people from abuse. EVIDENCE: The Complaint Policy and procedure has been given to people and the house meetings offer the opportunity to talk about their concerns and worries. The questionnaires sent to people before the site visit confirmed that people knew about their right to complain and who they could talk to if they had worries and concerns. The home follows the Manchester Multi-Agency Adult Protection Policy and Procedures. All staff have had specific adult protection training and they were aware of the issues around protecting vulnerable people. The systems for managing, recording and auditing peoples’ personal finances was clear and accurate. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a homely, comfortable and well maintained environment. It was clean, hygienic and had the systems in place to protect peoples’ health. EVIDENCE: The home was clean, well decorated and maintained and suitable to meet peoples’ needs. Regular health and safety checks are made to make sure the home is safe. There are suitable laundry facilities and clear procedures for the safe handling of soiled materials and awareness of the importance of safe working practices in the control of cross infection. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 17 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): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a staff team who are competent and have received the training and knowledge to meet peoples’ needs. The recruitment process ensures that the required checks are made so that staff are safe to work with vulnerable people. EVIDENCE: Through talking to people, discussions with staff and observing how they work and interact with people the home has shown that the staff team have a good working knowledge of peoples’ needs. During the day there are between three and four staff on duty supporting people in the home and the community. During the evening and over-night there are two staff on duty. The team consists of the Manager, two senior workers, nine support workers and domestic staff. The majority of the staff team work full-time hours and this gives the home more flexibility in setting the rotas to meet peoples’ support needs. At the time of the visit six of the nine support workers had achieved the NVQ Level 2 or above. This is above the recommended levels for staff employed with vocational qualifications.
Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 18 The home continued to offer staff a comprehensive Induction programme and access to a range of mandatory and specific training connected with supporting people with mental health needs. The staff training files were up-to-date and contained clear training plans. The home’s recruitment process ensured that all the required checks were made prior to staff starting work at the home. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has the management structure and style that benefits people and the policies, systems and practices in place to protect peoples’ safety and welfare and the systems needed to gather peoples’ views on the home and the service they receive. EVIDENCE: The manager had the qualifications, training and skills to show that they could operate the running of the home effectively. They had the values and skills needed to provide people with the opportunities to make decisions and choices about their lives and be involved in how the home can improve for them. They are supportive of new ideas and suggestions from people and the staff team. The home continues to operate a quality assurance system that looks at how people see the service and how it can be improved. The home seek peoples Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 20 views of how the home is helping them, or not, and tries to involve them as much as possible in decisions that affect the home. The home has a structured programme of health, safety and environmental checks and audits to make sure the home is safe for people and staff. Fire logs were seen and found to be clear and regularly updated. Servicing and checks on equipments, gas and electric facilities are maintained on a yearly basis. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 3 X Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 22 NO 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. Standard Regulation Requirement Timescale for action 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 YA9 Good Practice Recommendations It is recommended that the home makes sure that all identified risks have a clear action plan and guidance in how to reduce the effects of that risk. Creative Support DS0000021607.V301350.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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