CARE HOME ADULTS 18-65
Elizabeth House Denmark Road Gloucester Glos GL1 3HW Lead Inspector
Mrs Caroline Jones Unannounced Inspection 6th March 2006 02:30
06/03/06 14:30 Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 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 Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 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. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Elizabeth House Address Denmark Road Gloucester Glos GL1 3HW 01452 782960 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) National Star College To be appointed Care Home 24 Category(ies) of Physical disability (24) registration, with number of places Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: Elizabeth House is one of two residential homes providing off site accommodation to students from the National Star College. The college owns the property, which was converted and fully refurbished into accommodation for 24 students with a physical disability almost 5 years ago. Situated in a residential area, the home provides easy access to the centre of Gloucester. Most students have single accommodation, some with en-suite facilities, which include a shower. There are three double rooms and sufficient bath/shower rooms and toilets. An independent living flat and training kitchen are also provided. Students have access to a spacious and comfortable lounge, a dining room, computer room and student kitchen. The home has two mini buses and students also use taxis and local transport systems. The application for the manager to become the Registered Manager is currently being processed by the Commission for Social Care Inspection. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place during the afternoon and early evening. The inspection focused on the six key inspection standards not inspected at the announced inspection, following up recommendations made at the last inspection and meeting students to get their comments and views. What the service does well: What has improved since the last inspection?
Both staff and students reported that since an adjustment to the timing of the lift doors, the lift has been more reliable and there had been no breakdowns. The plan to fit a second lift is on time and due to be put in during the summer holidays. The nurses have started to look at ways of joining the nursing records with the care records and are due to try out a new system soon. ‘They have decorated the dining rooms, staff did a 90 minute makeover’ were among the comments from students about a recent project to brighten the dining areas, this was one of several areas where pictures and information has been fixed at a level to make it easier for student using wheelchairs to see. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 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. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 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 Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 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): None of the above standards were inspected on this occasion N/a EVIDENCE: N/a Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 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): None of the above standards were inspected on this occasion N/a EVIDENCE: N/a Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 16 Students living at Elizabeth House are able to develop their independence and access activities and services in the local community. EVIDENCE: The group of staff spoken to listed a range of local community resources that students access including a local pub, the GP practise, town centre shops, cinemas and a local church. This was confirmed in discussions with students. There were a number of ways described for making students aware of local events, although use of the Internet was most frequently mentioned. Students reported that some advance planning was sometimes required to ensure that enough staff were available for them to go out. Students reported that more spontaneous trips to the local pub are possible and staffing constraints did not prevent their going out into the community. There is an adapted vehicle based at Elizabeth House. Discussions with staff confirmed their awareness of recognising that respecting the rights and responsibilities of students. Knocking on doors, using screens in shared rooms, offering choices, giving privacy to individuals in personal care,
Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 11 privacy for couples, talking to students about age restrictions and generally talking with and listening to students were among the ways identified. Practise observed and comments from students confirmed that Elizabeth House operates to promote student independence. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 At Elizabeth House students are fully involved in deciding how they will receive the care and support they need. EVIDENCE: Detailed care and manual handling plans are drawn up with students and set out how students wish their care needs to be met. Copies of manual handling plans are available in student rooms so that they are readily available to any staff helping a student. Specialist and technical support is available to students both at college and at Elizabeth House. Students spoken to knew their key worker and confirmed that they could choose to receive personal care from a member of staff of the same gender. Students were happy that there was some negotiating of times for assistance with personal care to be fair to all students living there. The nurses based at Elizabeth provide ongoing support and review for all general and psychiatric nursing care needs. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 13 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 Students at Elizabeth House and their families can be confident that their views will be listened to and any complaint made by them will be investigated. Students at Elizabeth House and their families can be confident that staff at the home will report any allegation or suspicion of abuse, however the are not always kept informed of the progress or outcome of any investigation. EVIDENCE: Students spoken to were aware who they would raise any concern with, and were confident that they would be listened to. Students knew the different opportunities that are available both at Elizabeth House and on the main campus to give their views and comments generally. Staff were able to describe their roles in the event of their receiving a complaint. The manager reported that there had been only one complaint made since the last inspection. This had only recently been received and related to issues on the main campus and had been passed on to the Residential Services Manager to investigate. The responses of staff in discussion confirmed that they are familiar with what constitutes abuse. Members of staff could describe how they would respond, including if they witnessed abusive behaviour from a colleague. Members of staff have access to a copy of the college Safeguarding Policy, however there was no associated procedure. It was not clear from the records at Elizabeth House what was the outcome from an allegation of abuse made by a student living at Elizabeth House. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 14 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): None of the above standards were inspected on this occasion N/a EVIDENCE: N/a Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 15 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): None of the above standards were inspected on this occasion N/a EVIDENCE: N/a Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 16 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): 42 Students can be confident that health and safety of students is protected and safeguarded through the homes accident and fire safety procedures, although some additional fire testing and drills are needed. EVIDENCE: The homes’ accident log showed clear recording of events; the Health & Safety representative on the main site, and the Residential Services Manager are sent copies of the report, and a copy put on the student file. Student files seen including copies of accident reports. Where accidents required remedial action this had been undertaken. Blank copies of the forms and a copy of the procedure were available for staff. The Fire Log records show regular testing of alarm system and fire safety training to both staff and students. The Deputy manager reported that evacuations and further training planned in the next few weeks. Following discussion it was agreed that this would include night time drills. There was no evidence seen, as indicated in Fire Safety Action plan, of recorded weekly testing of all self-closing fire doors, fire exits into external fire
Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 17 escapes, and monthly testing of break glass points. The Fire Safety records included a detailed Fire Risk Assessment for the house. Staff spoken to confirmed that they had undertaken manual handling updating in the past year and First Aid training. The Manager and staff were not clear about who was the homes’ First Aider, assuming that this was the nurse on duty. Looking at the file of one student, whilst there was a list of their electrical items brought into the home there was no evidence that the safety of the equipment had been confirmed with by the college or from home. It was reported that such information might be in earlier records, which have since been archived. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 18 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X X X X X X 2 X Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3. 4. Standard YA29 YA42 YA42 YA42 Regulation 23.2 (c), (n) 13.4 17. (2) Sch 4.14 13.4 Requirement Timescale for action 01/09/06 A reliable means for students to get to all parts of the building must be provided. The home must make suitable 01/09/06 arrangements for training of staff in First Aid. The home must record every fire 01/05/06 practise, drill or tests of fire equipment. The home must maintain 01/09/06 adequate records to confirm the safety of electrical equipment 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 Refer to Standard YA6 YA20YA9 YA34 Good Practice Recommendations Greater co-ordination and sharing of information is recommended between care and nursing records. It is recommended that copies of existing Risk Assessments for students self-medicating are transferred to their current files. It is recommended that recruitment systems be tightened to ensure that references are on file prior to a person’s
DS0000016429.V286004.R01.S.doc Version 5.1 Page 20 Elizabeth House 4 5. YA24 YA23 appointment being confirmed and there is evidence that any gaps in employment have been explored. Continued monitoring of the amount of dining room space is recommended. It is recommended that Protection procedures be reviewed to make sure that the information about outcome of any abuse investigation is understood and recorded at the home when investigation takes place by other. Elizabeth House DS0000016429.V286004.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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