CARE HOME ADULTS 18-65
Duncan House 18 Huckleberry Close Purley on Thames Berkshire RG8 8EH Lead Inspector
Stephen Webb Unannounced Inspection 9th January 2006 11:00 DS0000057646.V272669.R01.S.doc Version 5.0 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 DS0000057646.V272669.R01.S.doc Version 5.0 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. DS0000057646.V272669.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Duncan House Address 18 Huckleberry Close Purley on Thames Berkshire RG8 8EH 0118 942 7608 0118 942 6671 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) Purley Park Trust Limited Mrs Bernadetta Johnson Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (2) of places DS0000057646.V272669.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents within the PD category only to be accommodated in ground floor bedrooms 15th July 2005 Date of last inspection Brief Description of the Service: Duncan House is one of five recently built units to replace the old main house on the Purley Park site. It is now one of eight smaller, purpose-built units on the attractively landscaped site, together with a separate club-house. The house opened in May 2004 and accommodates eight adult service users with a learning disability in a two-storey unit. Like all of the units on site, it now has a designated manager and staff team, who meet the needs of the service users on a day-to-day basis. The site is enclosed apart from at its entrance, and provides a community within which service users can circulate freely, without the need for direct staff support. Service users are able to visit friends in the other houses. When off-site, all of the service users are supported by a staff member to varying degrees. DS0000057646.V272669.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out between 11.00am and 3.15pm. The inspection included discussion with the manager, examination of records and policies, a tour of the unit and time spent talking with service users. The inspector also had lunch with service users. The service users made lots of positive comments about the unit and the staff working with them, and obviously enjoyed their lunch. There was obvious warmth in the interactions between service users and staff. Two requirements remained outstanding from the last inspection. What the service does well: What has improved since the last inspection?
The staff team had become established since the last inspection and morale appeared to be good. Regular team meetings have now been established. DS0000057646.V272669.R01.S.doc Version 5.0 Page 6 The unit has begun to focus on improving the quality of the food provided, whilst still addressing the preferences of service users. The homeliness of the unit continues to develop as service users settle in. 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. DS0000057646.V272669.R01.S.doc Version 5.0 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 DS0000057646.V272669.R01.S.doc Version 5.0 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): EVIDENCE: None of these standards were examined on this occasion. Standards 2, 4 and 5 were examined at the previous inspection, and found to be met, with the exception of a requirement to obtain appropriate countersignatures on two service user contracts. This had since been addressed. DS0000057646.V272669.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 The needs and aspirations of service users are recorded within their essential lifestyle plans, which are explained to them by their keyworker, via a pictorial/symbol version. Service users routinely make decisions about their day-to-day lives, and are consulted appropriately. EVIDENCE: Each service user has an essential lifestyle plan, written by their keyworker, which details their needs, likes, dislikes, interests and the way they do and don’t like to be supported by staff. Individual aspects such as any allergies, dietary or health requirements are also included, as are details of individual communication methods. The document also contains a version compiled with symbols and images, which is gone through with the service users by the keyworker. DS0000057646.V272669.R01.S.doc Version 5.0 Page 10 The essential lifestyle plan is reviewed every six months, with alternate statutory and in-house reviews, though the placing authority are invited to the interim in-house reviews. Service user’s files contain a separate section on health and medical issues, as well as record sheets for appointments with external professionals. Service users are supported to make day-to-day living choices around activities, food, preferred times to get up and go to bed and involvement in household tasks. They recently took part in decision-making about the Christmas plans and decorations, and have already obtained brochures to assist them with planning their next holiday. They had also been involved in the recent decision to move the main meal to lunchtimes for a trial period. None of the service users is able to fully manage their finances, which are held centrally and issued to them weekly in small amounts, which they may retain or give to the staff to look after in a cash tin, within separate zip wallets. In/out/balance record sheets are maintained for each service user, and receipts are retained for any expenditure, whether it is by/with the service user or on their behalf. DS0000057646.V272669.R01.S.doc Version 5.0 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 the following standard(s): 16, 17 The rights of service users are respected and they are encouraged to take appropriate responsibility in aspects of their daily lives. Service users are offered an increasingly healthy diet, which also reflects their individual preferences, and clearly enjoy the meals. EVIDENCE: As already noted the service users have considerable freedom of choice within the day-to-day routines of the unit. They can move about the unit freely and most can also make use of the safe campus without the need for staff support. Several are regular visitors to service users in other units on site, including one who visits his wife in one of the other units. The staff knock before entering bedrooms, and the bedrooms are equipped with appropriate locks, which some service users can use. There is continuing interaction between service users and staff throughout the day, though service users can opt to spend time alone if they wish.
