Inspection on 09/05/07 for Faycroft

This inspection was carried out on 9th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Faycroft 27/06/06

Faycroft 10/11/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Faycroft New Street St Georges Telford Shropshire TF2 9AP Lead Inspector Mike Moloney Unannounced Inspection 9th May 2007 09:30 Faycroft DS0000065004.V335137.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 Faycroft DS0000065004.V335137.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. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Faycroft Address New Street St Georges Telford Shropshire TF2 9AP 01952 616515 01952 616515 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) Care Tech Community Services Limited vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2006 Brief Description of the Service: Faycroft is registered with the Commission for Social Care Inspection to provide accommodation and personal care for a maximum of six adults with learning disability. The home stands in its own grounds and is conveniently located in a residential area of St. Georges, Telford, close to local amenities and just a short journey from Telford Town Centre. CareTech Community Services Ltd is the provider and was registered with CSCI on 11.08.05. Caretech’s philosophy is included in the Statement of Purpose for the home and states ‘CareTech and their staff work on the philosophy of enabling people to live as full a life as possible, supporting them in their daily activities and any identified long term plans. We recognise that all people with disabilities should be given due respect to their individuality enabling all to be fully involved in any decisions having an affect on their lifestyle commensurate to the level of their abilities and enabling people to maintain all their entitlement associated with citizenship’. The current fees charged per person range from £762.47 to £1606.72 per week. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, records kept in the home, medication records, discussions with the staff team, tour of the premises, previous inspection reports and talking with as well as observing the care experienced by people using the service. What the service does well: What has improved since the last inspection? What they could do better: It was clear that some work had been started to improve the environment in which the service users live. This must be completed in order to ensure the safety of the residents and their full access to all of the facilities within the building, such as the bathrooms. The safety of the service users would also be enhanced if all of the necessary safety checks were carried out on a regular basis so that service users and their families could be sure that such things as the fire alarms and the thermostatic hot water controllers were working. The cleanliness of the kitchen and the one bathroom in use at the time of the inspection could also have been better, particularly the bathroom where the Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 6 debris from the previous days building work could have caused an injury to anyone using it. Further efforts by the home to obtain the views of all of the stakeholders would also be a good thing in that it may identify residents’ preferences for different activities so that less time would be spent with nothing meaningful to do. This would be of particular benefit on Sundays when there are too few staff on duty to enable service users to go out. 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. The summary of this inspection report can be made available in other formats on request. Faycroft DS0000065004.V335137.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 Faycroft DS0000065004.V335137.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Prospective people and their representatives have the information needed to choose a home and they are assessed so that the home can determine whether or not they can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One service user had been admitted to the home since the last key inspection. Looking at the records and talking with the service user himself as well as the staff confirmed that the information necessary to create a care plan that would meet his needs had been obtained before he came to live at the home. This was done by visiting him at his previous home and by him making a number of visits to this home before he finally moved in. Faycroft DS0000065004.V335137.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. Staff are provided with detailed information to ensure the individual assessed needs of people receiving a service are met. People are appropriately supported to make decisions and are enabled to take responsible risks within a risk-assessed framework, which is regularly reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records for two of the service users who were living at the home at the time of the inspection were looked at. These were seen to contain a comprehensive list of their likes and dislikes. These likes and dislikes covered a range of areas such as foods and activities. This information was incorporated into the individuals’ support plans and activities that met these preferences were seen to have been risk assessed according to the support needs of that person. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 10 Talking with the staff confirmed that they were fully aware of the contents of these plans in that they talked of ways in which they had met the needs that had been identified in the manner outlined in those documents. Observing and listening to the staff interacting with the residents also demonstrated that they offer choices to the residents when they can. Faycroft DS0000065004.V335137.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. The number and type of activities undertaken by the service users is limited therefore restricting their opportunities to develop their life and social skills. Rights and responsibilities are promoted and people are provided with a varied diet in accordance with their personal preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records for two of the service users were looked at. From those records it could be seen that one of them had been out of the home on eight occasions during March 2007. Walks, visits to a pub and shopping to various places were amongst the activities recorded. Seven such activities were recorded as having taken place during April 2007. The regular weekly activity sheet for this person listed such things as cleaning their bedroom, changing the bed, booking a hair appointment, walking to the shop, Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 12 spending time in the garden, vacuum cleaning the lounge, baking a cake, helping prepare the menu and spending one evening at ‘Club 2000’. The activities outlined for the second service user were similar to the above as were their frequency. Records also showed that some work had been carried out to identify the preferences of the two people concerned but the manager stated that this would be developed further. During the inspection two of the service users were seen to be left for long periods of time without input from the staff. One was seen to go into the garden and sit on a settee that had been placed there prior to disposal. It was also noted that other service users were not in the home during the inspection as they were attending various day activities. The service users that were in the house at the time of the inspection were asked and they said that they like the food that is prepared for them and are involved in the drawing up of the menus. Faycroft DS0000065004.V335137.