CARE HOME ADULTS 18-65
Florrie Robbins Penshurst Avenue Handsworth Birmingham West Midlands B20 3DQ Lead Inspector
Gerard Hammond Unannounced Inspection 9th February 2006 09:00 Florrie Robbins DS0000016728.V283302.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 Florrie Robbins DS0000016728.V283302.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. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Florrie Robbins Address Penshurst Avenue Handsworth Birmingham West Midlands B20 3DQ 0121 331 1817 0121 331 1820 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) Mr Roger Murray Mr Paul Murray Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 30th August 2005 Brief Description of the Service: Florrie Robbins is registered to provide accommodation, care and support for up to five adults with learning disabilities. The Home is owned and run by Alphonsus Care. The property is a purpose built detached house lying to the rear of one of the Organisations other homes (Charles House, Birchfield Road). The Home has its own front entrance on Penshurst Avenue, but the rear of the property can be accessed through the back garden of Charles House. The house is within walking distance of the centre of Perry Barr, and there is a wide range of community facilities in the area, including shops, pubs, restaurants and places of worship. Public transport links are particularly good, with a choice of several buses, and also a train station. All of the single bedrooms have en-suite shower facilities and wash hand basins. Downstairs are two bedrooms, a lounge, dining room, and kitchen. There is also a bathroom and separate w.c. Upstairs there are three more bedrooms, another bathroom, shower room, and w.c., the laundry, and the office. There is limited off road parking at the front of the house, and a private small lawned garden to the rear of the property. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second visit of the current year, and was unannounced. This report should be read in conjunction with the one written following the inspection carried out on 30 August 2005. Direct observation and sampling of records (including care plans, personal files, previous reports and safety records) were used for the purposes of compiling this report. The Inspector was unable to seek residents’ views directly as people were out attending activities for most of the time spent in the Home. Individuals’ communication support needs and levels of learning disability also make it difficult to consult appropriately. The newly appointed Manager was interviewed formally, and a tour of the building was also completed. What the service does well: What has improved since the last inspection?
A new Manager has been appointed since the last inspection. In the limited time that has been available to him since taking up his post, he has begun work to meet outstanding requirements. An interim care plan has been devised for one resident who has been referred for assessment and investigation of epilepsy. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 6 The Medication policy has been amended to give guidance to staff about action to be taken in the event of a medication administration error. New furniture and curtains have been purchased for the dining room, and further work is scheduled to improve facilities in the lounge. A previous requirement to include recent photographs on staff member’s personal files has now been met. 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. Florrie Robbins DS0000016728.V283302.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 Florrie Robbins DS0000016728.V283302.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): 2, 4 Residents’ needs and aspirations are appropriately assessed, and prospective service users have the opportunity to visit and to try out what the Home has to offer, to support decisions about placement. EVIDENCE: There have been no admissions since the time of the last inspection and there is currently one vacancy. The Manager advised that consideration is being given to offering a place to a prospective resident. As previously reported, there are systems in place within the Organisation to ensure that individual’s needs can be assessed appropriately, and that people have the opportunity to visit and stay over prior to making any decisions about placement. Florrie Robbins DS0000016728.V283302.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): 6, 9 Care plans are still in need of further development so that they include individuals’ personal goals and aspirations, and the desired outcomes can be measured. The system and practice of reviewing care plans is also in need of some attention. Individuals are encouraged to take risks responsibly, so as to enhance opportunities for independence, but risk assessments still require further development. EVIDENCE: Key Standards 6, 7 and 9 were assessed at the last inspection. Standard 7 was fully met; Standards 6 and 9 were met in part. It was noted at the time of the last inspection that the Trainee Manager had made positive efforts to develop care planning, but that further work was required to bring this fully up to standard. Since the last inspection this person has left the Organisation, and a new Manager has now been appointed. It should be acknowledged that he has had limited time to address fully all the requirements made at that time, and that these are therefore still outstanding.
Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 10 Care plans are in need of development to include residents’ personal goals and aspirations. As previously observed, goal setting is currently quite limited. This needs to be expanded so that goals have outcomes that can be measured, and that these are linked explicitly to areas of assessed need. Outcomes should be evaluated at review, with whole care plan reviews taking place at least every six months, to comply with National Minimum Standards (6.10). It was noted that recording of review meetings was also limited. Again, as previously reported, review meeting records should show the names of all people taking part, and should be in sufficient detail to enable the reader to follow the discussions that took place and understand how decisions have been made. The previous requirement to develop individual’s communication guidelines remains outstanding also. It was noted that some work has been done towards updating risk assessments, but these too are in need of further development. Risk assessments should be directly cross-referenced with the care plan(s) to which they refer, and vice versa. In particular it was noted that one resident has bed rails, but there is still no risk assessment in place to cover the use of these. This must be addressed, and it is recommended that professional advice be sought with regard to their use. It was also noted that the risk assessments for all of the residents were jointly held on a single file. This does not comply with current data protection legislation. Personal information on named individuals should be maintained on each individual’s personal records. There is a need to differentiate between risk assessments that are generic (e.g. those relating to general environmental issues) and those that are specific to individual people. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 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 Residents are able to take part in some appropriate activities and to access the local community, but the range, quality and frequency of opportunities needs to be improved. Planning and recording of activities also requires further development. EVIDENCE: All Key Standards were assessed at the last inspection. It was reported that some improvement is required in the range, frequency and quality of opportunities currently available to people living in the house. The Organisation provides its own day service, and all of the residents were out attending day activities at the time of the inspection visit. The Manager reported that discussions are taking place within the Organisation with regard to how information is shared about what people actually do during the day. Under current arrangements there is very little information available about individuals’ activities when they are away from the Home. Activity recording needs to improve, so that it is possible to assess the quality of this aspect of each person’s “care package”. As previously indicated, there should
Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 12 be clear links between people’s assessed needs and wishes, and the activity opportunities made available to them. The range and frequency of such opportunities are prime indicators of the quality of life that each person enjoys, and serious thought should be given to how evidence of this is produced. Planning and delivery of activity opportunities should form an integral part of the management of each person’s care plan: day activities should not be something that goes on “over there somewhere”. The continued development of person-centred approaches would have a positive effect on this, as previously reported. Activity opportunities should be clearly linked to individuals’ agreed goals, and planning should include an indication of the intended purpose of each activity. The Manager indicated that the issue of residents’ day programmes is under review within the Organisation, including availability of transport at the home and also the development of alternative activities from the house. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 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): EVIDENCE: All Key Standards were assessed at the last inspection. A requirement to produce an interim care plan for one resident who has epilepsy has now been met. This needs to be kept under review, and amended as required, in accordance with guidance from the responsible consultant. It was noted that the medication policy has now been amended to provide guidance to staff in the event of a medication administration error. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Key Standards 22 and 23 were assessed at the time of the last inspection. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 As previously reported, communal areas supplement individuals’ private spaces, but some development is required. EVIDENCE: Key Standards 24 and 30 were assessed at the last inspection, and met in full. As previously reported, the house is on a domestic scale and in general is pleasantly decorated and well maintained. Residents’ rooms are all individually styled, and there is ample evidence of personal effects and possessions throughout. A requirement was made at the last inspection that consideration is given to the viability of changing the dining room and lounge around, as the lounge is not big enough to accommodate all of the residents together at once. This has been done, and it has been decided to continue with current arrangements for the time being. The Manager advised that the lounge is scheduled for redecoration. The lounge carpet is now also in need of replacement. The dining room furniture has also been changed since the last inspection visit, and one resident in particular chooses to watch television in this room in preference to the lounge. Consideration needs to be given to the suitability of the current lounge furniture to the needs of the residents, particularly in relation to
Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 16 meeting mobility requirements. This should be appropriately assessed and replaced as necessary. He advised that the current resident group do not seek to use the lounge together, and that this is the basis for the recent decision. Requirements to repair or replace damaged tiles and worktops in the kitchen, to clean the extractor fans throughout the house, and to produce a plan for improving the facilities in the garden remain outstanding. As indicated in the last inspection report, the house is kept neat and tidy, with a good general standard of hygiene maintained throughout. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 The staff team is generally well trained, qualified and competent, but there are some gaps in training that need addressing. General recruitment policy and practice support residents’ protection. EVIDENCE: A training and development assessment has been provided since the inspection visit. Information provided in this and in reports completed by the Operations Manager indicates that one senior member of care staff is qualified to NVQ level 3 and one member of night staff is qualified to NVQ level 2. Four other staff members are shown as registered for NVQ Level 2, but this dates back to 2002 (2001 in one case). Four of the staff team are said to have completed Learning Disability Awards Framework (LDAF) training, with another four members registered and working towards this. All but two members of staff have received adult protection training. There is no indication that any member of staff has received training in supporting people with Autistic Spectrum Disorders, and this should be addressed, in view of residents’ identified needs. However, it is understood that the Manager recently completed a relevant course of study in this subject prior to taking up his current post. It is also noted that he is the only person to have received any training in care management. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 18 Sample checking of staff files indicated that documents required by regulation are in place. A previous requirement to include a recent photograph on each person’s file has now been met. It was noted that staff meetings are scheduled regularly: requirements relating to formal supervision of individual staff members were met in full at the last inspection. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Residents benefit from living in a home that is generally well run. A report is required to demonstrate how residents’ views underpin selfmonitoring, review and development of their service. General practice promotes the health, safety and welfare of the residents. EVIDENCE: The recently appointed Manager is qualified to NVQ level 4 and holds the Registered Manager’s Award. He is also a qualified Assessor for NVQ students. Since taking up his post he has sought to develop the service for the benefit of people living in the house and begun to work towards meeting outstanding requirements. An application to be registered as the Manager has also been submitted to CSCI, as appropriate. The Manager also indicated that he has been well supported by his line manager and from within the Organisation in general since starting work at Florrie Robbins. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 20 It was noted that visits and reporting required under Regulation 26 (Care Homes Regulations 2001) is not currently up to the required standard. The Registered Provider must ensure that these visits, which should be unannounced, take place at least once a month, with a written report being made available to the Registered Manager and to CSCI. It should be acknowledged that the current Service Manager has acquired this responsibility since the time of the last inspection, and has submitted reports since this visit. Other quality assurance and monitoring systems are in place within the Organisation, including additional audits by managers from other homes in the group. Information on quality assurance and monitoring should be collated from all relevant sources, and a report produced on the outcome of this work. Attention is drawn to the intended outcome for National Minimum Standard 39 that “Service Users are confident that their views underpin all self-monitoring, review and development by the home”. It is important that the report on quality assurance and monitoring activity reflects this appropriately. The records relating to testing of the fire alarm and emergency lighting systems were sample checked. Records of testing of temperatures at water outlets were also examined. All these had been completed regularly as required. Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 2 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 X 2 X X 3 X Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15(2b) 17(3a) Requirement Develop existing care plans as indicated in the main body of this report: set targets and review as appropriate. Include detailed communication guidelines for each resident. Outstanding since 30 November 2005. Cross-reference risk assessments to relevant care plans, and vice versa. Ensure that risk assessments for named individuals are filed on personal records. Develop risk assessment for use of bed rails. Further develop residents’ activity opportunities and provide appropriate staff support to facilitate this. Expand activity recording to demonstrate clear links to individuals’ assessed needs and wishes, and to their personal goals. Evaluate activity opportunities in detail when care plans are reviewed. Repair or replace damaged tiles and worktops in the kitchen. Clean all extractor fans in the house. Outstanding since 30 November
DS0000016728.V283302.R01.S.doc Timescale for action 30/04/06 2 YA9 13(4b-c) 30/04/06 3 YA12 YA13 16(2m-n) 18(1a) 31/05/06 4 YA24 23(2b,p) 30/04/06 Florrie Robbins Version 5.1 Page 23 2005. 5 YA28 23(2) Assess the suitability of the 30/04/06 furniture in the lounge to residents’ current assessed mobility needs. Produce a plan for improving the facilities in the garden. Make arrangements for members 31/05/06 of the care team to receive training in supporting people with Autistic Spectrum Disorders, in accordance with residents’ assessed needs. The Registered Provider must 30/04/06 ensure that visits and reporting required under Regulation 26 (Care Homes Regulations 2001) is carried out as necessary. Produce a written report evaluating Quality Assurance and Monitoring activity, demonstrating how service review and development is underpinned by residents’ views. 6 YA35 18(1a,c) 7 YA39 26 24 (2) 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 YA6 Good Practice Recommendations Plan to record all current information about how individual residents communicate, and incorporate into communication guidelines for each person. Seek help to develop the capacity of the team to enhance communication opportunities for residents. Expand training opportunities in care management practice to additional members of the care team. 2 YA35 Florrie Robbins DS0000016728.V283302.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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