DS0000057646.V272669.R01.S.doc Version 5.0 Page 12 Service users are encouraged to be involved in food shopping and meal preparation as well as other household tasks, though the level of involvement varies. They were fully consulted recently about the proposal to move the main meal of the day to lunchtime for a trial period. Following developments in the dietary requirements for one service user, the unit have begun to examine diet and menus across the board, and are working to introduce more healthy meals whilst also responding to the likes and dislikes of service users. This could be a valuable exercise in encouraging a more healthy regime of diet and exercise for all, especially given the ageing of the group, and the increasing frailty of some of them. Meals are taken as a group, in an attractively furnished lounge/dining room. Some support is required to individuals at the table. It was clear from the lunch taken with service users, that they enjoy the food provided, and though little involvement in the meal preparation was possible on this occasion due to individual’s involvement in activities, service users conformed that they do take some part in food shopping and meal preparation. DS0000057646.V272669.R01.S.doc Version 5.0 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 the following standard(s): 19 The physical and emotional health needs of service users are effectively met. EVIDENCE: As noted earlier the care plan files of each service user contain a separate section detailing the contact with external medical professionals, including GP, chiropodist, psychologist, psychiatrist, optician, dentist etc. The records indicate that the range of service user needs is well met by visiting professionals and where necessary by supporting off-site appointments. The chiropodist attended during the inspection and confirmed she visited weekly. A local GP visits the site weekly to see anyone who needs to be seen. Should there be a preference for a female GP or one from another practice, this can also be arranged. In the run-up to annual reviews, each service user has an annual medical check-up with the GP. At present, the visiting GP effectively holds an on-site surgery in the office of one of the other units on the campus, which provides a private room for consultations. It would be preferable if the GP were to visit each service user in their own bedroom.
DS0000057646.V272669.R01.S.doc Version 5.0 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 the following standard(s): 22, 23 The complaints procedure had been explained to service users, and in conversation, it was clear that some had raised issues informally, which had been resolved effectively without needing to be treated as complaints. Service users are protected from abuse, neglect and harm, though staff should receive regular training on the protection of vulnerable adults, from an accredited trainer. EVIDENCE: The unit has an appropriate complaints procedure in place, including a version in symbol format, which is gone through with each service user and explained to them. Those who are able, countersign their own copy in their file. There is a unit-based complaints log, where brief details of any complaint are recorded, together with brief explanation of action taken. This is backed up by a central collective complaints log for the whole campus and a central confidential background record, which contains copies of any relevant correspondence, statements and any other papers pertaining to each complaint. The unit’s log contained no new entries since May 2005 and the manager confirmed there had been no new complaints made. It was clear from conversation with the manager and team leader and some service users, that minor issues were raised and resolved effectively by staff, without the need for them to become complaints. DS0000057646.V272669.R01.S.doc Version 5.0 Page 15 However, a previous requirement for the Regulation 26 monitoring visitor to countersign the unit complaints log to evidence their monthly monitoring of it, as required, had yet to be actioned. This should be addressed promptly. The service has an appropriate vulnerable adults protection procedure and a copy of this, together with the local multi-agency vulnerable adults protection protocol was present in the unit. One incident which had occurred between two service users, had been appropriately investigated and resolved. The training spreadsheets in the unit were not totally up-to-date, but indicated that three staff had seen the adult protection training video in May 2005, and one new staff member had yet to see this. There was no record of recent attendance on vulnerable adults protection training by staff, but this was reported to be in the pipeline. The inspector should be notified when staff receive the training on the protection of vulnerable adults. DS0000057646.V272669.R01.S.doc Version 5.0 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): 24, 30 Service users live in a homely, comfortable and safe environment, which is maintained in a clean and hygienic condition. EVIDENCE: The unit provides an attractive and purpose-built environment for service users, which includes the privacy of individual bedrooms. Communal areas are bright and attractively furnished. The décor in some areas is beginning to deteriorate, but the manager was hoping to include this in her development plan for the unit. She planned to involve the service users in the choice of colour scheme. The unit has become increasingly homely as the service users have settled in and has now begun to reflect their individuality. Observation of, and conversation with, the service users indicates that they feel very much at home and relaxed within the unit. The unit is provided with adaptations to meet the needs of the service users, including a bath hoist walk-in showers with folding seats, and wide doorways and corridors.
