CARE HOME ADULTS 18-65 73 High Road Gorefield Wisbech Cambridgeshire PE13 4PG
Lead Inspector Don Traylen Announced 29 April 2005 @ 10:00 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. 73 High Road Version 1.10 Page 3 SERVICE INFORMATION
Name of service 73 High Road Address 73 High Road Gorefield Wisbech Cambs PE13 4PG 01945 870968 01945 871364 NA Milbury Care Services Garrick House, 2 Queen Street, Litchfield, Staffordshire WS13 6QD Anita Dawn Blackburn Care Home (PC) 7 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) Category(ies) of Learning Disability (LD) 7, registration, with number Physical Disability (PD) 7, of places 73 High Road Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection This is the first inspection sonce registering with the CSCI. Brief Description of the Service: 73 High Road Gorefield is a seven bedroomed detached house in the small village of Gorefield, close to Wisbech in north Cambridgeshire. The home has been completely refurbished for the servicethat was first registered in December 2004. The home has a high standard of decoration and is well furnished. The comfortable and spacious rooms makes the home a relaxing and secure environment for service users. There is a large garden area to front and left side of the property and a large patio area with adequate seating and table arrangement for all service users to use. The driveway provides ample parking space for the service users vehicle as well as for staff and visitors. 73 High Road Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was conducted on a warm sunny day over a period of 6.5 hours that allowed the inspector to meet all the service users. The registered manager completed a pre-inspection questionnaire. Each service user, or their relative, was given a comment form to complete. The Commission received comment cards from two service users and three relatives. Two relatives were contacted by telephone to ascertain their views. Five staff were on duty during the inspection and the inspector spoke to most staff and had longer discussions with two staff. The registered manager was available throughout the inspection and the company’s Responsible Individual, Mr Richard Fletcher, visited the home and was available to speak to the inspector. What the service does well:
Overall, the service is careful to attend to complex and very different individual needs for people with learning disabilities. The home has managed to do this with respect and through a thoughtful and sensitive understanding of each service user’s circumstances and of their potential development and happiness. The home has provided the service for seven service users only since December 2004. The home arranged for lengthy and careful pre-admission assessments for each of the service users, five of whom moved from one establishment on the 1st December 2004 and for two service users who moved to the home in February 2005. Care Planning has been thoughtful and ensures that service users are the focus of attention and are included in the process. Family links have been maintained and increased in some circumstances. The manager and assistant manager are commitment to giving person-centred care. Service users are stimulated and have a variety of interests and activities they follow. For instance, two service users attend mass every Sunday at the church opposite the home. The built environment of the home is conducive to providing a calm and homely situation where service users have ‘settled-in’ and have established themselves as the owners of their environment. The home employs staff who are united as a team and are flexible in their approach to giving care and to the needs and wishes of service users. Recruitment of staff is rigorous and has resulted in a positive members of staff who demonstrated their enthusiasm during the inspection. The home insists on a thorough induction programme before offering additional training. 73 High Road Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 73 High Road Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 73 High Road Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1.2.3.4.5. Service users’ welfare is ensured by the home who conduct a detailed and considered pre-admission assessment process that establishes a firm understanding of individual needs. EVIDENCE: The home provides care for seven service users with complex and different needs. Five of the service users had previously lived in another care home in Cambridgeshire that had recently closed. The home arranged comprehensive re-assessments and extensive care planning, consultation and trial visits to the home before any of the five service users moved in. The manager worked alongside care staff in the service users’ previous home to ensure that sufficient information and knowledge of each prospective service user’s needs was understood, and that the manager and staff were able to determine if they could appropriately care for these five prospective service users. A careful method for introducing service users to the home and for assimilating prospective service users was applied to ensure that each service user was content and happy to share. Two service users who moved to the home in 2005 had comprehensive care management assessments signed by the service user and care mangers. The reasons to ensure that each service user’s needs are met were fully appreciated by care staff who spoke to the inspector. Overall, the assessment process that was evident in the records and the assessment details of each
73 High Road Version 1.10 Page 9 service user, showed the home operated as a team to carefully consider the range of needs, including the emotional wellbeing of each service user. Care staff who spoke to the inspector demonstrated their awareness of the different backgrounds of each service user, their history of care, their family links and their individual behaviours and likes and dislikes. The manager and inspector agreed that the home should devise an improved assessment tool for their use. Service users’ contracts were not available on the day of inspection and the manager was advised that contracts must be kept in the home and made available for inspection. A Recommendation and Requirement have been made in relation to each of these two issues. 73 High Road Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10, Care planning is carried out in a manner that fully includes service users and their families in the written Care Plans and in the daily routines organised in the home. EVIDENCE: Two Care Plans showed that care is extensively planned and is being developed as an ongoing objective of the home. The manager stated that the home is still in the process of developing, with each service user, their plan of care and that this is regarded as a continuous and ongoing process. The manager stated she intends to develop a more person centred approach in the descriptive clement of delivering care. The manager stated that changing needs and personal preferences must be recognised. For instance, the home arranged for all service users to attend various function offered by the church in the village. Two service user have been very definite in their intention to attend mass regularly each Sunday and have been recognised and made welcome by the church community. Care Plans revealed planning for “essential lifestyle”, which accounted for likes and dislikes and for “strengths and abilities”. Care Plans did indicate outcomes and aims and although the descriptive element of achieving outcomes was not fully recorded, the issues concerned with achieving each outcome had been
