Inspection on 03/10/05 for Durham Street and Endymion Street

This inspection was carried out on 3rd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Durham Street and Endymion Street 03/03/09

Durham Street and Endymion Street 13/03/08

Durham Street and Endymion Street 27/03/07

Durham Street and Endymion Street 24/10/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Durham Street and Endymion Street 49 51 & 53 Durham Street Hull East Yorkshire HU8 8RF Lead Inspector Christina Bettison Announced Inspection 3rd October 2005 09:30 Durham Street and Endymion Street DS0000065657.V255629.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 Durham Street and Endymion Street DS0000065657.V255629.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. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Durham Street and Endymion Street Address 49 51 & 53 Durham Street Hull East Yorkshire HU8 8RF 01482 329226 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) Avocet Trust Undergoing Registration Process Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. that the manager is registered with the CSCI within six months of the date of registration. that no service users move into 43a Durham Street until all building works are completed, all checks have been undertaken by the Building Control, Fire Department and Environmental Health and a site visit has been undertaken by the inspector to ensure the house meets the NMS in relation to the environment. 20th July 2005 Date of last inspection Brief Description of the Service: The service at 49-53 Durham Street is managed by Avocet Trust who rent the premises from Sanctuary Housing Association. It is one of a small number of similar services that Avocet provides. Avocet Trust is a registered charity. 49-53 Durham Street is registered to provide care and accommodation for up to 5 adults with a learning disability. The home is off Holderness Road to the east of the city centre. 49-53 Durham Street consists of three separate living units. No. 49 is a ground floor flat for one person, with a bedroom, living room, kitchen, bathroom and rear garden. Nos. 51 and 53 have similar facilities with an additional single bedroom each and are for two adults. No. 51 is at ground floor level. No. 53 is above it, accessed by an internal staircase with own front door.The properties adjoin each other and share a large communal garden at the front. There is parking available on the street. 48 Endymion St is a terraced property for two people owned and managed by Avocet trust. The house consists of a small hall, lounge, dining room, kitchen and utility room, and two bedrooms with en-suite facilities. There are shops, pubs, park, medical centre, post office and churches all within walking distance. Public transport to various parts of the city is easily accessible. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 5 Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours and was an announced inspection. A tour of the premises took place, care files, rotas, staff lists and training records were all examined. 6 staff, 4 service users and the manager was spoken to. Care practices and interactions were observed during the inspection. What the service does well: What has improved since the last inspection? Most of the staff have now done training on how to safely give medication. Where service users have behaviour that is difficult to manage there should be a plan to tell staff what to do, this has now been put in place so that service users are treated fairly and understand how staff will deal with them. The window that was broken at Durham St has now been repaired. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 7 The managers have completed a list of all the training that staff have done, so that they know that staff have the ability to meet service users needs and what more training they need. 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. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 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 Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 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): 2,4 Service users needs and individual aspirations are thoroughly assessed ensuring that staff are given enough background information in which to develop individual plans and therefore meet the service users needs. EVIDENCE: There had been one new service user admitted since the previous inspection. The care file was examined as part of the inspection process. It contained a copy of the Social Services assessment and care plan that clearly identified the service users needs and the service users relative had also provided important information to support the assessment. However the care plan specified a different provider to Avocet and it is recommended that the social services team are contacted to amend this. The inspector was informed by both staff and relatives that the service user was given opportunities to test drive the home with visits and overnight stays prior to admission. He also had the opportunity to choose which bedroom he wanted with the support of his family. The service user told the inspector that he liked living at the home. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 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 Service users do not have an individual plan that reflects their full range of needs, choices or behaviour management etc thereby placing them at risk. Without this there is no assurance that their care needs will be met. EVIDENCE: Three service users care files were examined as part of the inspection process, two files contained individual plans which were basic, however for the recently admitted service user there had not been an individual plan developed that reflected their needs. This meant that a member of staff returning from holiday had very little information on how to provide the appropriate care and support, a requirement has been made in respect of this. There was evidence of 6 monthly reviews having been undertaken. At the previous inspection a specific service user had behaviours that were negatively affecting other service users and needed specific one to one support Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 11 and a consistent approach. An individual care plan (this still required further development) and a behaviour management strategy had been developed and there was evidence of a range of specialist support and meetings being held. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 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): 12,13,15,16,17 Service users are provided with activities and meals that reflect their individual needs and wants. Relatives and visitors are made welcome at the home and good links to the community enrich their social and leisure opportunities. EVIDENCE: Service users social, emotional, communication and independence skills are developed and maintained by the staff team dependant on the service users ability. Specialist intervention and support is offered by specialist staff. This was evidenced by the care files and specialist assessments and treatment programmes implemented for some service users. Some service users attend adult education classes, five senses (Avocets own day service) and take part in some household/garden activities. Service users participated in leisure activities in the community e.g. bowling, swimming, shopping, outings to the seaside, visits to cafes and pubs and pursue their own hobbies. Some service users attended the church. Staff spoken to demonstrated their commitment to supporting service users to Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 13 access the community and appropriate activities and clearly identified it as a part of their role. Staff were observed interacting in a positive way with service users and promoting their dignity and respect. Staff could explain where there had been incidents whilst out in the community and risk assessments had needed to be amended and additional staffing provided to enable service users to still go out. Transport is provided in the form of cars and the use of public transport. Contact with families is encouraged and maintained. Families are welcomed to visit and families spoken to said that staff kept them well informed of progress, problems and/or illness. Service users had unrestricted access to the house and gardens unless restrictions imposed as part of a management plan. Meal times were observed to be flexible and service users are encouraged to follow a healthy eating option but taking into account their ages, likes and dislikes and specific needs in relation to specific dietary needs. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 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): 18 The service users personal support needs are clearly documented and are being met by the service and staff. The staff have a good understanding of the service users needs. This is evident from the positive relationships, which have been formed between the staff and service users. . EVIDENCE: Three service users care files were examined as part of the inspection process. There was evidence that contact with GP, dentist, optician, audiologist, chiropody, community nurses and therapists and consultants was being facilitated on a routine basis for service users. Service users likes and dislikes were clearly documented and the use of communication passports developed by Avocet help people to understand how the service users like to be assisted and what things they don’t like or what might upset them. The home has a key worker system and times for getting up, going to bed and meals appeared to be flexible. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 15 Where decisions need to be taken on behalf of a service user, best of interest meetings are held involving relevant people who have the service users best interest at heart. Families are encouraged and supported to be as involved as they wish to be. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 16 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): 23 The staff team were not fully aware of Protection of Vulnerable Adults policies and procedures and their responsibilities within these therefore strategies are not in place to ensure service users are protected from abuse, neglect and harm. EVIDENCE: Some staff spoken to were not clear about their responsibilities within the POVA procedures and only two staff out of the 11 had received any training, therefore training must be provided. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 17 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): EVIDENCE: None of these standards were assessed at this inspection, however there is an outstanding requirement that staff are provided with adequate and safe sleeping in facilities. The inspector was informed that when 43a Durham St is completed the office will move there and the current office will be converted into a staff sleep in room, therefore the timescale has been extended. Durham Street and Endymion Street DS0000065657.V255629.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): 33,35,36 Service Users are cared for by a satisfactory number of staff, however inadequate provision of all mandatory training and low morale is compromising the quality of care provided. EVIDENCE: Three new staff had recently been appointed and were awaiting clearances before commencing work. Some staff were being moved around the site to ensure the mix of ability and experience was appropriate to meet service users needs. At the previous inspection it was identified that staff were not receiving supervision 6 times a year and that staff meetings were not being held frequently, there was no evidence at this inspection that there had been any improvements in these areas therefore they remain as outstanding requirements. There is an issue of low morale at the home which is detailed under NMS 38 in this report, however the inspector observed attentive and caring staff that appeared to know the service users needs well and a social work student on placement commented that it was a “great placement” and felt she was learning a lot and the staff team had been very supportive. Also staff commented that they felt supported by both the manager and senior. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 19 The manager reported that within Avocet Trust there is a Human Resources section responsible for organising training. Since the previous inspection an audit of staffs training had been completed which evidenced training that had been provided, this was linked to the needs of service users, e.g. moving and handling, epilepsy, basic food hygiene and first aid, however not all staff were up to date with their mandatory training, specifically infection control. 7 of the 11 staff have got NVQ level 2 in care. Since the previous inspection the majority of staff had received appropriate medication training. A staff member spoken to that had recently started at the home commented that they had not been provided with any induction training not even basic fire awareness and was not aware of how the fire alarm worked or the evacuation plan. At the time of the inspection this had been rectified by the manager but raises concern at the lack of induction given to new staff, both in house basic induction and LDAF induction. The registered person must ensure that all new staff receive basic in house induction and induction training that meets LDAF standards. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 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 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): 38,40 Since the last inspection there has been little improvement regarding the issue of low morale, staff supervision, staff meetings and the support of new staff members has deteriorated and could present a risk to the health, safety and welfare of the service users. EVIDENCE: At the previous inspection the manager reported that there was a longstanding issue of low morale at Durham St. During this inspection the inspector spoke to a number of staff and without exception they all spoke of low morale. Staff had made official grievances for which they had not received a response at the time of the inspection. Reasons given for the low morale were staff shortages; low pay, working a lot of additional shifts and difficulties with a particular staff member. The manager was aware of these issues and reported to the inspector that action was being taken to address the issue. Three new staff had recently been appointed and were awaiting clearances before commencing work. Some staff Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 21 were being moved around the site to ensure the mix of ability and experience was appropriate to meet service users needs. Staff commented that they felt supported by both the manager and senior. The registered person should continue to address the staff feelings of low morale. Policies and procedures were examined as part of the previous inspection since then some have been updated, one of these being the use of physical interventions. The quality assurance manager is making steady progress in reviewing and amending the policies and procedures in line with changes in legislation and best practice guidance and the timescale for completion has been agreed at 31/1/06. Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 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 4 x Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x x x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 2 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Durham Street and Endymion Street Score 3 x x x Standard No 37 38 39 40 41 42 43 Score x 2 x 2 x x x DS0000065657.V255629.R01.S.doc Version 5.0 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 Standard YA6 Regulation 15 Requirement The registered person must ensure that all service users have an individual plan that covers all aspects of personal, social and health needs. The registered person must ensure that all staff are aware of their responsibilites regarding POVA. Training must be provided. The registered person must provide staff with adequate and safe sleeping facilities when sleeping in. Timescales of 3/12/03, 3/8/04 and 31/5/05 not met, still within this timescale. The registered person must ensure that staff meetings are undertaken regularly The registered person must ensure that all new staff receive both in house induction and induction training that meets LDAF standards The registered person must ensure that all staff have an individual training profile. (Timescale of 30/9/05 not met) The registered person must DS0000065657.V255629.R01.S.doc Timescale for action 03/10/05 2 YA23 13 (6) 31/03/06 3 YA28 23 31/12/05 4 5 YA33 YA35 8 18 (1) 03/10/05 03/10/05 6 YA35 18 (1) 31/03/06 7 YA42YA35 18 (1) 31/12/05 Page 24 Durham Street and Endymion Street Version 5.0 8 YA36 8 9 YA40 24 ensure that all staff are up to date with mandatory training. Still within timescale The registered person must ensure that all staff receive formal supervision at least 6 times per year. The registered person must ensure that Avocets policies and procedures are reviewed and amended in line with changes in legislation and best practice guidance. Still within timescale 03/10/05 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA38 Good Practice Recommendations The registered person should ensure that the social services care plan accurately reflects the service to be provided and by whom. The registered person should seek to address the staff feelings of low morale Durham Street and Endymion Street DS0000065657.V255629.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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