CARE HOME ADULTS 18-65
Glenside (10) 10 Glenside Allerton Liverpool Merseyside L18 9UJ Lead Inspector
Sonya Robinson 17
th Unannounced Inspection & 25 January 2007 09:40
th Glenside (10) DS0000025273.V323372.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 Glenside (10) DS0000025273.V323372.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. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Glenside (10) Address 10 Glenside Allerton Liverpool Merseyside L18 9UJ 0151 724 5994 9999 H/O tel no - 0151 524 3606 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) North West Community Services (Merseyside) Limited *** Post Vacant *** Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th July 2006 Brief Description of the Service: 10 Glenside Close is registered to provide personal care to 3 people with learning disabilities. All rooms are at ground floor level. Service users have single bedrooms. There is a large bathroom, a separate toilet, a large living room, kitchen and laundry room. There is a staff sleeping-in room, which is also used as a quiet area for service users and provides access to the garden. Bathing and mobility aids are provided. There is parking space to the front of the premises and a small garden area. The home is situated in a residential area of Mossley Hill and is close to the city centre. There are shops in close proximity to the home and a good size shopping centre close by. The service users have a minibus and several of the staff are designated drivers. There is access to train and bus services. Access to a vehicle and the proximity to public transport potentially provide opportunities for service users to be have an increased community presence and would allow them to participate in more community based activities. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over a two day period commencing at 09.40 am on the 17th January 2006. The inspection was concluded after a second visit on the 25th January 2006. During this inspection a number of issues were discussed with the acting manager and members of staff on duty regarding the care provided to service users. All three of the service users were present and I observed how service users care was provided as well as the interaction between staff and service users. I looked around the building to assess its suitability to provide a comfortable, homely environment for service users to ensure their safety. Selections of records that are kept were looked at. These included records regarding service users care and records relating to staff. The information gained on the day of the site visits contributes to the basis of any judgments made. The main focus of the inspection process was to understand how the home was meeting the needs of the service users and how well staff were themselves supported by the organisation to make sure they had the skills, training and support to meet the needs of the service users. I would wish to acknowledge the assistance and co-operation of the staff of the home during the course of this inspection. I would also wish to particularly thank the service users for their patience and tolerance throughout my time in their home. What the service does well:
An examination of an initial assessment pro forma showed that all the information recommended in the National Minimum Standards for Care Home’s for Younger Adults is available. This allows for a good assessment of the needs of potential service users and would be a useful tool in reaching a decision as to whether these needs could be met at the home. Staff report that the home has positive relationship with neighbours. This helps to ensure the service users are recognised a members of the local community. There are no restrictions on visiting times and contact with family, where applicable, and contact is encouraged. Records show that service users are supported to attend healthcare appointments and have access to health care services. The home is clean and tidy, though there are now some areas that require attention.
Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Glenside (10) DS0000025273.V323372.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 Glenside (10) DS0000025273.V323372.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): 1, 2, 3, 4, 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current preadmission assessment documentation allows for an adequate initial assessment of need so that the home can be sure that they can meet the needs of the service users. The current contractual arrangements do not satisfactorily safeguard the service users from the risk of financial abuse. The statement of purpose also needs to be expanded upon to meet the legislation. EVIDENCE: The statement of purpose for this home does not cover all the required information as listed in Schedule 1 of The Care Homes Regulations 2001. This was highlighted at the last key inspection in July 2006 and remains outstanding and must now be actioned. When reviewed this should provide useful information for prospective service users to help them and their representatives to reach a decision about whether they wish to move into the home. There have been no new service users admitted to the home since the last inspection. The service user group have been resident for several years and during this period there have been no further admissions. It was stated that the manager for the home would assess any new service users. The manager would visit a prospective service user where they were currently living.
Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 9 Information would be gathered from the service users’ carers, social worker and any other relevant agencies. An examination of an initial assessment pro forma showed that all the information recommended in the National Minimum Standards for Care Home’s for Younger Adults is available. This, when completed, would help ensure that any placement would be appropriate. Staff informed me that given the level of complex needs of the service users it is difficult for staff to communicate with them and for service users to make their needs known. It was stated that communication is mainly through the use of smell and touch with service users responding to certain stimuli. Advice is to be sought from specialist therapists such as language or occupational therapists. This would provide an opportunity for service users to be reassessed to see if there may be alternative methods of communication available. This was also highlighted at the previous inspection. Given that staff report that service users have changed greatly over recent years, service users should be appropriately reviewed involving the placing authority, relatives and advocates as appropriate. This should take account of the service users known likes and dislikes. The acting manager stated that the contracts between the service users and North West Community Services have been reviewed, since the last inspection and these were observed during this inspection. These must now be signed by a representative on behalf of the service user if the service user is unable to do so. The acting manager reported that family/advocates are in the process of being approached to support service users in this process. This must be addressed as a matter of urgency so that service users can be fully safeguarded from any potential form of financial abuse. This also remains outstanding from the previous inspection. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 10 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, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are not sufficiently met by the current approach to care planning. Care plans must be regularly reviewed to fully reflect the assessed and changing needs of service users. EVIDENCE: Since the last inspection service users care plans have been amended in parts. Service user plans now need to be reviewed and this was acknowledged by the acting manager. Where appropriate, this should be undertaken with the service user (involving significant professionals, family, friends and advocates). Care plans should then be reviewed at least every six months and updated to reflect the changing needs of the service user. The agreed changes must then be recorded and actioned. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 11 Communication guidelines are in place though staff reported that given the needs of the service users communication was difficult. Visual prompting was a method used to encourage service users to make a choice. For example staff were using three objects with one service user to seek their opinion about whether they wished to go out for a walk using a the wheelchair, without the wheelchair or on the bus. Staff reported due to the changing needs of this service user that this approach has become less effective than previous. Methods of communication should now be reviewed and specialist services should be sought if this is appropriate. Records of service users likes and dislikes and preferences around daily living, such as what time they like to get up and the activities they enjoy are also in place, though staff reported that it was difficult to go out for specific activities, for example taking one service user swimming because of staffing levels within the home. The acting manager acknowledges this as an issue and is to seek further guidance around this. Given the communication difficulties that were reported it is recommended that relatives and/ or advocates are encouraged to help secure the service users opinions in making decisions and individual choices and that were decisions are made by others that this is recorded and why. Risk assessments are carried out for both personal and environmental risks. These indicate the support that service users need to safeguard their wellbeing and take part in activities. However these were found to be undated so it was difficult to assess if and when these had been reviewed. A risk assessment on the use of bed rails was also in place. Agreement around the use of bed rails with the service users families has been recorded with a daily record being made that the bed rails are safe for use and fit for purpose. This ensures service users are not placed at unnecessary risk of injury from ill fitting or unsuitable equipment. Since the last inspection one service user has obtained a new specialised bed, another specialised bed has been ordered for another service user. The remaining service user will now also require a new bed as it was noted on this inspection that the frame of the bed was coming apart which poses a health and safety risk. This was acknowledged by the acting manager who informs that this will be actioned quickly. The home has a policy in place with regards to confidentiality, staff spoken to were aware of issues of confidentiality and who and when to share information. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 12 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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not have opportunities for personal development and have very limited opportunities to participate in activities. The daily routines must better support the needs of service users to lead a fulfilling lifestyle. EVIDENCE: At present none of the service users attend employment or day care. Staff reported that activities have also become restricted over recent months. A record is maintained in the driver’s logbook of journeys undertaken. The review of this revealed that over the last month the service users have been out for a drive to Asda, to Tesco’s, to Costco, to the Chemist, to Southport, to collect the parking permit (Blue badge) that is used when going out and one service user has been swimming once. Other activities documented were use of DVD’s, one occasion of the use of the home’s ‘sensory room’ and staff reported service users also like to “relax in the chair”. The increasingly limited
Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 13 opportunity as reported by staff was apparently due to the changing needs of the service users and staffing issues. Staff also reported that they had good links with neighbours but involvement within community life was also limited. The area of activities must now be revisited in order to maximise service user fulfilment and enjoyment. Records observed indicated that service users had been on holiday with staff individually and had visited Dublin, Spain and Centre Parks respectively. Staff reported that service users often enjoy two holidays a year though clarity is needed as to how this was funded and to how the decision on the venues for holidays are arrived at. The arrangements for consultation on such matters need to be explicitly set out within the contractual agreement and statement of purpose. Safeguards must be in place to ensure that any decisions to use service users finances to fund staff to accompany service users on holiday are transparent and duly authorised by the placing authority or person with the legal authority to do so. Service users in long-term placements normally have the cost of an annual holiday included within the overall care package. There are no restrictions on visiting times and contact with family where applicable is encouraged. Daily routines were discussed with the new acting manager who acknowledges that daily routines need to be looked at. As a starting point the acting manager now highlights specific tasks and roles within their daily diary for staff to undertake. It was observed on the first day of inspection that two service users remained in their wheelchairs one in the lounge and one in the sensory room throughout the day. Interaction with service users appeared limited as both were sat facing a television throughout the day. The third service user has some mobility and was observed walking around the lounge and hallway. The level of stimulation and opportunity to engage in meaningful interaction must improve. Two service users use PEG feeds. I advised the staff to seek advice from the dietician to investigate the difficulties one service user was experiencing. It was evident that they were vomiting on a regular basis and this needed to be followed up. This was actioned and the dietician gave staff specific instructions which were observed being noted for all staffs’ attention. An examination of the menu records indicated that meals are provided for one service user. Gaps were evident within these records and staff also informed that menu’s are not planned in advance but are decided by staff on the day. The manager was reminded that is necessary to maintain a record of menus and meals taken and that this should demonstrate the provision of a balanced, varied and nutritious diet. Planning on a daily basis does present the opportunity for service users to access the local community to go shopping for fresh produce and would be encouraged. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 14 Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 15 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, 20, 21 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manner in which personal support is provided must improve. Health needs of service users could be expanded upon to further meet their needs and generally promote service users wellbeing. The administration of medication practice must improve as it may place service users at unnecessary risk. EVIDENCE: Records show that staff are provided with guidance around providing appropriate personal care to service users. This includes the preferences of service users. Training records also show that some staff have received appropriate training in providing personal care with dignity as well as supporting individuals who may require assistance with more specialist ways of feeding, such as PEG feeding. This training should be revisited as staff were observed giving a PEG feed without communicating (either verbal, tactile or gesture) with the service user and another service user was observed being placed in a wheelchair getting ready to go out. Again no communication was used and the wheelchair brakes were not fixed initially. Given the level of care that the service users in this home need this is unacceptable practice. Service
Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 16 users should at all times be treated with dignity and respect. Staff must be able to demonstrate a service user focus to their practice and inappropriate practice should be challenged. With regards to aids and adaptations it was noted that since the last inspection two service users have received new wheelchairs via an occupational therapist (OT), one service user has received a new specialist bed and another has been ordered. New hoist equipment was also observed in one service users bedroom. The Tracking hoist in the bathroom is in need of repair and the bathing cradle must not be used as it is held together with washing line and masking tape. This was discussed with the acting manager and assurance were given that a new bathing aid had been ordered by the visiting OT and the contractors for the hoist in the bathroom had also been notified. Records show that service users are supported to attend healthcare appointments and to access to health care services when they are needed. Though it was difficult to establish when service user had last received a full annual health check. This is to be followed up by the acting manager and reorganisation of service user files should take place to better evidence the support given and required by these service users. Staff reported that since the last inspection they have received medication training. The medication records and corresponding medication were examined and gaps in recording medication were evident. Medication was also found to be insecurely stored. The lock had broken on the cabinet. The acting manager is aware of this and informed that steps have been taken to rectify this. It was discussed that this must be actioned quickly in order to safeguard the well being of service users. The administration of medication was observed on inspection and despite staff receiving training in the area of medication staff were observed dispensing medication into the palm of their hand and walking to the lounge area to give to a service user. This raises several issues. The potential for cross infection is increased and there are hygiene issues to be aware of as no gloves or a medication container/ pot were used. Further this practice would contradict good practice guidelines in the safe administration of medication. The home is reminded of ‘ The Administration and Control of Medicines in Care Homes and Children’s Services’ policy document which was published by The Royal Pharmaceutical Society of Great Britain. This was also raised at the previous inspection and must now be actioned. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The policies and procedures that are currently in place are good. When needed to be implemented or followed they would help in ensuring that service users are protected from abuse. However aspects of training and practice must be reviewed to ensure that service users welfare remains paramount. There should be systems in place that allow advocates to raise issues on behalf of service users so that their views can be heard. EVIDENCE: There is a complaints procedure available. Given the needs of the service users information is to be made available to enable a complaint to be made on behalf of a service user by an advocate/ relative. The complaints procedure describes the stages of the complaint and the timescale for managing complaints. The staff were aware of the content of the complaints procedure and how to respond to complaints. The CSCI has not received any complaints about this service since the last inspection. There is a Whistle Blowing Policy and Liverpool City Council’s Adult Protection Procedures were available. Staff are given training on induction on issues surrounding adult protection. However in light of some of findings of this visit it is important that staff revisit aspects of the training and specifically those around what may constitute poor practice including recognising and reporting all forms of abuse. There should also be systems in place whereby advocates/
Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 18 communication support workers can visit service users and if necessary raise issues on their behalf. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and tidy, though an ambient temperature is to be maintained at all times. There are some areas around the home that require attention to promote a more comfortable and pleasant environment for service users. EVIDENCE: A tour of the home showed that the home was clean and tidy. There was evidence in the daily diary of specific tasks being given to staff members on a daily basis. Staff reported that this is working better. Since the last inspection the carpets in the communal areas have been cleaned and whilst their appearance has improved they are worn and may require to be replaced in the near future. The carpet in the sensory room requires repair or replacement as it has come away from the doorway. The sofa’s in the lounge are also worn and don’t necessarily meet the needs of all the service users. Recliners may be more suitable to their needs and it is recommended that advice is sought
Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 20 from a specialist source, for example and occupational therapist. The fireguard around the working fire in the lounge is to be appropriately repaired or replaced as it was held together with tape. Given the potential possible risk identified the new acting manager informed that this would be actioned promptly and planned to remove the guard in the first instance and implement a risk assessment to determine if a guard itself was still necessary. Staff informed that since the last inspection the dryer in the laundry had been attended to and that it was in good working order. It was observed that a staff member was putting sodden washing outside to dry despite being a very cold day. When asked, staff informed that the spin cycle on the washing machine was not working and this was the reason why washing had to go outside, as it was too wet to go in the dryer. The washing machine was checked with another staff member and was found to be working. Staff did inform that some staff were more able in laundry care than others. This must be addressed now with all staff who attend to the laundry within this home in order to maintain good hygiene and control of infection. Staff must be aware that foul laundry must be washed at appropriate temperatures (65 C for not less than ten minutes) to control risk of infection. On both days of inspection the sensory room in particular felt cold, the temperature was taken using the homes thermometer. The readings were 16 C and 15 C respectively, which was verified by staff. This was raised with the new acting manager, as the recommended temperature is 21 C in accordance with the Department of Health Winter Warm fact sheet 2007. She actioned this on inspection and extra portable heaters were obtained for the home. These heaters have a safety device so that if the heaters and knocked or fall over that they automatically switch off. A risk assessment should now also be introduced. A gap surrounding the patio window in the sensory room was also noted and this window ‘bounced’ on touching. It was felt that this could be affecting the ambient temperature within this service, as the central heating system was on. The acting manager informed that this will be raised as a matter of urgency with the landlord of the property and that the room will be unavailable to service users until this matter is resolved. Staff reported to myself that over Christmas day and Boxing Day that the home was without central heating and hot water. Staff informed that they wrapped service users in duvets to keep them warm. This was rectified later on, on Boxing Day. This again raises several areas for concern. The service must introduce a contingency plan in the event that this or other significant events may occur in the home and the action to be taken given the vulnerability of the service users. The Commission should also have been informed under Regulation 37 of the Care Homes Regulations 2001 as the well being of service users were affected. Staff should be reminded that the Commission has a 24hr helpline system in place. The on call/ monitoring systems should be reviewed as despite being in post the acting manager was unaware that this incident had occurred. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 21 Two service users bedrooms were found to be personalised and there were appropriate cot sides and pressure relieving mattresses for those service users who have been assessed as requiring such. A further service user’s room would benefit from being personalised as would the communal areas. A daily risk assessment check on the use of cot sides is recorded. The home has one bathroom for service users, issues are apparent as discussed earlier within this report. There is a separate toilet for staff and visitors, the hand washing facilities for this toilet are situated in the laundry room next door. During the inspection the home was visited by a water maintenance company to undertake a routine check for legionnaires in the home’s water system. This is a requirement for all registered services in accordance with Care Homes for Adults National Minimum Standards and Regulations 2001. The water company reported no issues arising but staff were unfamiliar with the whereby of the health and safety file to file the certificate. I located the file for staff and discussed with staff that they should be aware of health and safety issues within the home and the importance of the information contained within it. This was discussed with the acting manager on the second day of inspection, as she was unavailable on the first day. She will address this with staff and informed that she will ensure that staff are familiar with health and safety. It is recommended that staff receive training in this area. Given this and other issues raised in this report. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users would benefit from staff receiving more structured support from consistency of approach. Staff should also receive regular one to one supervision sessions, have a personal development plan and an appraisal. Staff meetings should also take place on a regular basis and a record be maintained. Service users would also benefit further if 50 of staff had completed formal training as outlined in the national minimum standards. EVIDENCE: Staff described the working morale as low on inspection. They spoke positively in their attitude of service users but were “fed up” of what they felt as constant new staff and “being left to get on with it”. Some of this is felt that over the last six months they have had three different managers. The staff spoke positively of the new acting manager and recognised that things needed to change. It is recommended that policies and procedures for the home be discussed in regular staff supervision and staff meetings. Both of which have lapsed over
Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 23 recent months. Also that the role of professional agencies should be included within this. For example who and when to contact to obtain specialist advice about possible communication aids. The staffing rota showed that there is a minimum of two staff on duty during the day and evening with a third member of staff available for some shifts. Staff interviewed said that the staffing levels at times would benefit from being increased to enable more one to one time with service users to meet the needs of the service users and enable service users to take part in group and individual activities outside the home. At night there is one sleeping and one waking member of staff available. An induction programme is provided for staff. This covers training around manual handling, health and safety, food hygiene, first aid and the protection of vulnerable adults. Following this the staff files show that staff attend training courses relevant to the duties they perform at the home, such as training in PEG tube feeding, epilepsy management and medication management. Staff are then encouraged to undertake an NVQ in caring for adults with a learning disability. Steps are being taken to ensure that 50 of staff have undertaken this qualification. The organisation does have a rolling programme of training for staff and an up to date training matrix was given to me on the day of inspection. It may be necessary for some staff to undertake refresher training in response to issues raised when regular one to one supervision is reinstated and maintained. All staff should then have a personal development plan and an appraisal. This will ensure a well trained and supported staff team supports service users. Staff personnel files were observed at the head office of North West Community Services on the morning of the 25/01/07. The information accessible was much improved from the last inspection and the HR manager was aware of the requirements involved with a registered service and was responsive to questions asked. As the acting manager develops systems within the home she will need to be mindful that in accordance with policy and guidance published by CSCI in November 2005, with the agreement of CSCI, providers who have a centralised human resources department can hold some recruitment information within this department as long as there is sufficient documented evidence at the home that all the required checks and references have been undertaken and there is an agreement with CCSI as to the criteria for accessing the records held at the human resources department. The manager of the home should write to the CSCI to propose suitable arrangements for storing the necessary information and the commission will respond to confirm whether they are acceptable. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 24 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, 38, 39, 40, 41, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality assurance systems are ineffective and there are deficiencies in health and safety that could fail to safeguard service user welfare if not addressed. EVIDENCE: Since the last inspection the home has had three different managers. The new acting manager expressed her commitment to the service and is aware of all of the issued raised in this report. She informs that all of the issues raised will be addressed as quickly as possible and she is keen to work with CSCI in order to raise standards within this home for the benefit of all. In particular she intends to improve the quality of care to promote positive outcomes for the service Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 25 users within this home. An application for registered manager must be submitted to the Commission. Staff informed that the Service Manager carries out regular quality assurance audits and visits the home monthly and also carries out a thorough audit of service users’ health and welfare, accidents, risk assessments both personal and environmental, and staffing levels. However copies of the audit report are not available at the home for inspection. A financial audit is conducted once a year by the parent company. Again this was unavailable for inspection. Both of these issues were raised at the last inspection. During the writing of this report the Service manager was contacted and asked to fax through these monthly audits to the Commission. These have now been received. A number of risk assessments were observed on inspection and these were found to be undated it was therefore difficult to assess when and if these had been reviewed. The records of the gas supply safety check, electrical wiring safety checks, portable appliance safety checks were seen and were in order. However, fire records were observed to have lapsed over recent months. The home is reminded that fire alarms must be tested weekly, emergency lighting monthly, a minimum of four fire drills a year, fire instructions should be given to staff on a regular basis and fire equipment should checked annually by a person qualified to do so. The latter was found to be in order. Since the last inspection that home has a fire risk assessment in place. None of the staff on duty could inform of its whereabouts or contents. This was discussed with the acting manager and must now be actioned. The fire risk assessment was located within the health and safety file within the home. A valid certificate of employers liability certificate was displayed in the entrance hall of the home. The registration certificate issued by the Commission for the home was unable to located on this inspection. Under the Care Standards Act the certificate of registration must be displayed in a prominent place within the home. Discussion with the new acting manager took place with regards to service user’s files. They will need to be reviewed, reorganised and updated to reflect the changing needs of the service users and staff should be clearly aware of how best to support them in accordance with their individual needs. The daily diary needs to be expanded upon or existing documentation needs to be reviewed or completed more fully. Limited information was available. Records should reflect a clear picture of how the service user day and night had gone, how they had engaged with staff and how staff had cared and supported service users in accordance with their wishes, likes/ dislikes/. Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 26 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 1 2 3 3 2 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 1 28 2 29 2 30 2 STAFFING Standard No Score 31 2 32 2 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 1 2 3 LIFESTYLES Standard No Score 11 1 12 1 13 1 14 1 15 2 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 2 2 2 1 2 1 1 1 Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 4, 5 Requirement The registered person must ensure that the statement of purpose covers all the matters listed in Schedule 1 of the Care Homes Regulations 2001 (Previous timescale of 13/10/05, 06/05/06 & 20/10/06 not met). The registered person must ensure that the contract/statement of terms and conditions between the home and the service user clearly states the facilities and services that are included in the fees payable and any additional costs to service users and what they are, and that they are signed. (Previous timescale of 13/10/05 & 06/05/06 & 20/10/06 not met). The registered person must ensure that copies of the monthly responsible individuals representative reports following their visits to the home are available for inspection. Timescale for action 30/05/07 2. YA5 5 30/05/07 3. YA39 26 30/05/07 Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 28 4. YA3 12 (Previous timescale of 13/07/05 & 06/02/06 & 20/10/06 not met). The registered person must ensure that staff can communicate effectively with service users using the individual’s preferred mode of communication. (Previous timescale of 20/10/06 not met). The registered person must ensure that service user’s care plans are reviewed and updated to reflect changing needs; and agreed changes are recorded and actioned. (Previous timescale of 20/10/06 not met). The registered person must ensure that risk assessments carried out for both personal and environmental risks are signed, dated and reviewed. (Previous timescale of 20/10/06 not met). The registered person must ensure that medicines are administered and documented according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society of Great Britain and the requirements of the Misuse of Drugs Act 1971. (Previous timescale of 10/07/06 not met). The registered person must ensure that staff have regular supervision. (Previous timescale of 20/10/06 not met). The registered person must
DS0000025273.V323372.R01.S.doc 30/05/07 5. YA6 15 30/05/07 6. YA9 13 30/05/07 7. YA20 13 01/03/07 8. YA36 18 30/05/07 9. YA43 25 30/05/07
Version 5.2 Page 29 Glenside (10) ensure that a copy of the financial audit conduct once a year is available for inspection. This can be forwarded to CSCI. (Previous timescale of 20/10/06 not met). The registered person must ensure that the fire risk assessment specifically detailed with regard to the home is known by all staff. The registered person must ensure that ensure service user’s have access to, and choose from a range of appropriate leisure activities and facilities. The registered person must ensure that one service user’s bed is repaired or replaced as it is coming apart. The registered person must ensure that service user views or appropriate advocate involvement must be documented with regards to service user’s holidays in order to safeguard service users. The registered person must ensure that staff receive training on skin care pressure relief. The registered person must ensure that menus are maintained and show a varied, balanced and nutritional diet. 10. YA42 23 01/03/07 11. YA14 16 30/05/07 12. YA6 16 01/03/07 13. YA14 16 30/05/07 14. YA16 18 30/05/07 15. YA17 17 30/05/07 16. YA17 18 The registered person must 30/05/07 ensure that staff undertake refresher training with regards to specialist feeding. The registered person must ensure that staff receive training
