Inspection on 14/09/06 for Elm Road, 13

This inspection was carried out on 14th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Elm Road, 13 02/02/06

Elm Road, 13 16/08/05

Elm Road, 13 09/11/04

Elm Road, 13 03/06/04

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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 Elm Road, 13 13 Elm Road Seaforth Liverpool Merseyside L21 1BJ Lead Inspector Mrs Elaine Stoddart Key Unannounced Inspection 14 and 18th September 2006 10:00 th Elm Road, 13 DS0000005242.V295793.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 Elm Road, 13 DS0000005242.V295793.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. Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Road, 13 Address 13 Elm Road Seaforth Liverpool Merseyside L21 1BJ 0151 476 1967 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) Expect Limited Mrs Maria McCarthy Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 MD. Date of last inspection 2nd February 2006 Brief Description of the Service: 13 Elm Road is a mid-terraced house situated in a residential area of Seaforth. Parking is available on the road at the front of the house. The home is registered to provide care and support for three adults who have mental health difficulties. Currently there are two women in residence. The home is generally well maintained. The home is of a domestic setting in all aspects and is indistinguishable as a care home. The home is operated by Expect, formerly Sefton Support Services. Crosby Housing Association owns the house. Staff are on duty 24 hours a day to provide care and support for the service users who live there, the overall philosophy being to maximise ordinary living and to promote independence of the service users in all aspects of their daily life. The cost for the service is £280.00 per week. Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two visits. It was an unannounced (site visit) and was conducted as part of the regulatory requirement for care homes to be inspected. A tour of the building and garden was conducted and a selection of care staff and home records were viewed. Case tracking was undertaken for the two residents to assess the care provided at the home. This involved discussion with the manager, staff members, residents and observation during the visit. It was not possible to obtain the direct views of one resident due to the nature of her disability however; her experiences were obtained through discussion with the manager, staff and general observations and compliance with standards. Satisfaction survey forms “Have Your Say About …” were distributed to the residents prior to the inspection. Comments included in the report are taken from the survey forms and also during the site visit. What the service does well: In the main the house is comfortable and clean providing a safe and homely environment for residents. Care plans are detailed and other records about residents are well written, easy to follow and up to date to ensure that staff have the information they need to provide residents with the correct level of care and support. Residents are given opportunities to live their lives in accordance to their wishes and the staff ensure that residents are assisted to make choices and decisions. Regular contact with family members is encouraged and visitors are made welcome. Daily routines are flexible to meet the needs of the two residents accommodated who are supported to be involved in the daily routines of the home. Some of the staff employed have worked with the residents for many years thus providing continuity of care and support in the way the residents prefer. The residents are supported by staff that are qualified and competent to do their jobs. An ongoing training programme is in place. Residents’ benefit from a service that is well managed. The service ensures the protection of residents by following a robust recruitment procedure and the staff are trained in adult protection procedures. Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Elm Road, 13 DS0000005242.V295793.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 Elm Road, 13 DS0000005242.V295793.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): 2,3. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ needs are fully assessed prior to admission the home to ensure their needs can be met. EVIDENCE: Assessments of need were viewed for both residents accommodated. These contained detailed information relating to the care needs of the residents and included information on medication, religious beliefs, personal profiles, risk assessments, family contacts, likes and dislikes and preferred daily routines. This information enables the staff to obtain an understanding of the resident’s background and assists them in providing the care and support required. Elm Road, 13 DS0000005242.V295793.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. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are encouraged to make decisions and are supported to participate in daily living activities. Their changing needs and personal goals are reflected in their care plans. EVIDENCE: Both residents individual plans of care were viewed and were found to contain detailed information on their assessed needs, identifies how these needs are to be met and are drawn up in consultation with all involved in their care. The information covers what they can do independently i.e. personal care and areas in which they need assistance i.e. finances, medication. These care plans are reviewed formally every six months. In addition the staff to review their mental health, activities, physical needs, personal hygiene and family contacts complete monthly summaries. This enables the home to closely monitor change and developments that occur. Care plans demonstrate daily routines in place and how the residents are encouraged to make their own decisions in what they wish to do. Records Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 10 showed the residents likes and dislikes i.e. seeing their families, and these wishes are respected and encouraged by the staff. Both resident are encouraged to take part in the daily routines of the home and are encouraged to lead independent lifestyles within the risks identified. Risk assessments for both residents are in place and are reviewed regularly by the home’s manager to assess changing need. Elm Road, 13 DS0000005242.V295793.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. