CARE HOME ADULTS 18-65
Georgina House 20 Malzeard Road Luton LU3 1BD Lead Inspector
Linda Cappello Unannounced 28th June 2005 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 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 Stationary 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. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Georgina House Address 20 Malzeard Road Luton LU3 1BD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 456574 01582 456574 Parkcare Homes (No 2) Ltd Care home 3 Category(ies) of LD Learning disability - 3 registration, with number of places Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th March 2005 Brief Description of the Service: Georgina House is a semi-detached house situated in a residential area of Luton, close to Luton town centre and is owned by Craegmoor Healthcare. There are local shops and a park close to the home and a bus service available to the town centre. The home is registered for three residents with learning disabilities but there is currently one vacancy. Each resident has a good sized single bedroom, two on the first floor and one on the ground floor. The bathroom and toilet are located upstairs, along with the office/staff room. There is a lounge/diner and kitchen on the ground floor. The home has a large enclosed rear garden and a paved area at the front of the building with parking for two cars. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the afternoon and evening on 28th June 2005. The deputy manager and one member of staff were on duty and both residents were in the home. The care plans for both residents were examined and all areas in the home were visited. The inspector is grateful for the help given by the staff and residents during this inspection. What the service does well: What has improved since the last inspection?
The home did not have its own manager and this had meant that the care the residents received was not always as good as it should be. Since the last inspection, the deputy manager has been working in the home and has helped a lot of things to improve. The plans which set out how each resident is to be looked after were much better and the staff were now very clear about areas where the residents might be at risk in some way and had written plans to help keep them safe. The home is also making sure now that what is written down is kept in a safe place. The staff had been asking the residents more often about what they liked, for example for dinner and what activities they wanted to do. The staff are making sure that the residents get to church regularly because they both enjoy this and also that they get to daycare or to college. The staff also help the residents to stay in touch with their family and friends and spend time helping the residents learn how to do things for themselves, like washing up, cleaning their rooms and washing their clothes. The staff make sure that the residents get the medication they need and this is done in a safe way and make sure that residents get to hospital appointments. There are now always enough staff on duty and they are staff who know the residents. The deputy manager makes sure that he sits down with them regularly to talk about how things are going and discuss any problems. He has also worked out good ways of helping the residents to stay calm.
Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 standard(s) 1,5 A resident’s guide and contract in a new format has been developed which will give prospective residents good information. EVIDENCE: The home had been required after previous inspections to develop a resident’s guide and contract in a format which would enable residents to read and understand it. These have now been developed with the help and ideas of residents from a nearby home. They now need to be provided to each resident at the home and discussed with them, and their relatives or representatives if they wish, in order to meet the standard. The home has not had any new admissions for the past 2 years and it is, therefore, not possible to assess standards 2,3 and 4. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 standard(s) 6,7,8,9,10 Significant improvements have been made in the care plans, risk assessment and recording their choices so that residents’ can be confident that all staff know how best to meet their needs. EVIDENCE: The home has been required after previous inspections to make improvements to the content and detail of the residents’ care plans and in the past few weeks this work has been undertaken. Almost all of the elements of each residents’ daily living needs are now addressed in care plans and the necessary risk assessments have now been written. There are still some elements which need to be added but the staff are now clear about what they need to do and are committed and motivated to make sure these are written. The Deputy Manager, who has facilitated these improvements, is committed to introducing Person Centred Planning which will enhance the plans and ensure that the plans are truly written from the perspective of each resident. There are only 2 residents in the home at present and they have very different needs and communication abilities. However, the home is committed to trying to give them choice and encourage the residents to take decisions for themselves where it is safe for them to do so. The staff have recently been
Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 10 trained to communicate in Makaton and this has enabled one resident to make his wishes known to staff and for staff to communicate more effectively with him. For example, the staff have recently gone through the menu with each resident to make sure that the food which is prepared has been chosen by them. The staff have also begun to use a digital camera to take photographs of food and activities to assist the residents to make choices. The staff now have clearer care plans for the residents and have developed risk assessments around most aspects of their daily lives. The risk assessments help the staff to make it as safe as possible for the residents to live as independently as they can. For example, a new risk assessment for one resident when he is out in the community has made it clearer to staff what they need to do to help him to stay calm and safe when crossing the road. The records for both residents are kept in a locked cabinet in the office which is, itself, locked unless staff are present. Residents are, however, made aware that they can look at their care plans when they wish to. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 standard(s) 11,12,13,14,15,16,17 The home is committed to enabling residents to enjoy a fulfilling lifestyle by finding out what each resident likes and helping them to take part in activities. EVIDENCE: Each resident has a time set aside each week when they carry out their household chores according to their abilities. They are assisted and encouraged to take as much responsibility as they can for tasks such as cleaning their rooms and doing their own washing and ironing. There is a sense of purpose in the way the residents take part and progress is noted and acknowledged. Many of the staff have worked with the residents for some years and so are very knowledgeable about the residents and what they are interested in doing. They are enabling them to maintain their interests outside of the home, for example, one resident goes to drumming lessons once a fortnight. Both residents attend a local church and staff know that they enjoy this. The staff have consulted with relatives to ensure that they are happy with the type of church attended. Both residents attend daycare facilities and send information
Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 12 to the daycare staff to ensure that there is effective communication. However, the communication back to the home from the daycare facility is unfortunately not very comprehensive. The staff are also committed to making sure that the residents are happy and relaxed within the home and wait to see each evening whether the residents want to go out or do an organised activity in the home or whether they are tired from their daytime activity and want to just relax in the house or garden. These choices are recorded so it is clear that staff are sensitive to the residents’ needs and choices. The residents have contact with their families, one is in telephone contact with his relatives and one has regular home visits. Friends are welcomed at the home or the residents are taken to visit them. As has been discussed above, the residents have now been consulted about what food they like to eat so the menu is their choice. It is organised on a 4 week basis and includes fresh food. Fresh fruit is also available. The staff are very aware of any food allergies and adjust the menu accordingly. A clear care plan is in place for one resident whose fluid intake has to be controlled. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 standard(s) 18,19,20, The personal support and healthcare needs of residents are well documented in care plans and risk assessments to ensure that they are safely met, however, care must be taken to ensure that regular healthcare checkups are arranged. EVIDENCE: The improved care plans now set out in much clearer detail the way in which personal care is to be given to residents and are written from the individual resident’s own perspective. If the home can adopt a person centred planning approach, this will enhance and improve the good work that has recently been undertaken. The home makes sure that regular appointments for following up medical conditions are made and kept but does need to make sure that each resident has at least an annual check up with the dentist, optician and chiropodist. Only one of the residents is administered medication in the home and the systems in place were found to be safe. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 standard(s) 22,23 The home has policies and procedures in place in relation to complaints and protection but staff would benefit from training to give them a range of strategies to deal with challenging behaviour. EVIDENCE: The home has a policy and procedure to deal with any complaints but has not received any recently. The home also has policies and procedures in place to provide protection to residents. The staff have recently learnt from the deputy manager, some new strategies for working with one resident whose behaviour can, at times, be particularly challenging, and this has resulted in him being calmer and less distressed and anxious. This has improved his quality of life and that of the other resident. To build on these improvements, the staff group would benefit from some further training to help them understand how to avoid and deal with challenging behaviour and to understand specific conditions such as autism. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 standard(s) 24,25,26,30 The home is being well maintained and bedrooms are individually suited so that residents can enjoy a safe and clean living environment. EVIDENCE: Regular maintenance and cleanliness of the home is being maintained and even the garden has been tidied so that residents can make good use of the outdoor space. The residents would now benefit from some suitable activity equipment in the garden. Residents bedrooms are suitable to their needs. One resident has many personal possessions in his room and likes to spend time in his room. Another resident’s bedroom has been equipped to suit his specific needs and, although it looks rather bare, this is necessary for his safety and is documented in his care plans and risk assessments. The home was clean and free from offensive odours during this unannounced inspection. The home has been required since February 2005 to provide a separate laundry so that the washing machine can be removed from the kitchen. This is a small space and is not suitable for cooking food and dealing with soiled laundry. The home’s freezer has been removed from the
Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 16 lounge/dining room where it was taking up valuable space and is now kept in the spare bedroom which cannot continue indefinitely. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36 The residents’ quality of care has improved considerably since there has been a consistent staff group and a deputy manager working in the home. EVIDENCE: Until recently staff at this home were shared with a nearby home which the manager is also responsible for. A consistent group of staff were identified to work in this home and the residents have benefited from having the same staff on duty who work together as a team. The home has also made significant improvements since the deputy manager was asked to work within this home and he has been able to support the staff to develop better care plans and more consistent approaches to the way staff work with the residents. The staff member interviewed was clearly more motivated and enthusiastic about her role and was keen to learn and develop more. The staff have very good knowledge about the residents’ individual needs and preferences and have been able to learn new strategies when working with them. As has been discussed above, the staff have now been trained to use Makaton and this has substantially improved their communication with one of the residents. The home has a matrix of training needs which shows that staff have undertaken the mandatory training and are receiving appropriate refresher training. The staff would now benefit from more specific training as
Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 18 discussed above and must attend training in the Protection of Vulnerable Adults. Supervision is now taking place regularly for this group of staff and this is, again of benefit to the staff and residents. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42 The home is well-run on a daily basis with clear leadership and good team working so that residents needs are consistently and safely met. EVIDENCE: The provider company has been required to review its management structure and to appoint a manager who has sole responsibility for this home and this is to take place shortly. For the past few weeks, the deputy manager has been working in this home and has provided strong and clear leadership. This has greatly improved the quality of care given to the residents and the level of support to staff. However, standards 37 and 38 cannot be fully met unless the registered manager is performing to this level. The very positive improvements seen must be maintained when the new manager moves into post. No concerns about health and safety issues arose during this inspection. Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x 2 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 x x x 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Georgina House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 1 1 x x x 3 x I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 21 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 1 Regulation 5 Requirement Each resident must be provided with a service user guide and contract which is in a suitable format Original dates November 2003, August 2004, February 2005, April 2005 not met N.B. the guide and contract must now be supplied to and discussed with each resident All staff must receive training in the recognition and prevention of abuse, in working with challenging behaviour and in specific conditions such as autism . The washing machine must be removed from the kitchen and alternative, separate laundry facilities provided Original dates of February and June 2005 not met) . Timescale for action 31st July 2005 2. 22,32,35 13(6) 18(1)(a,c) 31st October 2005 3. 30 13(3) 23(2)k 31st October 2005 Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 22 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 14 Good Practice Recommendations The equipment and facilities in the garden available for the use of residents should be reviewed Georgina House I51 S15011 Georgina House V236109 280605 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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