DS0000025273.V323372.R01.S.doc 17. YA18 18 30/05/07
Page 30 Glenside (10) Version 5.2 in maintaining dignity and the promotion of independence of service users. 18. YA18 18 The registered person must ensure that staff receive up to date training in the safe moving and handling of service users. The registered person must ensure that the ceiling tracking hoist in the bathroom is repaired or replaced. The registered person must ensure that a bathing aid is obtained. The registered person should ensure that the medication training is evaluated, as poor practice remains apparent. The registered person must ensure that medication must be stored in an appropriate lockable facility. The registered person must ensure that Health, hygiene and infection control training is undertaken with staff with particular reference to medication and laundry care. The registered person must ensure that staff receive refresher training in the protection of vulnerable adults. The registered person must ensure that the carpet in the sensory room receives attention, as it is poses a hazard as it has come away from the doorway. The registered person must ensure that the fireguard in the
DS0000025273.V323372.R01.S.doc 30/05/07 19. YA18 13 01/03/07 20. YA18 13 01/03/07 21. YA20 13 01/03/07 22. YA20 13 01/03/07 23. YA20 13 30/05/07 24. YA23 18 30/05/07 25. YA24 23 30/05/07 26. YA29 23 01/03/07
Page 31 Glenside (10) Version 5.2 lounge is appropriately repaired or replaced if deemed necessary by risk assessment. 27. YA30 16 The registered person must ensure that staff in charge of laundry care must know how to work the laundry facilities in order to maintain appropriate control of infection measures. The registered person must ensure that the home maintains an ambient temperature at all times. The registered person must ensure that the patio window in the sensory room receives attention. The registered person must ensure that the service has a contingency plan for use in emergencies to protect the well being of service users. The registered person must ensure that CSCI are notified of significant events affecting the well being of service users. The registered person must ensure that there is an effective on call/ monitoring system in place. The registered person must ensure that staff have a personal development plan and an appraisal. The registered person must ensure that an application for registered manager is submitted to CSCI. 01/03/07 28. YA24 23 01/03/07 29. YA24 23 30/05/07 30. YA24 13 30/05/07 31. YA24 37 01/03/07 32. YA39 24 01/03/07 33. YA35 18 30/05/07 34. YA37 8 30/05/07 Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 32 35. YA42 23 The registered person must ensure that fire records are maintained. The registered person must ensure that the certificate of registration is displayed in a prominent place. 01/03/07 36. YA37 The Care Standards Act 2000 01/03/07 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 YA5 Good Practice Recommendations When drawing up the contract the registered person should ensure that the service users are supported by family, friends/advocate as appropriate. The registered person should ensure 50 of staff (including agency) hold an NVQ 2 or equivalent. The registered person should ensure staff are able to demonstrate how individual choices have been made; and record instances when others make decisions and why. The registered person should ensure that service user’s in long term placements have as part of their basis contract price the option of an annual holiday outside the home, which they should be able to choose or plan for. The registered person should ensure that the involvement of advocates/ support groups is actively promoted. The registered person should ensure that staffing levels are appropriate to the needs of the service users. The registered person should ensure that daily routines reflect the needs of the service users, including in house activities. The registered person should ensure that service users
DS0000025273.V323372.R01.S.doc Version 5.2 Page 33 2. YA32 3. YA7 4. YA14 5. 6. 7. 8. YA3 YA33 YA16 YA19 Glenside (10) 9. YA22 10. 11. YA24 YA24 have a full health check if after reorganisation of service user files highlight this. The registered person should ensure that systems are in place to allow advocates/ families to raise issues on behalf of the service user where appropriate so that their views can be heard. The registered person should ensure that the carpets in the communal areas are replaced in the near future. The registered person should ensure that consideration is to be given to obtaining recliners or appropriate seating in the lounge to further meet the needs of the service users. The registered person should ensure that a risk assessment is undertaken and documented with regards to the portable heaters. The registered person should ensure that one specific service users bedroom and the communal areas in the home are personalised. The registered person should ensure that the organisation policies and procedures are discussed in staff supervision. The registered person should ensure that staff meetings are held on a regular basis, which are documented and maintained. The registered person should ensure that staff receive training around the roles of health care professionals and other statutory bodies. The registered person should ensure that service users files are reorganised, reviewed and updated. 12. YA24 13. YA26 14. 15. YA36 YA33 16. YA35 17. YA41 Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Glenside (10) DS0000025273.V323372.R01.S.doc Version 5.2 Page 35 - 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!