Inspection on 31/10/06 for Edward House

This inspection was carried out on 31st October 2006.

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 06/02/06

Edward House 19/07/05

Edward House 09/12/04

Edward House 21/06/04

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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 Buckley Unannounced Inspection 31st October 2006 09:30 Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edward House Address 14/16 Edward Street Werneth Oldham OL9 7QW 01616241908 0161 620 3550 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) Turning Point Mrs Christine Anne Mercer Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (8) Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 17 residents to include: * up to 9 residents in the category of MD (Mental disorder excluding learning disability or dementia under 65 years of age). *up to 8 residents 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. 6th February 2006 2. Date of last inspection 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. Accommodation 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 residents are physically able. Ground floor bedrooms are available as is an assisted bathroom, which provides level access for those residents who may find stairs difficult or require assistance. Edward House is registered to provide care for up to 17 residents with enduring mental health problems and is a community-based project. Their aim is to encourage residents to take an active part in the community through education, work based projects and community work. Residents are provided with a licensing agreement, which states what they can expect from services in the home. This also includes information on how to access the complaints procedure. A copy of the last inspection report is on display in the hallway of the home. The weekly range of fees charged by the home range from range from £526.68 to £546.08. Additional charges are made for hairdressing, personal toiletries, podiatry and magazines. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection which included an unannounced visit to the home took place on the 31st October 2006 and was conducted by one inspector. During the inspection three resident’s files were looked at in depth. Four residents were interviewed in private alongside group discussion with residents. Two staff, the manager and acting deputy manager were also interviewed. Eight residents’ questionnaires were sent for completion, none had been returned at the time of writing this report. Questionnaires were also sent to the professionals who visit the home. The inspector had a look round the building and looked at a selection of residents and staff records, as well as other documentation, including duty rotas, medication records and staff recruitment. What the service does well: What has improved since the last inspection? The home had made a number of improvements to the environment some corridors had been decorated. Residents said, “I like the colour of my door because I chose it myself”. New floor covering and furniture had also been bought for the dining room. Medication policies and procedures had been upgraded ensuring the safety of residents. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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 DS0000005549.V313118.R01.S.doc Version 5.2 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 Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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): 1, 2, 4 & 5 Quality in the outcome area is good. This judgment has been made using available evidence including a visit to this service. A detailed assessment from health professionals ensures the home meets the needs of residents. Information given to residents prior to their admission and visits to the home allows them to make an informed choice. EVIDENCE: The resident guide and licensing agreements are given to residents on admission to the home. Any house rules are included in these documents to ensure residents know of these and agree to abide by them. Residents are encouraged to visit the home on several occasions prior to them making a decision. Two residents were from out of the local area and confirmed they had visited. One said “I really liked the look of the home and staff were very friendly”. A detailed assessment of residents needs is obtained prior to their admission from health professionals to ensure their needs can be met. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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, 8 & 9 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to take control of their lifestyle and health care needs. EVIDENCE: Residents talked about regular meetings with their key workers to discuss any health and personal development issues. Practical issues of maintaining hygiene standards in the home and personal bedrooms are also monitored through these meetings. Resident interviewed knew who their key worker was, also who to speak to should their key worker be on leave or sickness. Records were maintained of meetings with their key workers, one resident said, “staff are very good here and support me a lot”. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 10 The inspector noted an improvement in some of the resident’s mental health since the last inspection. Several were taking more pride in their personal appearance and they were able to communicate their feelings and express themselves in a positive way. All felt it was due to staff input and patience. Formal resident meetings are held on occasion, the last being April 2006. The home should review this situation in order to provide a more regular forum to gain residents views. Many residents go out unaccompanied to participate in community activities or meet with friends. In some instances holidays abroad were planned. The manager reported that a detailed risk assessment would be completed in consultation with other professionals. One resident said, “I just go out where and when I like”. Examination of care plans and recording systems found these could be improved by streamlining the care records ensuring all paper work was completed, signed and dated. Outcomes for residents were not affected by this shortfall. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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): 12, 13, 15, 16 & 17 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with opportunities for personal development, education and leisure, which are community based to promote their independence. Meal times were well managed with choice being promoted in the home. EVIDENCE: Residents talked freely about their activities in the community. Examples were given of art classes, keep fit and computer training. A resident said, “I attend a maths class and assertiveness course”. Others talked about going out for meals and going out alone shopping. Residents are encouraged to spend weekends with family and friends if possible. In some instances holidays are arranged within a risk assessment framework. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 12 Residents took pride in showing the inspector their certificate of achievements, which were displayed, within their rooms. There was evidence that professional reviews in the home addressed educational and leisure needs with referrals being made to a local day care facility. Discussions had taken place with staff and residents on trips out and short holidays. Residents confirmed at interview forthcoming trips. Activity records should be maintained and included in care planning. Residents involved in art classes had the opportunity to display these in local exhibitions. The inspector dined with residents who were aware of the day’s menu. One resident said, “I really like the dinner today, but not the tea. I just ask for something else, there is always an alternative choice if you don’t like it”. Residents are allowed to smoke in the dining room, which can become congested, with smoke making it uncomfortable for the non-smokers. It is acknowledged that while meals are being served and eaten residents are asked to refrain from smoking. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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): 18, 19 and 20 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements in place supported residents in meeting their physical and emotional needs. Medication procedures were sufficient to protect the interests of residents. EVIDENCE: Residents were encouraged to manage their health care needs to the level of their capabilities. One resident said, “I prefer to seen my GP alone”. Another said, “Staff come with me for hospital appointments”. The home maintains links with the community psychiatric nurse (CPN) who forms part of the review system in order to monitor resident’s physical and emotional needs. All health care visits are recorded and resident’s daily notes were detailed. Outcomes for residents were positive on the day of inspection. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 14 However there were inconsistencies in the home’s recording systems i.e. signature and dates not recorded also some change in care delivery had not been added to care plans. In discussion with the manager they produced their own audit file, which identified shortfalls in recording systems that the home was addressing. These shortfalls had also been noted in Regulation 26 visits which requires the organisation to monitor progress in the home. The inspector was satisfied that these issues were being addressed. The home had made much progress in the ordering, administration and storage of medication and developed a comprehensive medication policy. Residents who go out on weekend leave are given a dosette box completed by the pharmacy for self-administration within a risk assessment framework. All staff receive training in the administration of medication. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were knowledgeable about the complaints procedure and were confident they could raise concerns/complaints with staff and they would be listened to. Residents are largely protected from abuse through the training in place for permanent staff, however, the lack of such training for bank staff potentially leaves residents at risk. EVIDENCE: Residents are provided with a copy of Turning Point’s complaints procedure on admission to the home and additionally advice on how to make a complaint is displayed in the home. At interview residents stated they felt able to complain to other Keyworkers or the manager if they were not happy about anything. The daily meetings which take place with residents also provides an opportunity for residents to raise any concerns individually or as a group. The Commission For Social Care Inspection (CSCI) has not received any complaints about the service provided at Edward House. Permanent staff within the home receive protection of vulnerable adults training. However, whilst bank staff are used on a regular basis the opportunity for this training is not available to them. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. The home is well maintained and provides a comfortable environment for residents. EVIDENCE: Since the last inspection the home has made a number of improvements to the environment i.e. new floor covering and furniture for the dining room, some replacement windows and decorating of corridors. Residents said they had been asked to choose the colour they wanted their bedroom door. A number of resident’s bedrooms had also been redecorated. Outside gardens well maintained with a small patio area to the rear of the property, allowing residents to fresh air and a change of environment if they so wish. There were odours in certain areas of the home, however staff were taking action to manage the situation. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 17 The home has one smoking lounge, with residents being able to smoke in the dining room except when meals are served. Owing to the number of residents who do smoke both areas were congested with smoke. The home should review ventilation systems in these areas for the benefit of residents who do not smoke. Residents invited the inspector to see their rooms which were clean, tidy and personalised, Certificates of achievements were displayed on their walls. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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): 32, 34, 35 and 36 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Recruitment procedures were robust for the protection of residents. Training provided ensures staff have the appropriate skills to support residents, this provision if extended to bank staff would further enhance the quality of the workforce which would benefit residents further. EVIDENCE: Examination of two newly recruited files found they contained information of references obtained and evidence of criminal record bureau checks. Turning Point provides a mandatory induction for permanent staff. The manager reported this had been reviewed to bring it in line with Skills For Care. The home recruit their own bank staff who are generally used on a weekly basis times. Unfortunately the comprehensive induction and training offered to permanent staff is not made available to bank staff. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 19 Due to staff changes in the home, they have fallen short on this inspection of 50 of staff holding NVQ’s, however new staff had been enrolled to undertake training. There was evidence that supervision for permanent staff had taken place. Unfortunately this had not been carried through to bank staff working in the home on a regular basis. At interview staff demonstrated a good knowledge of residents needs and goals. It was evident that good communication took place through regular handovers, keyworker and staff meetings. Residents interviewed gave examples of how their keyworker supports them, “staff are very good and support met to hospital appointments”. It was noted that at weekends staffing levels are reduced to a minimum of two staff for 17 residents who are required to support and supervise residents alongside cooking and domestic duties. A senior member of staff is on call if required. During interviews with staff they said that routines were different over a weekend period i.e. no doctors appointments, and as such a reduction in the staffing levels could be accommodated without impacting on resident support. Residents spoken with said they felt the atmosphere to be more relaxed at weekend. The home must keep under review the changing mental health needs of residents and increase staffing levels (specifically weekend) according if a need is identified ensuring documented evidence is maintained. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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): 37, 39, 41 and 42 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Residents felt able to voice their opinions, promoting ownership in the home. In the main, record keeping supports and promotes the health and safety of residents. EVIDENCE: The manager is a qualified mental health nurse who holds NVQ4 in management and has over twenty years experience in mental health issues. Residents discussed regular meeting with their Keyworkers in which they were able to voice any concerns or activities they would like to be involved in. Residents gave examples of areas they were consulted on i.e. decoration and food. Health care professionals questionnaires were on file, one stated, “homely atmosphere with residents being treated as individuals”. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 21 Equipment in the home has been tested by professionals and risk assessments had been undertaken on the building. The home had been inspected by environmental health who had made minor requirements which had been completed by the home. All staff had received food hygiene training. The Inspector found irregularities in record keeping i.e. case planning and recording systems as mentioned previously in this report. These had also been identified through the managers audit system and Turning Points Regulation 26 visit. The Inspector was satisfied that an action plan was being implemented to improve recording systems and that outcomes for residents remained positive. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 3 X Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA6 YA8 YA23 YA30 YA35 YA36 Good Practice Recommendations The registered person should ensure that a resident’s activity record is included in care planning at all times. The registered person should ensure that residents meetings are held a minimum of 6 times a year and recorded. The registered person should ensure bank staff have access to induction training, supervision and the protection of vulnerable adults. The registered person should increase ventilation in the smoking and dining room for the health and safety of residents. The registered person should increase NVQ training for staff to a minimum of 50 . The registered person should keep under review staffing levels over a weekend period, ensuring any additional staff used are recorded on the duty rota. Edward House DS0000005549.V313118.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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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