Inspection on 14/12/05 for Gladstone Road, 31

This inspection was carried out on 14th December 2005.

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 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gladstone Road, 31 12/06/09

Gladstone Road, 31 10/07/08

Gladstone Road, 31 31/07/07

Gladstone Road, 31 15/05/06

Gladstone Road, 31 01/07/05

Gladstone Road, 31 04/03/05

Gladstone Road, 31 23/09/04

Gladstone Road, 31 01/03/04

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

CARE HOME ADULTS 18-65 Gladstone Road, 31 31 Gladstone Road Bootle Liverpool Merseyside L21 1DG Lead Inspector Debbie Corcoran Unannounced Inspection 14th December 2005 10:00 Gladstone Road, 31 DS0000005247.V277225.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 Gladstone Road, 31 DS0000005247.V277225.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. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gladstone Road, 31 Address 31 Gladstone Road Bootle Liverpool Merseyside L21 1DG 0151 476 1964 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 Ms Tracey Jackson Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 MD. Date of last inspection Brief Description of the Service: 31Gladstone Road is a four bedroom terraced house situated in a residential area of Bootle. The home is registered to provide accommodation to three adults who have a mental health concern. There are currently only two service users living at the home. The service provider for the home is Expect, formerly know as Sefton Support Services. This organisation is in the voluntary sector and is a registered charity. The registered Landlord for the property is Hornby Housing Association. The home provides staff 24 hours per day and operates on the principle of ordinary community living. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over a period of approximately three hours. During the visit both service users were spoken with and one member of the staff was spoken with. A tour of the home was carried out. Records examined included; service user’s care plans, health and safety records, medication administration records, staff rotas, menus and other relevant records. What the service does well: What has improved since the last inspection? What they could do better: The findings of this inspection were generally good. One area for improvement identified at this inspection and at the previous inspection is that service users could be more included in the daily running of the home and in using and developing their independent living skills and taking greater ownership of their home. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 6 The manager has been absent from the home for a number of months. This person has made an application for registration as manager with the Commission but this application cannot be processed until the manager returns to work and completes the registration process. This must be addressed as a matter of priority when the manager returns to work. Risk assessments are generally good but need to be developed in a small number of areas. Staff are not currently being provided with regular and recorded supervision sessions. There is some room for improvement in the presentation of the home. 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. Gladstone Road, 31 DS0000005247.V277225.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 Gladstone Road, 31 DS0000005247.V277225.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): These standards were not assessed on this occasion. EVIDENCE: Gladstone Road, 31 DS0000005247.V277225.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, 7, 8, 9 Service users have a plan of care which clearly reflects their needs and the plans are reviewed. Service users are not consistently being encouraged to use and develop their independent living skills and exercise choice. When service users are involved in an activity which involves taking risks the risk is assessed and managed. The service users are being restricted from activities but these are not identified as part of a risk assessment. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 10 EVIDENCE: Each of the service users has a care plan. These were examined and are of a good standard and include information on the person’s daily routines, likes and dislikes, skills and needs, targets for personal development, a health action plan, weekly activity plan, finance action plan. In addition to the care plan each of the service users has an Essential Lifestyle Plan (ELP). These include detailed information as to how to successfully support the service user and details on what is important in their lives and what their aspirations are. Each of the service users has had a community care review and this has included inviting the service user and their relatives / representatives and relevant others to a review meeting chaired by Social Services. One of the service user’s care plans is due for review. There is room for improvement in the level of consultation with service users, for example there is no evidence that service user meetings take place. There is also room for improvement in staff encouraging and supporting the service users to be involved in all aspects within the home and in using and developing their independent living skills. For example the staff should be supporting the service users to go shopping for the home’s weekly shopping. This was an issue which was raised at the previous inspection and yet there was a recent example of when staff have been shopping for service users as opposed to with service users. A risk taking and risk management policy are in place at the home. When a service user is involved in any activities which are thought to present a risk then a risk assessment is carried out. The risk assessments were examined and found to include a good level of information on what the potential risks are to the service user and the steps which staff need to take to minimise the risk or prevent the risk from occurring. The risk assessments cover many different aspects of the service user’s support and they are reviewed regularly. One of the service users risk assessments needs updating to reflect the change in their circumstances. Risk assessments must be developed to ensure that they also cover activities in which the service users are restricted. For example the use of locks on doors. Gladstone Road, 31 DS0000005247.V277225.