DS0000057646.V272669.R01.S.doc Version 5.0 Page 17 Each bedroom has become very individualised to reflect the interests and personality of its occupant, with the support of their keyworker. In one bedroom, a damaged drawer unit was observed, which will need to be replaced, if it is not repairable. Service users have good access to local facilities off-site via the available “pool” transport, and can also utilise the on-site clubhouse, which is an excellent facility where events, classes and activities can be hosted. The unit was found to be clean and free of unpleasant odours. DS0000057646.V272669.R01.S.doc Version 5.0 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 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): 36 Service users benefit from an increasingly settled and motivated staff team, who now meet regularly, but still require more frequent supervision. EVIDENCE: It was felt that the staff team, which had been very new at the last inspection, was now becoming more established and settled, and was well motivated. A previous requirement to increase the frequency of team meetings had been addressed and these were now happening on a monthly basis. Appropriate minutes were retained. However, individual staff supervision had yet to be increased to organisational expectations. (Every 4-6 weeks). This should be addressed. The remainder of this standard was not examined on this occasion. DS0000057646.V272669.R01.S.doc Version 5.0 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): 39, 42 The views of service users and relevant others, are not currently obtained systematically as part of a quality assurance strategy, though they are taken account of on a day-to-day basis. An effective cycle of quality assurance needs to be established. For the most part, the health, safety and welfare of service users is promoted by the unit, though portable appliance testing remains outstanding. EVIDENCE: The manager reported that there had been staff meeting discussions around the possible content of the new quality assurance system and questionnaires, but as yet these were not completed. The system is to be based on further development of a previous model. A copy of the proposed model and questionnaires should be forwarded to the inspector. DS0000057646.V272669.R01.S.doc Version 5.0 Page 20 The manager had begun to develop the annual development plan for 2006/7 in the form of a spreadsheet with entries for specific tasks and events. In isolation this format is rather limiting and it is suggested that it be supported by a written format giving details of the identified areas of action required and some discussion of how they are to be addressed. Then the proposed actions can be scheduled on the spreadsheet throughout the year to distribute the work on a priority basis. The development plan should include a review of the service over the past year and should also be informed by any shortfalls identified via the quality assurance system, complaints, inspection reports or regulation 26 reports, as well as addressing any training and premises issues. Identified areas such as developing a healthier menu for service users can also be included in the plan and relevant tasks scheduled during the year. A previous requirement to establish an annual schedule of portable appliance testing had yet to be addressed in this unit and should be seen as a priority as it is a health and safety issue. It is understood that work has begun on this testing in other units. The proposed date for this testing in Duncan House should be provided to the inspector. The remainder of Standard 42 was not examined on this occasion. DS0000057646.V272669.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000057646.V272669.R01.S.doc Version 5.0 Page 22 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 YA22 Regulation 22 Requirement The unit complaints log should be countersigned by the manager and Regulation 26 visitor regularly. This requirement remains outstanding from last inspection. Notify the inspector when staff have received vulnerable adults protection training. A systematic quality assurance system should be established and details forwarded to the inspector. The annual development planning system should be developed further, and include an annual review of the service. The testing of all portable electrical appliances must be addressed as a priority. The proposed date of this testing should be provided to the CSCI. This requirement remains outstanding from the previous inspection. Timescale for action 10/03/06 2 3 YA23 YA39 13, 18 24 10/04/06 10/04/06 4 YA39 24 10/04/06 5 YA42 13 10/03/06 DS0000057646.V272669.R01.S.doc Version 5.0 Page 23 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 YA36 Good Practice Recommendations The frequency of supervision remains insufficient and should be increased to organisational expectations, to provide improved individual support to staff. DS0000057646.V272669.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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