CARE HOME ADULTS 18-65
Henshaws Society for Blind People 45 Yew Tree Lane Northern Moor Manchester M23 0DU Lead Inspector
Helen Dempster Unannounced 14 June 2005 11:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Henshaws Society for Blind People Address 45 Yew Tree Lane Northern Moor Manchester M23 0DU 0161 945 3665 0161 945 4114 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Henshaws Society for Blind People Responsible Individual - Ms Dianne Asher Ms Averill Williams PC Care home only 6 Category(ies) of LD Learning disability registration, with number PD Physical disability of places SI Sensory Impairment Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 06 October 2004 Brief Description of the Service: Yew Tree Lane is a care home that is owned by Henshaws Society for Blind People. The home provides long-term residential accommodation for up to six (6) service users within the category of Younger Adults (YA). All the young adults must have a visual impairment and may have a learning or physical disability. The premises is a large detached house that has been extensively refurbished as a care home. It is set in pleasant grounds which the young adults have access to. The home is situated in a residential area of Northenden within easy reach of all the amenities of Sale. The home has access to the local transport network and is near to the main motorway links in the area. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced. It started at 11.00am and finished at 4.30pm on 2 June 2005. All of the 7 requirements and all but one of the 6 recommendations made at the previous inspection in October 2004 had been fully addressed. This is good practice. The inspector spoke to 2 of the 3 young adults living at the home, the manager and a range of staff. The young adults living at the home were formerly students of Henshaws College in Harrogate. They prefer to be referred to as students, so this is the term which will be used to describe them throughout this report. What the service does well:
Assessments of students’ needs were very good and gave a clear picture of students’ needs from their own point of view. Wherever possible, a home assessment was done with the student before they were admitted, but it was also done at the home to see if the new student and students who already lived there could get on together. Students’ needs, wants and what they wanted to achieve were recorded well in their support plans, so that they could be supported and cared for in the way they wanted to be. Support plans were written from the students’ point of view and the views of their family. Students were encouraged and supported to be as independent as possible and risks were assessed when there was a problem with a particular choice. Day to day records were very detailed and included separate activity records. Students rights were respected and they were encouraged and supported to live full lives, including attending college, leisure activities, shopping and seeing their family and friends. Good staffing levels helped students to get out in the community, to college and in one case, to the gym. Students had a healthy diet and were encouraged to make choices and be as independent as possible. The manager was aware of disability discrimination law and respecting rights. At the time of inspection, the organisation was acting as an advocate for one student about access to college courses. Students were able to have telephone calls and stay with their families Students’ meals were planned with them each week and staff helped them to shop for food and make meals. Cultural needs were met e.g providing Halal meat. Students’ views were listened to and acted upon through complaints and just listening to people and they were protected from abuse, neglect and self harm. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 6 The building was well adapted to meet the needs of the students. All the students have a single room with en suite facilities and specialist equipment to meet their needs. The home was attractive, clean, tidy and comfortable. Staff said they had good access to training from the organisation, so students’ needs were met by well trained staff. At the time of inspection, staff were having training at the home in moving and handling. What has improved since the last inspection? What they could do better:
Information was available to prospective students, but this needed to be in a format that the students, who are visually impaired and cannot read it, could access. Students did not have a contract/terms and conditions and a requirement was made about this. The assessment of the social worker was not always on files and a requirement was made about this. On viewing files, it was noted that students can display challenging behaviour. The need for a policy on in what circumstances and in what way restraint could be used was discussed and a requirement was made accordingly. There was also no policy on intimate relationships and a requirement was made accordingly. The receipt of medication was not being signed for, there were no risk assessments about self medication and no care plans concerning the administration of ‘when required’ (PRN) medication. A requirement was made about this. Some aspects of fire safety practice needed review to maintain safety at the home. Fire safety practice in the home needed revising to ensure that the fire risk assessment is freely available to staff and is a working document, to ensure that the emergency lighting is checked when staff complete the other weekly fire safety checks and that records of fire drills include the response time. A requirement was made accordingly. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 7 The benefits of a key worker system was discussed. Staff felt that this would be good for students. A recommendation was made about this. 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. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 and 5 Information was available to prospective students, but this needed further revision and to be in a format that students could readily access. Assessments of needs were of a high standard and gave a clear picture of students’ needs from their own point of view. This good practice would be enhanced by providing students with a contract/terms and conditions. EVIDENCE: The Statement of Purpose was stored on computer but was not readily available in a hard copy. It needed reviewing to meet the specifications of Standard 1 e.g. including a copy of the most recent inspection report. The service users guide had been reviewed since the last inspection and some aspects of it were good practice e.g the section on “what we want to do this year”. However, it needed further revision to meet the specifications of Standard 1, including making it available in a format that the students can access. A requirement was made accordingly. The students’ files contained assessments from the Henshaws College in Harrowgate. The manager explained that wherever possible, she completes a home assessment with the student prior to admission. As the assessment criteria is compatability with other students, as well as meeting the needs of the individual, the pre admission assessment often took place at the home. Those assessments viewed were of a high standard and gave a clear picture of
Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 10 the students’ needs. The assessment of the placing authority was not consistently available on files and a requirement was made accordingly. There was no contract/ terms and conditions on students’ files and a requirement was made accordingly. The contract needs to clarify house rules on smoking, drugs and alcohol. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Students assessed needs, wants and personal goals were documented to a high standard in their support plans, so that they could be supported in the way they preferred. The home needed to provide these plans in a format that the students can access. Students were encouraged and supported to be as independent as possible and restrictions on choice were justified through risk assessment. EVIDENCE: Support plans were detailed and comprehensive, were written from the students’ point of view and through discussion with the students’ families, and were subject to review. Good practice included the section on “ Things that are most important to (student)” and “To be successful in supporting (student) you need to know”. Day to day records were also detailed and comprehensive and included separate activity records and incident report sheets. Files were clearly indexed for ease of access of information. This good practice could be further enhanced by providing care plans in a format that the students can access. The manager stated that support plans can be read to the students, but that an audio copy could be considered.
Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 12 On viewing files, it was noted that students can display challenging behaviour. The need for a policy on in what circumstances and in what way restraint could be used was discussed and a requirement was made accordingly. One student managed her finances independently. The other 2 students had the support of their families, but did manage some of their money on a day to day basis. Risk assessments were in place for students. There was evidence to suggest that where choice was minimised in any way this was explained to students and was supported by risk assessment. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16 and 17. Students rights were respected and were encouraged and supported to live full lives. Appropriate staffing levels enabled students’ access to community based activities in line with their expressed wishes and this is commendable. Students had a healthy diet and were encouraged to make choices and be as independent as possible. EVIDENCE: The students all attended a variety of college courses. Appropriate staffing levels facilitated students access to college and other community based activities e.g attending a gym, in line with their expressed wishes. On occasions 2 staff supported 1 student to community based activities. The fact that staffing deployment was needs led is commendable. The manager demonstrated good awareness of disability discrimination legislation and respecting individual’s rights. At the time of inspection, the organisation was acting as an advocate for one student concerning access to, and choice of, college courses.
Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 14 There was clear evidence of maintaining family links. Students do maintain telephone contact and stay with their families. There was no policy on intimate relationships and a requirement was made accordingly. Students’ meals were planned on a weekly basis, in consultation with them. Students were accompanied by staff to shop for food and wherever possible, to assist in it’s preparation. Nutritional needs, likes and dislikes, and support needed to eat, were well documented. Cultural needs were met e.g providing Halal meat. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 20 Students were cared for in the way they preferred and required. Medication practice needed review to ensure that students control their own medication unless risk assessments demonstrate that this is inappropriate. EVIDENCE: Support plans demonstrated that students were cared for in the way they preferred. (See individual needs and choices for details). Some students were prescribed medication. A policy was in place, staff had received training in the administration of medication and a record of returns to the pharmacy was held. The receipt of medication was not being signed for, there were no risk assessments concerning self medication and no care plans concerning the administration of ‘when required’ (PRN) medication. A requirement was made accordingly. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Students’ views were listened to and acted upon and they were protected from abuse, neglect and self harm. EVIDENCE: The complaints policy and a record of the investigation of complaints was in place. Manchester City Council’s Protection of Adults from Abuse Policy was in place and staff had received training in the protection of adults from abuse. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26 and 30 The premises are clean, tidy, attractive and homely and are appropriately adapted to meet individual needs. Some aspects of fire safety practice needed review to maintain safety at the home. EVIDENCE: The premises was well adapted to meet the needs of the students. All the students have a single room with en suite facilities. ). Students’ rooms were locked when they were out, but none of them held their own key. A requirement was made to the effect that students hold their own key unless risk assessment demonstrates that this is not possible. Specialist equipment, including tracking hoists, were provided to meet individual needs. The home was attractive, clean, tidy and comfortable. Fire safety practice in the home needed revising to ensure that the fire risk assessment is freely available to staff and is a working document, to ensure that the emergency lighting is checked when staff complete the other weekly fire safety checks and that records of fire drills include the response time. A requirement was made accordingly. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Access to staff training is a strength of the organisation and students’ needs are met by appropriately trained staff. EVIDENCE: Staff described good access to training from the organisation. At the time of inspection, staff were having training at the home in moving and handling. Staff described useful induction training when they commenced employment and a range of training, including Learning Disability Award Framework accredited training towards achieving NVQ. The benefits of a key worker system was discussed. Staff felt that this would be beneficial to students. A recommendation was made accordingly. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40 Service users’ rights and best interests are safeguarded by the homes policies and procedures. EVIDENCE: Policies and procedures in the home had been reviewed in March 2005. Staff sign the record to indicate that they have read them. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x x 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 2 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Henshaws Society for Blind People Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x x 3 x x x CS0000061522.V222852.R01.doc Version 1.30 Page 21 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 YA1 Regulation 4 and 5 Requirement The Statement of Purpose and Service Users Guide must be reviewed to meet the specifications of Standard 1 and Schedule 1 and must be in a format that students can access. The assessment of the placing authority must be consistently available on students files. Each student must have a contract/ terms and conditions. Care plans must be in a format that the students can access. A policy must be drafted which clarifies in what circumstances and in what way restraint could be used. A policy on intimate relationships must be drafted. .Students should hold the key to their own room unless risk assessment demonstrates that this is not possible. Timescale for action 14/09/05 2. YA2 14(1) 14/08/05 3. 4. 5. YA5 YA6 YA6 5(1) 15 13 14/09/05 14/09/05 14/09/05 6. 7. YA15 YA25 12 12 14/09/05 14/08/05 Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 22 8. YA20 13 The receipt of medication must be signed for, risk assessments must be in place concerning self medication and care plans must be in place concerning the administration of ‘when required’ (PRN) medication. . Fire safety practice in the home must be revised to ensure that the fire risk assessment is freely available to staff and is a working document, the emergency lighting is checked when staff complete the other weekly fire safety checks and that records of fire drills include the response time. 14/08/05 9. YA24 23(4) 14/08/05 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 It is recommended that a key worker system is introduced. Henshaws Society for Blind People CS0000061522.V222852.R01.doc Version 1.30 Page 23 Commission for Social Care Inspection 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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