CARE HOME ADULTS 18-65
Gracelands Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ Lead Inspector
Janet Oxley Announced Inspection 21st February 2006 9.40 Gracelands DS0000038691.V270235.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 Gracelands DS0000038691.V270235.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. Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Gracelands Address Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ 01691 652153 01691 652153 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) Loppington House Limited Miss Julie Palin Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: Gracelands is registered with the Commission of Social Care Inspection (CSCI) to provide accommodation and care for seven people with a learning disability. The home is situated in the village of Whittington in North Shropshire. Loppington House Ltd owns the home and the Registered Provider is its Director, Mr Paul Harris. The Registered Manager for Gracelands is Ms Julie Palin. The seven people living at the Gracelands had previously lived at Loppington House and were chosen carefully for their compatibility. They were fully involved in the resettlement process, choosing decoration, furniture and fittings prior to moving into the home. The service users access a workshop and retail outlet two days a week where they are afforded the opportunities to experience making items to sell then actually selling the finished products. Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection reviewed key standards only as the home is currently considered to be performing well and thus warrants the application of a reduced methodology The inspection was announced and commenced at 9.40am. It included observing activity within the home, inspecting the premises, looking at records and case tracking and talking to the Proprietor, Manager and two staff who were welcoming and helpful throughout the inspection. Those residents seen at the time of inspection appeared well looked after and content. It was found that the National Minimum Standards assessed had been met with a number exceeded, and that the overall quality of care provided was good. Visitors, relatives and visiting professionals continue to express satisfaction with the service and care the residents are receiving and have been complimentary regarding the management and care practices at the home. What the service does well: What has improved since the last inspection?
Gracelands continues to develop programmes for each individual along with all relevant staff training. This aspect has included the organisation commissioning the services of an external speech and language team to compile individual assessments and train the staff in the use of Makaton to improve communication skills. It was evident that staff are continually improving, upgrading and individualising the resident’s bedrooms and all communal rooms, including the outside areas. A number of areas have been redecorated since the last Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 6 inspection, a dishwasher has been installed and work has commenced to move and improve the laundry facilities. It has to be noted that at this home that the staff are constantly reviewing all aspects of the service to achieve best practice and maintain a high quality service. 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. Gracelands DS0000038691.V270235.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 Gracelands DS0000038691.V270235.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): x Appropriate procedures are in place that would enable the successful admission of new residents to the home. EVIDENCE: Although no new residents have been admitted to the home since 2002, when first opened, there are appropriate admissions policy in place should the need arise and the statement of purpose is kept up to date. Gracelands DS0000038691.V270235.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 and 9. Each resident has a comprehensive and updated care plan, which includes aspects of daily living and care they require. Staff evidently respect resident rights and there is a constant monitoring and review process to ensure their identified needs are being met and individualised care given. EVIDENCE: Care documentation pertaining to one resident was inspected. The care plan was very comprehensive and well maintained providing the staff team with all the necessary information required to meet individual needs. Detailed reports are completed in preparation for reviews, which are attended by all relevant persons. The plans include set objectives, which are monitored and reviewed and these are incorporated in staff supervision with the named key worker. Individual and generic risk assessments are well established. With staff support, the residents who are able, are engaged in all aspects of the running of the home and it was apparent that they are enabled to make decisions about their lives with professional assistance. The registered provider is the Chairman of PCAS advocacy service. Self advocacy meetings are regularly facilitated in the home and external advocates meet with the residents on a one to one basis. Financial matters appeared
Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 10 satisfactory with individual records maintained which are audited regularly by individual advocates and external auditor. Gracelands DS0000038691.V270235.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): All The lifestyle of the service users living at this home appears to be satisfactory and through a framework of activities, independence, personal and social skills they are encouraged to develop. Family ties are maintained and regular communication with relatives is encouraged and supported. EVIDENCE: The organisation has a retail shop and workshop based in the local town and the residents access both of these facilities on two days during the week. One day each week a ‘hobby’ day takes place when each resident can enjoy individual interests. It was considered that this aspect of the residents lives could be improved by having additional staff on duty at week-ends. Currently they are unable to go out on these days as only two staff are on duty. In addition the critical care role these staff on duty is somewhat impeded as they also have to clean, cook and attend to laundry duties. Each individual is supported to maintain family links by letter, telephone or visits. The menus and provisions in the kitchen indicated that a good diet is offered and all residents were seen to be having their breakfast in a relaxed and happy manner.