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. The health and personal care that people receive is based on their individual needs and are safeguarded by the medication procedures currently in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two of the service users files were looked at. These showed that the appropriate healthcare professionals are consulted as necessary and that health action plans are in place for each of the service users. The plans contained guidance to the staff about how the individuals liked to be given the different elements of their care. The management and storage of medication was looked at and both were seen to be appropriate. The records showed and staff spoken to during the inspection confirmed that they had received appropriate training for the handling of medication. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. People who use the service and their representatives are able to express their concerns and have access to a robust, effective complaints procedure. People living at the home are protected from abuse, and have their rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated that no complaints had been made since the last inspection. Two allegations have been made since the last inspection and these were referred into the local policies and procedures for the protection of vulnerable adults. The home had a copy of their complaints procedure and policies which complied with the local policies and procedures for the protection of vulnerable adults, both being part of the systems that ensures that the service users are listened to and protected from abuse, neglect and self-harm. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 Quality in this outcome area is adequate. Service users are not fully provided with a comfortable and clean place to live as the fabric of the building requires some attention and the cleanliness of parts of the house was unacceptable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was seen to be in the process of being decorated. One of the downstairs toilets was seen to have no toilet paper. The manager explained that this was due to one of the service users repeatedly throwing it out of the window. A dispenser had been purchased but this had not been installed. There were two bathrooms, one of which was not in use at the time of the inspection due, the manager stated, to there being a leak. The remaining bathroom was seen to have debris on the floor from work that the manager Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 16 explained had taken place the day before. An area of the wooden window frame was seen to be very rough with exposed splinters that represented a danger to anyone using the bath. It was also noted that the extractor fan in that bathroom was not working. The kitchen was also looked at and this was seen to have grease and grime, both fresh and accumulated on the cooker, the hob and the tile splash-back around the cooking area. Access to the building is good as is access to the pleasant rear garden. The home is situated near to local shops. The home was seen to have a large garden that was available for the service users to use. This contained a number of old settees and chairs that were awaiting disposal that were not only unsightly but represented a hazard to the service users. The laundry is appropriately equipped and sited away from food preparation and eating areas. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area good People who use the service are safeguarded by the homes recruitment procedures and are supported by a trained and committed staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota was looked at and it showed that three staff were on duty at all times except for Sundays. The Commission for Social care Inspection had received a notification from the home about an incident that had occurred on a Sunday when one of the service users had wanted to go out but could not because no staff were available to escort them. The training records showed that the staff receive training appropriate to the identified needs of the service user group and that over 30 of the team have achieved NVQ2 or above in care. Talking to the staff who were present during the inspection confirmed that the records were accurate. Looking at the documentation relating to staff recruitment showed that all of the checks that are required to ensure that staff are fit to work with vulnerable Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 18 people had been carried out before individuals were allowed to start working at the home. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. The manager is approachable and supportive. Aspects of performance of the home are not regularly reviewed and the health, safety and welfare of service users and staff are not fully promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection the Commission for Social Care Inspection were awaiting an application for registration from the recently appointed manager. Talking with her established that she had not received formal recorded professional super vision since starting in this post in earl March. The records of formal provider visits were seen to have been kept at the home. The manager confirmed that one of these had been carried out by the manager of a sister home rather than a senior manager of the company as required by Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 20 the Care Homes Regulations 2001. At an inspection carried out in November 2006 it was established that the previous manager had carried out a survey of the families of the residents in order to obtain their views of the care given by the home. The company had carried out a quality audit in September 2006. A number of records designed to monitor the safety equipment within the home were looked at. These showed that hot water temperatures, fire exits, fire alarms and fire extinguishers had not been checked at the required intervals. However, the records for such things as the risk assessments for the use and storage of hazardous substances, portable electrical appliances and gas equipment were up to date. Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 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 Standard No Score 1 x 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 2 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 2 x Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA27 Regulation 23(2)j Requirement Timescale for action 30/06/07 1. YA30 2. YA39 3 YA33 4 YA42 Both of the bathrooms should be working and in a safe condition for the residents to use. 13(3)(4)16(2)(j)(k) The premises must be kept clean and hygienic with toilet paper made readily available (Previous requirement partly met). 24(1)(a)(b)(2)(3) The views of service users, family, friends and of stakeholders must be sought on how the home is achieving goals for service users (Previous requirement partly met). 18(1)a Enough staff must be available to meet the needs of the service users at all times and particularly at the week ends. 13(4)a & The checking of systems 23(4)(c)iv designed to keep the service users sake must be carried out at the prescribed intervals to ensure that they are working. 31/07/07 31/07/07 31/07/07 30/06/07 Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 23 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 YA14 Good Practice Recommendations More structured in-house activities should be developed that the individual service users are known to like and enjoy so that their time is more usefully spent. Unsightly and dangerous furniture should be removed from the garden. The manager should receive regular professional supervision so that her performance as manager can be monitored and assistance and guidance can be more readily given if necessary. 2 3 YA24 YA36 Faycroft DS0000065004.V335137.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Faycroft DS0000065004.V335137.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!