Inspection on 19/07/05 for Edward House

This inspection was carried out on 19th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Edward House 31/10/06

Edward House 06/02/06

Edward House 09/12/04

Edward House 21/06/04

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Creative Support

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

CARE HOME ADULTS 18-65 Edward House 14/16 Edward Street Werneth Oldham OL9 7QW Lead Inspector Sandra Bennett Unannounced 19th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Edward House Address 14/16 Edward Street Werneth Oldham OL9 7QW 0161 624 1908 0161 620 3550 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) Turning Point Mrs Christine Anne Mercer CRH 17 Category(ies) of MD Mental Disorder - 9 registration, with number MD(E) Mental Disorder - 8 - over 65 years of of places age. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered for a maximum of 17 service users to include up to 9 service users in the category of MD (Mental disorder excluing learning disability or dementia under 65 years of age), up to 8 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age). A manager must be in place at all times who has the qualifications, skills and experience necessary for managing the service and registered with the Commission for Social Care Inspection. 2 Date of last inspection 9th December 2004 Brief Description of the Service: Edward House is a large Victorian property, owned and managed by the charity Turning Point. The home is situated close to Oldham town centre, local amenities and public transport. Accommdation is provided in 12 single rooms,eight of which have ensuite. Two of these rooms also include a bath and shower. There are also three shared rooms, two lounges one of which is no smoking and a large dining room. There are ample communal toilets and bathrooms in addition to ensuite facilities. Attractive gardens are to the front of the property with patio garden areas to the rear. The home does not provide a lift, however most of the service users are physicaly able. Ground floor bedroms are available also an assissted bathroom which provides level access for those service users who may find stairs difficult or require assistance. Edward House is registered to provide care for up to 20 service users with enduring mental health problems and is a community based project.Their aim is to encourage service users to take an active part in the community through education, work based projects and community work. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unscheduled inspection took place on 19/7/05. During the inspection six service users were interviewed in private, as were three members of staff. Discussions also took place with the manager and acting deputy manager. Ten service user and relative questionnaires were left for completion none had been returned at the time of writing this report. The inspector also undertook a tour of the building and scrutinised a selection of service user and staff records, as well as other documentation, including duty rotas, medication records and the complaints log. What the service does well: What has improved since the last inspection? The home had met their previous statutory requirements in relation to medication and quality assurance. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 6 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. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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 Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 and 4 Information is available to service users to make an informed choice about the home. A detailed assessment from health professionals ensures the home meets the needs of service users. Service users are encouraged to visit the home prior to admission. EVIDENCE: Four service user files were examined and were found to have a detailed assessment of their need. Many of the service users had been resident at the home for a number of years and were happy to discuss their involvement in the assessment process. Some service users remembered their initial visit to the home and how welcoming staff and other service users were. Two service users who had been resident for the past year were able to discuss information they had received prior to their admission but stated that at this time they were not well enough to fully understand. The service users stated that has their health improved their key worker explained what was available to them and how staff will meet their needs. A service user guide was given to them to keep in their rooms for reference. Edward House does not provide intermediate care. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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 Service users each have a detailed plan of care and are involved in care planning and risk assessments process. Service users were happy with the support given by staff but concerned over the new staffing structure. EVIDENCE: Service users discussed their personal needs and preferred choice of lifestyle. They were aware that records were kept and stated “ we discuss this with our key worker on what we like to do or what will help us get better”. Risk assessments were completed and reviewed in order to assess service users progress. These were not always signed or dated making assessment of the relevance of these documents difficult. Service users spoke highly of the staff and the support they received from their key worker. They discussed the role of the activities co-ordinator and the loss they felt with their role changing through staff shortages albeit temporary. When asked how this had affected them they stated “not much at the moment because may key worker looks after me”. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 10 Service user meetings are held monthly and recorded. These showed that service users had complained over staff and management restructuring and shortages feeling that the manager was no longer available to them because of additional duties. The response was that the manager now holds a “surgery time “ 1-3 pm Mondays for individual service users to meet with them if they so wish. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12.13,14,15,16 and17 Service users are provided with opportunities for personal development, education and leisure, which are community based. Friendships have developed inside and out of the home, promoting service users independence. Service users responsibility in maintaining their preferred lifestyle is promoted through decision making in the home Appropriate well-prepared food is provided by the home. EVIDENCE: Service users were keen to discuss their achievements in the community through education and leisure. One service user stated they had obtained a certificate for computer studies with them being provided with a personal computer on loan through the educational system. Other educational courses included maths and English. Leisure activities included keep fit and visits to a Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 12 friendship club in the community where they were encouraged to go on trips out. Four service users also benefited from a mental health support worker. The ethos of the home is community based. Unfortunately they have nominal equipment in the home from which service users may continue with their leisure or educational studies. Service users discussed friendships they had developed in and out of the home and that they were able to bring in friends has long has they abide by the house rules. The managing of service users personal finances is discussed with their key worker in line with a risk assessment. Some service users interviewed held a cash card and were responsible for their own budgeting. For other service users the home maintains or provided assistance on budgeting through the key worker system. Service users are encouraged to participate in the preparation of meals to the level of their capability and are able to make personal snacks throughout the day. Service users said the choices of meals are discussed at their meetings and that there was always a choice available to them. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20 Service users were satisfied that their physical and emotional needs were being met. Medication procedures were not sufficient to protect the interests of service users. EVIDENCE: Five service users files were examined and contained detail care plans. However these were difficult to assess because of the structure of the file and the lack of signature and dates on care plans, reviews and risk assessment. The education, welfare and medical needs of service users had been recorded. Service users confirmed they are involved in the care planning process and their preferences taken into consideration. Errors were found in the administration and recording of medication. Changes were made to record sheets, which had not been signed or dated with no documented evidence of consultation with the service users gp. Risk assessments had not been completed for service users who self medicate. Service users consent to medication should be obtained or documented evidence of the consultation process with professionals why this has not been obtained. Eye drops were stored in a fridge when it was recommended not to do so. The date of opening and commencing treatment should also be recorded. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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) 22 and 23. Service users were confident they could raise concerns with staff and they would be listened to. Service users are protected from abuse and exploitation. EVIDENCE: Service users did say they felt listened to if they had any concerns or complaints. This was evident through minutes of service user meetings and the acknowledgement of the manager that their time in the administration of the home had been reduced through other commitments. The home did not maintain a log of complaints or concerns made by service users. Examination of information and leaflets given to service users from Turning Point on how to make a complaint found that these did not advice them on how to contact the CSCI should they be dissatisfied with outcome or investigation of the complaint. It is acknowledged that it is brought to the attention of service users through other documentation however this is a cause of confusion when not clearly stated in leaflets given to service users on how to make a complaint. Staff training in the protection of vulnerable adults is mandatory in the organisation. Staff demonstrated a good knowledge of the forms abuse may take and were aware of the action to take should they witness such action. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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 and 30 In the main the home provides a homely atmosphere for service users, however certain areas required additional odour control and replacement furniture. Service users bedrooms were appropriately personalised. EVIDENCE: Edward House provides a homely environment and atmosphere for service users. Many of the bedrooms have been personalised with the service users being keen to show the inspector their bedrooms and discuss their responsibility in maintaining hygiene standards and personal laundry. A selection of rooms was inspected. Three of which had odour problems that need to be addressed through discussions with health professionals or cleaning specialists. A number of chairs in bedrooms were damaged or badly stained. Service users can choose from a variety of communal areas one of which is a no smoking lounge. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 16 Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36 All staff were aware of their roles and responsibilities. The lack of training and supervision of bank staff may pose a risk to service users. Recruitment procedures were not robust enough for the protection of service users. The lack of security measures on night duty poses a risk to service users and staff. Effective communication systems in the home ensured the needs of service users were met. EVIDENCE: Examination of duty rotas found that 50 of the staff team were temporary or bank staff and as such had not been provided with relevant training in mental health issues and challenging behaviour. The use of bank staff at the home has been ongoing for a long period. Duty rotas showed that for the 28 days prior to the inspection 2-3 bank staff were employed on each shift to cover the home. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 18 At interview all bank staff demonstrated their in-depth knowledge of the service users needs. But it was identified that bank staff were not given the same level of supervision and training opportunities as the permanent staff. Regular handovers at change of shift ensured that service users needs were being met. All staff are encouraged to attend monthly staff meetings were policies and procedures are brought for discussion alongside developments in the home and service users progress. Examination of staff records found that one member of staff had commenced work without appropriate CRB checks being carried out and the also references for the applicant that had been obtained did not match those nominated on the application form. Gaps in the applicant’s employment history had also not been explored. Staff discussed issues they faced in relation to dealing with challenging behaviour and demonstrated how they are able to defuse difficult situations using their skill and support from other staff. Interviews with night staff highlighted that their position is vulnerable in that there is only one waking night staff plus someone sleeping on the premises on call. The lack of an emergency system or a method of summoning help by waking staff from the person on call cold leave staff and service users at risk. Permanent staff are encouraged to undertake NVQ in promoting independence of the four permanent staff interviewed three had achieved this. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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 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) 37,38,39,40,41,42 and 43 The recent depletion of management hours and staffing restructure in the home may pose a risk to service users over a longer period. Service users and staff are encouraged to voice their opinions on developments in the home and felt their concerns were acknowledged. Record keeping needs to be maintained to promote the health and safety of service users. The home has appropriate accounting and financial procedures. Quality audit systems were in place. EVIDENCE: The manager is qualified RMN who has recently completed NVQ4 in management. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 20 Following a recent restructuring of community services provided by Turning Point, the manager of Edward House has been made responsible for additional services that are operated from Edward House. The restructure has also resulted in care staff in the home having to take on additional responsibilities. Consequently the home was heavily reliant on bank staff to ensure that routines for service users in Edward House were being maintained. These staffing arrangements in the home are difficult to sustain and may pose a risk to service users. The home has good communication systems allowing the care needs of service users to be addressed. Some omissions were noted regarding the signing of service users care plans. The inspector was informed that omissions in record keeping were due to the staffing situation and the lack of time available to maintain records. There was documented evidence that service users and staff had voiced their concerns on developments in the home especial those related to the prolonged absences of the manager. Attempts had been made to addressing some of the service users concerns but service users continued to expressed their dissatisfaction with the management arrangements in the home. Policies and procedures were reviewed on a regular basis and brought to the staff team for discussion. Permanent staff had received mandatory training in health and safety. Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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 N/A 3 3 3 N/A Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 N/A 3 N/A Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 N/A N/A N/A N/A N/A 2 Standard No 11 12 13 14 15 16 17 2 2 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Edward House Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 2 3 3 2 2 2 F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 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. 1. Standard 19/41 Regulation 12(1a) Requirement The registered person must ensure that care plans reviews and risk assessments are signed and dated by the person completing them and maintained in good order. The registered person must ensure that medicines in the home are handled in accordance with the requirements of the Medicines Act 1968, guidelines friom the Royal Pharmaceutical Society and the requirements of the Misuse of Drugs Act 1971. The registered person must ensure that all staff working in the home recieve training in the care of service users with enduring mental health problems and challenging behaviour. The registered person must ensure that criminal record bureau checks are in place prior to staff commencing duty and referances are obtained from the people nominated by the applicacant. Any gaps in employment history should be explored and recorded. The registered person must Timescale for action 31/11/05 2. 20 13(2) Immediate 3. 32/35/37 18(1) 30/11/05 4. 34/41 18(4a,b) immediate 5. 36/38 18(2) 30/11/05 Page 23 Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 ensure that all staff working in the home recieve training and supervision. 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 11,12 Good Practice Recommendations The registered person should give consideration to the provision of equiptment such as computer in order for service users to continue their educational studies or leisure pursuits. The registered person should maintain a log of complaints made by service users and any action taken. Information on how service users can contact the CSCI at any time during a complaints investigation or outcome if they are dissatisfied with the process should be included in the homes complaints leaflets. The registered person should ensure consultation takes place with health professionals and cleaning specialist regarding odour control in the home. The registered person should ensure a review of security measures on night duty take place for the protection of service users and staff. The registered person should undertake a review of managment hours and staffing structures in the home to ensure that additional responsibilities allocated to the manager does not impact on the managment of Edward House. 2. 22 3. 4. 5. 30 36 43 Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 2nd Floor, Heritage Wharf Portland Place Ashton under Lyne OL7 OQD 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. Extracts may not be used or reproduced without the express permission of CSCI Edward House F54 F04 s5549 Edward Hse un v239735 190705 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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