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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): 18, 19 and 20. The health and personal needs of residents appeared to be met with evidence of regular review and of multi disciplinary working taking place on a regular basis. EVIDENCE: Residents records seen and discussions with staff indicated that the staff monitor health needs, make appropriate referrals and appointments to health care professionals. The support individuals require is well documented and on inspection it was evident that residents preferences for times of getting up and having meals etc were being respected. At the time of this inspection it appeared that medication was being administered, recorded and secured satisfactorily and staff have undertaken relevant training. The support of Doctors and Consultants for all residents is ongoing Behavioural changes of service users are also monitored and plans and risk assessments for activities are in place. Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 13 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 and 23 Gracelands has appropriate policies and procedures in place for the protection of residents. EVIDENCE: No complaints have been received since the last inspection. One concern received from a relative has been professionally and sensitively addressed. A full complaints procedure is available and given that the residents would have some difficulty understanding the concept of a complaint it was evident that staff are sensitive and have developed methods to identify what residents like, dislike or object to and explore new avenues in efforts to overcome the difficulties. As previously mentioned self advocacy meetings are facilitated and internal and external advocates meet with the residents on a regular basis to try to ensure that there are no outstanding issues or concerns. At the time of this inspection it was once again evident that the residents are very confident to do what they wish within the homes environment. Robust procedures are in place to protect service users from abuse and are included in all aspects of staff training. All staff have also received external accredited training on the subject. Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 14 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, 26 and 30. The standard of the environment within the home is good, providing residents with a warm, safe and homely place to live. EVIDENCE: The environment is homely. All residents are provided with single rooms which are very personalised. The home is furnished and equipped to a good standard throughout. A lounge, dining room and fully fitted kitchen are provided and outdoor space is proportionate to the number of people residing at the home. At the time of this inspection the standard of cleanliness and hygiene was satisfactory and redecoration in a number of areas has taken place since the last inspection. Work has commenced to move and improve the laundry facilities and plans are in hand to replace the dining chairs. Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 15 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 and 34. Residents are supported by a well trained and committed staff group who are generally meeting the needs of each individual in a sensitive and professional manner. Staffing levels at weekends need to be increased. EVIDENCE: One member of staff has been recruited since the last inspection and records indicated that the recruitment procedure had been robust. The two members of staff on duty were extremely complimentary regarding the induction training and the support and supervision they receive. The management continue to support staff to undertake their NVQ awards, a very good variety of other training has been undertaken and the staff on duty indicated that they were very sensitive to the residents needs and disabilities and that their attitudes and practice were monitored and supervised by the management. Inspection of the duty rota indicated that on most Tuesdays and Thursdays and at weekends there are only two members of staff on duty to care for the residents and to cook, clean and attend to laundry duties. Due to individual needs and disabilities it is impossible for these two staff to take the residents out of the home to engage in appropriate leisure activities, to use local community resources or to participate in community activities. Consequently it was considered that staffing levels need to be increased, especially at the weekends. Appraisals, recorded supervisions and regular team meetings take place.
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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 and 42. There are clear lines of accountability within the homes management structure and the management approach creates an open and positive atmosphere from which the residents benefit. The home regularly reviews all aspects of its performance and meets the requirements of the Fire Officer and Health and Safety Officer, promoting the health, safety and welfare of the people living at the home. EVIDENCE: The Manager has almost completed the NVQ4 in care and the Registered Managers Award. This has been delayed through no fault of her own. It is evident that she continues to update her own professional knowledge by attending a number of related courses to the resident group catered for. The manner in which the Manager, staff and residents responded to this inspection indicated that a sound management approach is in place and that staff are committed to achieving best practice and to developing equal opportunities. Sound quality assurance systems are in place and there was evidence available to indicate the proprietor and manager ensure, so far as is reasonably
Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 17 practical, the health, safety and welfare of service users and staff. All staff have attended a health and safety course and relevant mandatory training was reported to be up to date. At the time of this inspection no potential hazards were identified, there is a first aider on site at all times and the accident records were seen. All relevent records required are maintained in a professional manner. Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 4 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 x 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 3 x 3 x x 3 x Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 19 NO 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 YA33 Regulation 18(1)(a) Requirement That staffing levels be increased at the weekends to enable the residents to participate in community and leisure activities. Timescale for action 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gracelands DS0000038691.V270235.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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