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are given opportunities to live fulfilling lives in accordance to their wishes. Meals are offered at flexible times to meet the needs, choice and wishes of the residents. EVIDENCE: Detailed care records are in place, which reflect the wishes and care needs of both residents. Guidelines are in place for staff to ensure they are aware of how the residents wish to be supported and how to deal with any problems which may arise do to their mental health difficulties. Staff spoken to confirmed their understanding of these and as they have worked with the residents for many years they are confident in how to provide the support required. “I have worked with both residents for 8 years and know them inside out” Manager. Both residents who have mental health problems choose not to go outside the home. The manager and staff respect their decision and recognise that because of this it is particularly important that they are given opportunities for Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 12 stimulation at home. Records examined and the residents spoken to confirmed this. Both residents were observed to be relaxed in their environment and were watching TV in the lounge and chatted with staff on duty in the kitchen. A pleasant, relaxed atmosphere was in place during the two visits to the home. Details of activities, interests and hobbies that residents are offered and take part in at home were recorded in detail. One resident enjoys spending time in her room listening to her radio, reading and watching television in the company of others in the main lounge. Another resident enjoys pampering sessions, which include having her nails manicured, and her hair washed and styled. Both residents choose their own clothes, what they wish to wear and how they have their hair done. Both residents are encouraged to maintain contact with their families and this is available to them by daily phone calls, weekly visits by one resident, which she travels by taxi to see her family and visits by the family to the home. Both residents are encouraged to take part in the daily living tasks of the home by helping to choose the food, set the tables and tidy their own rooms. The daily routines are flexible and meals are served for them when they wish and both are included in choosing the menus. Residents are able to make drinks and snacks with support. Both residents said that they enjoy sitting in the small-enclosed garden during the summer months and have no wishes to go out. Additional hours are allocated to the home to enable them to go out supported should they wish. The manager and staff to review the resident’s activities, family contacts, and personal hygiene to ensure that any changes that occur are addressed and recorded in the monthly summaries. Both residents require staff support with finances and any correspondence. Elm Road, 13 DS0000005242.V295793.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): 18,19,20,21. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents receive personal support according to their wishes. EVIDENCE: Care files showed detailed information on the health care needs and personal support required for both residents and how they wish to be assisted in these areas. For example help with using the phone and taking medication. Both residents require some physical support with personal care but require mostly advice, guidance & support. Both care plans have a detailed and agreed routine, which showed the need for staff guidance and the importance of the routines for the residents. Regular care plan reviews allow staff to address any issues or changes to care that may be necessary. The death wishes of both residents are recorded and have been discussed in a sensitive manner using picture formats to discuss their wishes. Residents require assistance with medication, which is securely stored and administered by trained staff using the correct procedures. All stock is recorded on receipt and is administered from blister packs delivered from the chemist. A recommendation was made for staff to countersign any written Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 14 entries on the MAR sheet. Information is available to staff on the medication and the side effects to enable them to monitor progress. Both resident are encouraged to have regular health checks, which often require home visits, as they do not wish to go out and refuse to attend the Well Woman Clinic. These include monthly chiropody visits and eye tests when needed. A community psychiatric nurse attends regularly to administer injections and monitor health care for one resident and all visits are recorded. The home undertakes a medication review annually on both residents. Elm Road, 13 DS0000005242.V295793.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): 22,23. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Policies and procedures are in place to safeguard the residents who are aware of how to complain. EVIDENCE: There have been no complaints made about the service since the last inspection. Policies and procedures are in place and both residents confirmed that they would tell the manager. “I would tell Maria if I had a complaint”. Staff are in daily 24-hour contact with the residents and deal with any comments on a daily basis should they arise. Both residents have families who are in regular contact and have been referred to Sefton Advocacy service for support. All staff have received training in abuse awareness and physical intervention and confirmed they are aware of the procedures and commented, “I would not hesitate to report anything”. The home should make the new procedures ‘Safeguarding Adults’ available to all staff for reference. A copy is available at the home, however staff spoken to were not aware of this. This is contained within the recommendations of this report. Resident’s personal allowances are managed by the staff and daily expenditures are recorded, receipts obtained and all transactions and signed for. All monies are securely stored. Both residents have access to their own bank accounts and information on these are securely stored and risk assessments are in place. Elm Road, 13 DS0000005242.V295793.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): 24,25,26,27,28,29,30. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is clean tidy and provides a safe and comfortable environment for residents. EVIDENCE: All communal areas of the home were viewed in addition to the outside front and rear of the property. All areas were clean and tidy and maintained to a good standard. Both residents’ bedrooms were viewed, they were found to be comfortable and personalised to a good standard meeting the needs and lifestyles of individual residents. Both residents have been involved in choosing colour schemes and furnishings for their rooms. Both residents commented that they are satisfied with the accommodation. “We have a lovely clean house”. A stair lift is in place for one residents use and the service maintenance for this is up to date, 30/08/06. Smoke alarms and radiator covers and window restrictors are fitted throughout to ensure safety. Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 17 The kitchen, bathroom and shower rooms are in need of refurbishment as these areas compromise the dignity and comfort of residents and should be repaired or replaced. This has been recommended within the findings of this report. Elm Road, 13 DS0000005242.V295793.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): 31,32,33,34,35,36. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff are trained to carry out their roles. The recruitment and selection procedures are robust. EVIDENCE: Three staff files were examined and all contained the required identification evidence, two references, Criminal Record Bureau (CRB) checks and proof of qualifications. The recruitment policy is robust and meets the minimum standards. Staff files showed evidence that staff have undertaken a full training programme, which is required and equips them with the skills to meet the needs of the residents. The training programme is kept up to date and includes statutory training i.e. moving and handling and food hygiene. Additional training i.e. crisis intervention, medication and abuse are provided. Staff are encouraged to obtain National Vocational Qualifications (NVQ) and all the four staff based at the home are qualified in at least NVQ Level 2 (100 ). One member of staff is on duty per shift daytime and one for sleep in duty. The manager is available ‘on call’ at all times and there are emergency contacts if needed. Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 19 Records viewed and staff spoken to confirm that regular meetings take place to keep staff up to date. Handovers take place at the beginning and end of each shift to ensure staff are aware of residents progress and to balance finances. This was observed to take place during the visit. Additional staff hours are provided should the residents choose to go out with support or to assist the staff on duty. Regular bank staff are only employed during staff sickness and holidays. Regular supervision is in place and records and discussion with staff confirmed this. Annual appraisals are conducted for all staff. The staff spoken with were very positive about their work to meet the needs of the residents. “I love working herewith these residents”. Elm Road, 13 DS0000005242.V295793.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): 37,38,39,40,42. The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is well managed in the best interest of the residents. Systems are in place to seek their views. EVIDENCE: The manager has worked with the residents for the past 8 years and is experience and qualified in NVQ Level 4. The home was visited on two occasions and a positive, open and inclusive atmosphere was in place. The residents were observed relaxed and chatted freely with the staff on duty. The manager gives a clear sense of direction and leadership and the staff spoken confirmed this with positive comments. “Always supportive” “Maria is available at all times” “We have regular supervision and staff meetings” Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 21 Administration and recording systems in the home are organised, detailed, relevant, easy to follow and up to date. Policies and procedures are in place and were last reviewed in 2003. A recommendation is made for these to be reviewed annually to reflect change. Staff through the day-to-day running of the home value resident’s choices and opinions. The manager and staff were observed to be respectful towards residents placing them at the centre of their work. Records showed that quality monitoring systems are in place. This involves residents and/or their relatives/representatives being consulted on their views about the home. This is done through discussion, and/or written questionnaires. This is an important process as it shows that the home is run in the best interests of the residents. Also as part of a quality assurance process and in accordance with Regulation 26 of the Care Homes Regulations 2001 Amended (2004), a representative for the home visits the premises monthly. They interview residents and staff and inspect the environment. A copy of their findings is forwarded to the Commission. An ongoing staff training programme ensures that staff are trained to carry out their roles effectively. All staff are trained in health and safety and have access to a health and safety file for reference. Risk assessments are in place and reviewed regularly. Up to date certificates are in place and were viewed for all services i.e. gas, fire equipment and stair lift. Crosby Housing is responsible for the electricity contract and a letter to confirm this available to view. Fire records viewed are up to date to ensure the safety of the residents. All fire drills, smoke alarm checks, emergency lighting, water temperatures are recorded and up to date. Elm Road, 13 DS0000005242.V295793.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 X 2 3 3 3 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 X 3 X Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 23 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. 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 Refer to Standard YA24 YA40 YA23 YA20 YA27 Good Practice Recommendations Kitchen units should be repaired or replaced. Policies and procedures should be reviewed annually. Staff should be aware of the ‘Safeguarding Adults’ procedures. All written entries on MAR sheets should be countersigned. The bathroom and shower room should be refurbished. Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Elm Road, 13 DS0000005242.V295793.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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