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, 14, 15, 16 Service users are supported to be involved in activities and use community resources. Service users are supported to maintain relationships. Staff should encourage and support service users in developing their responsibilities, choices and independent living skills. EVIDENCE: Daily records were examined to assess the appropriateness of activities which service users are supported with. One of the service users attends a resource centre a number of times per week and is regularly supported in shopping, walking and lunches out. There have been a number of issues which have been affecting the amount of community and leisure activities for the service users and these were discussed in some detail. The registered person should review the current staffing arrangements to ensure that they are flexible in meeting the needs of the service users effectively as service user’s needs change. The service users are using local community resources but there are restrictions as to what is available locally. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 12 Discussions with service users and staff indicate that service users are supported to maintain relationships. As identified previously in the report there is some room for improvement in evidencing that the service users are being fully encouraged to carry out responsibilities. There are a number of areas whereby the service users could be more included in the day to day running of the home. The registered person should review the current arrangements for service user’s to use and develop their independent living skills and contribute to the day to day running of the home and general decision making. Gladstone Road, 31 DS0000005247.V277225.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): 19, 20 Service users are well supported to remain healthy. Medication is managed safely and in accordance with policies and procedures. EVIDENCE: There was a good level of evidence to indicate that service users are well supported in remaining healthy. Each service user has an action plan in relation to their health related needs. This includes information on the individual’s last annual health checks and ensures that target dates are set for further checks. Service user’s records show that the staff team are referring for specialist support in meeting the health related needs of the service users. Records indicate that staff are supporting the service users in accessing primary care resources including G.Ps, nurses, dentists, consultants and chiropodists on a regular basis. Information on service user’s specific health conditions is maintained at the home. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 14 A medication policy is in place at the home. The home maintains a record of all medication received, administered and stock checked. Medication administration records were examined and found to be appropriate with the exception of a small number of gaps in the records when agency staff have been working at the home. The procedures for administering medication and recording this must be clearly provided to agency staff. Medication storage was examined and found to be appropriate and well organised. Information is maintained on what medication is taken for and the possible side effects of the medication. The majority of staff have received medication training. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 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 Policies, procedures and practices are in place which aim to prevent an abusive, neglectful or issue self harm from occurring. Systems are in place for dealing with complaints and for dealing with allegations of abuse and staff have received training in the protection of vulnerable adults. EVIDENCE: The home has a complaints procedure which is time scaled appropriately and includes details of the Commission. A comments, complaints and suggestions notice is also available in the home along with a complaints leaflet. The complaints information should also be produced in more accessible formats. Through discussions with one of the service users it was clear that they are aware of how to make a complaint. There have been no complaints over the past 12 months. There is a protection of service users policy and an abuse policy in place at the home. A copy of Sefton Borough Council’s adult protection procedures is also available. Staff have been provided with training in protection of vulnerable adults. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 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, 30 There is room for improvement in how the home is presented. However, the home appears generally well maintained safe and clean. Service users bedrooms are personalised with their own belongings and can be locked for their privacy. EVIDENCE: A tour of the premises was carried out. 31Gladstone Road is a four bedroom terraced house situated in a residential area of Bootle, it is in keeping with other properties in the area and is indistinguishable as a care home. The house has one main lounge area, a dinning area, 1 ground floor bedroom and 3 first floor bedrooms. The ground floor bedroom is currently being used as a second lounge. This room is dark and dull and is in need of redecoration and refurbishment. A stair lift is in situ but this is not currently used. Furnishings, fittings and décor are generally of an appropriate standard and the home appears well maintained. The hall and landing areas and bathroom are a little stark and could be presented more homely . Service user’s bedrooms are personalised with their own belongings. Furniture and fittings are of a suitable standard. All service users have a lockable space in their bedroom and bedrooms doors are fitted with override locks. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 17 Health and safety checks are carried out regularly and records of these were up to date. The home was presented as clean and well organised throughout. Policies, procedures and practices for health, safety and hygiene are in place and staff are provided with training in health and safety. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 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): 32, 33, 34, 36 Service users benefit form being supported by a stable and long standing staff team who have had the opportunity to build relationships with the service users. Staff training opportunities are good and staff have received training in some specialised areas. Staff recruitment and selection practices aim to protect the service users. Staff meet as a team on a regular basis but are not being provided with one to one supervision regularly. EVIDENCE: Staff rotas were examined. The staff team is stable and this provides consistency for the service users and enables staff to get to know the needs of the service users. There are currently three care staff on the team and two of these staff have worked at the home for approximately two years and the third member of staff has worked at the home for ten years. The home is staffed by one member of staff 24 hours per day and additional staff are rotad to ensure a level of one to one support for the service users. This should be reviewed in order to ensure that the additional staffing is used flexibly and in line with meeting the changing needs of the service users. Two members of the staff team are reported to be undertaking a National Vocational Qualification (N.V.Q). Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 19 Staff receive training in core health and safety related skills and some members of the staff team have received training more specifically related to the needs of service users. Overall, the level of training opportunities available to staff are good. There was no evidence to suggest that each member of staff has an individual training and development assessment and profile or that a training needs assessment has been carried out for the staff team as a whole. Sefton Support Services have a recruitment and selection policy and procedure. This includes potential employees having to provide at least two written references and a criminal records disclosure prior to the commencement of their employment. There have been no new staff recruited to the home for a number of years and therefore the selection procedures were not assessed on this occasion. Staff are being provided with one to one supervision with a manager. However, supervision is not regular and does not meet the national minimum standards. Staff meetings are regular and recorded. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 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, 39, 41, 42 The manager has been absent from the home for some time and therefore this persons registration with the commission cannot be completed. Practices that promote the health and safety of service users and staff are in place. Service user’s rights are safeguarded by the safe keeping and security of records and all records are up to date and maintained appropriately. Quality assurance processes are in place, however, these need to be developed further. EVIDENCE: The home has been running with the absence of the manager. The manager is expected to return to the home in the near future and will need to progress her application for registered manager with the Commission. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 21 The home has a number of policies, procedures and practices in place which aim to ensure the health and safety of service users and staff and these include procedures on issues such as infection control, fire safety and moving and handling. Records of fire and other health and safety checks were examined and found to be up to date. The records kept at the home are in good order, up to date and maintained securely. A record of all accidents, injuries, incidents and complaints is maintained. All records were available for inspection with the exception of staff files as the member of staff on duty did not have access to these. The registered person ensures that the home is visited on an unannounced basis at least once per month and provides a report on the findings of the visit to the Commission in line with Regulation 26 of the Care Home Regulations 2001. These visits form part of the quality assurance process. The quality assurance process should be developed to include seeking the views of service users, their representatives as appropriate, and staff, in order to form an opinion on the standard of care provided. Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 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 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 x 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x 2 x 2 x 3 3 x Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 23 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 YA8 Regulation 12 (3) Requirement Service users must be given greater opportunities to be involved in the daily running of the home and encouraged to use and develop their independent living skills. A system for quality assurance should be introduced which includes seeking the views of service users and relevant others. The results of this should be published. Risk assessments must be updated to reflect changes. Restrictions on service user’s activities must be identified as part of a risk assessment and must be reviewed regularly. Staff must be provided with regular supervision. Medication administration records must be accurate at all times. Timescale for action 12/02/06 2 YA39 24 12/03/06 3 4 YA9 YA9 13 (4) (b) 13 (4) (b) 12/02/06 12/02/05 5 6 YA36 YA20 18 (2) 13 (2) 12/03/06 12/02/06 Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 24 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 YA35 Good Practice Recommendations The manager should produce individual training and development plans for each member of staff. The manager should also develop a training needs assessment and programme for the staff team as a whole. This training should be linked to the needs of the service users. Staffing arrangements should be reviewed to ensure that they are flexible and responsive to the needs of the service users. One of the lounges, the hall, landing and bathroom should be presented more homely. 2 3 YA14 YA24 Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 25 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 Gladstone Road, 31 DS0000005247.V277225.R01.S.doc Version 5.1 Page 26 - 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. 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