CARE HOME ADULTS 18-65
Davids Close (2) Werrington Peterborough PE4 5AN Lead Inspector
Nicky Hone Unannounced 03 May 2005 @ 07:40 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. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 2 Davids Close Address 2 Davids Close Werrington Peterborough PE4 5AN 01733 707774 01733 707811 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) Mr Alan George Atchison Mrs Beverley Lyne Harbour Care Home 7 Category(ies) of Learning Disability (7) registration, with number of places Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 01 December 2004 Brief Description of the Service: Originally a large, detached private house, set in its own grounds, 2 David’s Close became a home for people with learning disabilities in 1995. Accommodation for the seven service users is offered on two floors and comprises four single and two double bedrooms, lounge, dining room, kitchen, and utility room as well as a bathroom, toilets and a sleeping-in room/office for staff. Both double bedrooms have ensuite facilities: one of the doubles is currently used as a single room. The gardens include a wooded area along the rear fence and there is a fully enclosed outdoor swimming pool. Located in a quiet cul-de-sac on the outskirts of Werrington, the home is within a ten minute walk of local amenities, and is three miles from the centre of the cathedral city of Peterborough with its wide range of shops and leisure facilities. Peterborough City Council has granted planning permission for a two-storey extension which would increase the size of some of the bedrooms, add some ensuite shower facilities and remove the shared bedrooms, as well as increasing the number of people able to be accommodated. Building work has not started yet. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out over two days. On the first day, which was unannounced, the inspection started at 7.40 in the morning and lasted three hours. The deputy manager had been on duty through the night (sleeping-in) and was assisting service users to get up and have breakfast. The manager arrived soon after 8 o’clock and was the second member of staff in the home. All seven service users were in the home at the start of the inspection: four went out to their day time activities. The inspector spoke to two service users. Some of the paperwork was not available on the first day so the inspector arranged to return to the home, with a second inspector. The second day lasted one and a quarter hours. The owner and manager were both present: the findings from the inspection were discussed with them. What the service does well: What has improved since the last inspection? What they could do better:
An inspection in 2004 indicated that several requirements from previous inspections (in some cases dating back to 2002) had not been fully met. These included the requirement for each service user to have a care plan. A meeting was held with the provider and manager, and some improvement was made by the time of the next inspection in December 2004. However, in the six months since that inspection there has been little progress, and some of the requirements have been carried forward again. Individual service user plans must give detailed information on service users’ needs, aspirations and goals, and must give guidance to staff on how these are to be met. The issue of care plans has been discussed again with the provider and manager, who
Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 6 have been advised that the CSCI is taking legal advice with a view to taking further enforcement action. Opportunities for service users to develop independent living skills and to take responsible risks must be developed and the bad practices seen in the administration of medication must stop as they potentially place service users at risk. The number of staff on duty must be adequate to meet the needs of the service users, staff must have appropriate training, and the frequency and quality of staff supervision must improve. The inspector is still concerned that the manager has not been given the time or the support that she needs to manage the home effectively. This has resulted in several of the requirements from previous inspections not being met. It is very disappointing that the number of requirements is high. 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. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 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 Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 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) 1, 2, and 5 The information available is adequate for service users to know about the service they should get from the home. Some re-assessment of service users’ needs is carried out at social services’ yearly reviews. EVIDENCE: After the inspection in December 2004, the manager revised the statement of purpose and service user guide and sent copies to the inspector. These documents had improved. A copy of the service user guide was seen on service users’ files and was signed that it had been read to them. Each service user has a contract which, together with the service user guide, describes the service that they can expect from the home. All the service users at 2 David’s Close have lived at the home for several years. Some basic information was obtained when they were admitted, and some re-assessment, done at the reviews which social services hold yearly, was seen on their files. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 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 There is no clear or consistent care planning system in place to adequately provide staff with the information they need to meet service users’ needs. There is little evidence to show that service users’ healthcare needs are met. Risk assessments show that staff control service users’ activities which results in activity and choice being limited. EVIDENCE: Care plans contained very little information, did not describe the person or the support they need and did not provide staff with guidance on how to meet each individual service user’s needs. There was no information in the care plans to show that service users are encouraged to make decisions about their own lives. Risk assessments showed that service users are not encouraged in any way to take any risks: in fact, the action to be taken following the assessments showed that activities are curtailed. For example, one person was assessed as being able to put dirty washing into the machine, but not able to turn the machine on: the action to be taken said staff were to do this person’s laundry. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 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 standard(s) 11, 12, & 14 Service users have been able to choose whether or not they attend day care outside the home, and each person has a programme of day time activities which they seem to enjoy. There is a tendency in this home for staff to carry out tasks for service users so that opportunities for service users to develop independent living skills are limited. EVIDENCE: Originally all the service users continued to attend day care at the centre they attended before they moved to this home, but over the years individuals have decided to reduce the number of days they spend at the centre, or to stop attending altogether. Some daytime activities are organised by the home and each person has a programme of day activities. One service user has recently been allocated funding so that a support worker can work with him on a oneto-one basis for three sessions a week: he was very pleased to show the inspector his file in which he helps the support worker write down what he has done, and whether he enjoyed the activity. On the first day of the inspection the manager showed the inspector some forms she had devised to record activities and said these would be put in use
Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 11 that day: there was still no evidence of these being used, and therefore no clear record of activities on service users’ files, on the second inspection day. It was a requirement from a previous inspection that service users who are able to should be encouraged to do more things for themselves. At a previous inspection one service user had been very proud of making his own sandwich: it was noted this time that the service user’s breakfast of peanut butter on toast was prepared for him by the staff. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 & 20 Service users appeared to be getting the support they needed with personal care, however care plans were not detailed enough to make sure that staff have enough information to meet service users’ personal support needs, nor to be sure that healthcare needs are met. The poor medicine administration practices in the home have the potential to put service users at serious risk of harm. EVIDENCE: When the inspector arrived, service users were getting up, taking a bath or a shower, and getting dressed. There was one member of staff assisting those who needed it. They all seemed to get the help they needed and were all ready in time to be taken to their various day activities. However, the care plans seen were too brief and not detailed enough for staff, for example new staff or agency staff in an emergency, to know what personal support each person needs. The manager had devised a form to record health needs but these were not in use on either day of the inspection so there was no evidence to show that service users see a dentist, optician, chiropodist and so on. There were letters on file indicating that individual service users are supported by the learning disability team. This home uses the Boots blister pack (MDS) system to administer medicines which are kept in a locked cabinet in a locked cupboard. On the first day of
Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 13 the inspection the staff member brought the morning’s blister packs to the kitchen and left them unattended on the work surface while he took each person’s medicines to the dining room or their bedroom. This practice is unacceptable and must be stopped immediately. There was also a small packet of tablets on the worksurface in the kitchen: there was no name on these. This practice must also be stopped. The medication administration records were not signed at the time of administration. The manager agreed to make sure administration of medicines is carried out properly and safely. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) these standards were not inspected on this occasion. EVIDENCE: Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28 & 30 The home is clean, pleasantly decorated, and comfortably furnished, making it a pleasant place to live in and suitable for the people who currently live there. The use of the shower in the double bedroom by all the service users has the potential to compromise service users’ privacy. EVIDENCE: The only areas of the home seen on this visit, other than the office, were the kitchen and lounge/dining areas. These areas were pleasantly decorated, clean and free of any offensive odours. Although the home is suitable for the current client group, the staircase to the first floor would not be suitable for a service user with mobility difficulties. The home has a bathroom upstairs, with a bath, washbasin and toilet, and a toilet downstairs, for communal use. The double bedroom upstairs (used as a single room) has an ensuite bathroom, and the double bedroom downstairs has an ensuite shower room. The occupants of this room have agreed that their housemates can use their shower. The inspector has some concerns that this could infringe on the privacy of both the occupants of the room and the person using the shower, however, no service users or staff have said this is a problem.
Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 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 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, 34, 35, & 36 Training records were not adequate to show that staff have received sufficient and appropriate training to meet the needs of the service users and the requirements of the law. Staff supervision notes were not satisfactory. EVIDENCE: The turnover of staff in this home is very low, so staff and service users know each other well. Staff rotas showed that there are usually two staff on duty when service users are at home, except overnight when there is one member of staff sleeping in. The inspector is concerned that there are not enough staff on duty to be able to develop service users’ independence and choice. On the first day of the inspection there was no access to some records, including staff files. On the second day personnel files of three staff were inspected: some information required by the regulations was not in the files. No staff had been recruited since the last inspection. The training plan required following the last inspection had not been drawn up. There were certificates on the file of one staff member to show she had received training in several topics including health and safety matters, dealing with challenging behaviour and protection of vulnerable adults. There were some certificates on the wall in the office, and some on the wall downstairs,
Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 17 but no record of training that was adequate to demonstrate that all staff had received sufficient training to ensure they were able to meet the needs of the service users. Supervision notes were seen on the three files inspected. These notes demonstrated that there is a poor understanding of the use and value of supervision. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 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 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, 38, 41, & 42 The management of this home is not satisfactory which means that the outcomes for service users are not as good as they should be. Record keeping is not adequate to make sure that service users’ rights and best interests are protected. Health and safety matters are not given high enough priority so that service users are not at risk. EVIDENCE: The manager works the majority of her shifts hands-on as a support worker and only has two days a month on the rota for management duties. The fact that this is not sufficient is demonstrated by the poor quality of most of the records kept in the home, and the lack of guidance for staff on ways of improving outcomes for service users. This has been discussed on previous occasions with both the provider and the manager who have been advised that the CSCI will be considering taking further enforcement action. Portable electrical appliances have been tested, and maintenance records for the gas equipment (boiler, hob and oven) were seen. No COSHH (Control of
Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 19 Substances Hazardous to Health) datasheets for chemicals used in the home were available. There was no evidence that hot water is distributed at a safe temperature, as records of the tests done on the hot water are not kept. One bedroom door was wedged open on both days of the inspection: an immediate requirement was left with the manager. The fire log was not available for inspection on the first day of the inspection: it was seen on the second day. The record states that tests of the fire alarm and emergency lighting systems are carried out as required. Records showed that some, but not all, staff have received training in fire safety awareness, first aid, moving and handling and food hygiene. No staff have had training in the control of infection. Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 x x 3 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 2 x 1 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x 2 3 x 3 Standard No 11 12 13 14 15 16 17 1 2 x 2 x x x Standard No 31 32 33 34 35 36 Score x 2 2 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Davids Close (2) Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 2 x x 1 2 x I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 21 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 2 6 Regulation 14(2) 15 Requirement A full assessment of each service users needs must be kept under review and revised as necessary Each service user must have a written plan of care (Service User Plan) as detailed in Regulation 15. This requirement is carried forward from 2002, June & December 2003 and October 2004 Service users must be given opportunities for personal development and to take responsible risks A record must be available to demonstrate that service users are given opportunities for taking part in valued and fulfilling activities Administration of medicines must be carried out safely The registered person must ensure that the arrangements for service users to take showers respect the privacy and dignity of all the service users The registered person must ensure that at all times suitably qualified, competent and experienced staff are working at the care home in such numbers Timescale for action 15 July 2005 15 July 2005 3. 7, 9 and 11 12(2) 15 July 2005 15 July 2005 4. 12 and 14 16(2)(m) & (n) 5. 6. 20 27 13(2) 12(4)(a) 03 May 2005 On receipt of this report and ongoing On receipt of this report and ongoing
Page 22 7. 33 18(1)(a) Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 8. 35 18(1)(c) (i) 9. 35 18(1)(c) (i) 18(2) 10. 36 as are appropriate for meeting service users’ needs. This was a requirement in October 2004 Staff must receive training appropriate to the work they perform. All staff must receive a minimum of five paid days training per year. A training plan must be drawn up and submitted to the CSCI.This requirement is carried forward from the inspections in December 2003, October 2004 and December 2004: timescales of 30 November 2004 and 31 January 2005 for the training plan were not met Staff training records must be available to evidence that staff have received appropriate training Staff must receive appropriate supervision at least six times per year A training plan must be submitted to the CSCI by 31 May 2005 31 July 2005 All staff to have received two supervision sessions by 31 July 2005 10 May 2005 11. 37 8 12. 41 17 13. 42 23(4)(a) The proprietor must ensure that adequate management time is available to complete management tasks effectively. This requirement is carried forward from the inspections in December 2003 and October and December 2004: timescales were not met Records must be kept as required by regulation and must be available for inspection. This was a requirement in October 2004 Fire doors must not be held open except by a means approved by the fire authority. Wedges must be removed. An immediate requirement was left at the 31 July 2005 10 May 2005 Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 23 home regarding this 14. 42 13(3) Staff must receive training in infection control. This requirement is carried forward from December 2003 and October 2004. Timescales were not met COSHH data sheets, and accompanying risk assesments must be available for inspection 31 July 2005 15. 42 13(4) 31 July 2005 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 Good Practice Recommendations Davids Close (2) I53 I03 S15147 DAVIDS CLOSE V224835 030505 STAGE 4.doc Version 1.30 Page 24 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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