73 High Road Version 1.10 Page 11 recorded. Care Plans contained an extensive risk assessment conducted by the home. Family connections and regular methods of maintaining family links, transportation issues, finances and medication were addressed in Care Plans. Risk taking is balanced with individual abilities and the wishes of service users. For instance, two service users are being helped to go to a local shop unaccompanied. Precautions and plans have been set up to facilitate this within a reduced risk environment. Similar plans are made for a group to travel independently to Wisbech and meet care staff. Risks around the home are accepted but managed in a way that does not prevent service users from helping themselves to drinks and the freedom to chose. One relative stated that she is very pleased with the progress that one service user had made since he moved into the home. She stated ,“he has become much more active and much more independent since he moved into the home”. Another service user’s Care Plan showed he had been referred to a Physiotherapist and for a wheelchair to be ordered. During the inspection telephoned the manager checking about the support and assistance for a service user who had recently broken her leg. A specialist vehicle has been ordered by the home to facilitate service users who depend on a wheelchair when going out. Staff were observed to effectively communicate with service users who have different methods and abilities to communicate. One service user has progressed from occasionally attempting to walk, to walking more frequently than when she moved into the home in December 2004. 73 High Road Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,13,14,15,16, The home has an approach that is based on respect and listens to service users. Service users are encouraged to develop socially and psychologically and to hold aspirations. EVIDENCE: One relative stated she was pleased that her son was enabled to visit her every month. Comments made by relatives and staff indicated several developmental patterns in service users. The manager and assistant manager stated they were keen to find ways for service users to develop and to continue to enjoy activities. A regular visit to a specialist gym is arranged and trips out the local shop are usual. The manager stated that she has seen improvements in independence and communication in six of the service users since they moved to the home. Two relative stated that they felt that two of the service users are happier and more communicative since moving to the home. The manager stated that much of this personal progress is not shown in documents. Family are welcome at any time and relatives spoken to confirmed this arrangement.
73 High Road Version 1.10 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18.19.20.21. Service users are supported in ways that promote good health and personal wellbeing. EVIDENCE: The prescribed medication for all service users is well- managed by the home. Medication Records were accurate and a controlled drug was counted and was accurately recorded and stored in separate locked cabinets. Two service users informed the inspector they were well cared for and indicated their approval of care staff. Observations showed that service users were regularly included by care staff in many of their tasks and duties in the home and in conversation. The home has a death and dying policy that supports service users throughout a terminal illness if this is medically appropriate. 73 High Road Version 1.10 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23, Service users live in a safe and protective environment where their views are valued. EVIDENCE: Relatives spoken to stated they would complain if they had need but added they did not have any reason to complain about the care provided. Staff spoken to were aware of the need to protect vulnerable adults and were aware of how to report abuse. Not all staff have received this training but arrangements are in the process of being made. A requirement to provide this training for all staff has been made. The home has a complaints policy in the entrance/reception area for all visitors to read. 73 High Road Version 1.10 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30, Service users live in a home that is very well decorated and furnished, is comfortable and clean and has a high standard of facilities and generous communal spaces. EVIDENCE: One service user gave the inspector a tour of the building. He showed the inspector his room and said he was pleased with it and that there was a big bed for him. He stated he liked his bathroom and could have two baths each day. The home was very clean and well decorated. All bedrooms have full en-suite facilities. One room is equipped with a shower facility. All rooms have had their colour scheme chosen by service users. The communal areas include a large dining area and a lounge with French doors leading to a large patio area. Access to the outside is easy for wheelchair users and is on one level. The home has a relaxed and inviting atmosphere. It is bright and has adequate natural and electric lighting. Adequate storage facilities ensure the home is uncluttered and safe. The organisation has provided good quality accommodation with high specification detail.
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The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.32,33,34,35,36, Service users benefit from a motivated and dedicated staff team who are carefully selected and appropriately trained and have good interpersonal skills. EVIDENCE: The home has a staff recruitment policy. Staff files revealed that staff are provided with job descriptions. Two staff stated that they felt they were part of an effective and co-operative team supported by an open management approach to the home. Both staff confirmed they had CRB checks prior to commencing employment. Records kept in their staff files confirmed this. One to one supervision of staff is regular and is recorded. The General Social Care Council (GSCC) code of conduct has been established for all staff. 4 or 5 staff are on duty at any one time plus the manager who works 9am to 5pm Monday to Fridays and occasionally works alongside care staff on a shift. Staff induction training is thorough and is reinforced by external training for a range of courses including, communication and challenging behaviour and person centred care. NVQ level 2 and Learning Disability Award Framework accredited training is in the process of being arranged by the manager. She stated that she intends for all staff to be qualified in NVQ level 2 awards. The assistant manager is intending to commence NVQ level 4 in management. 73 High Road Version 1.10 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40, 41,42, The manager and the organisation ensure the home is managed for the overall benefit of service users. EVIDENCE: Two service users, three staff and two relative all stated that they felt they could approach the care staff or the manager with any concerns, should they wish. The home has an extensive range of policies and procedures in their Practical Guidance Manual that offers guidance and protection to service users. Policies include a code of conduct, a recruitment policy, whistle blowing, protection of vulnerable adults, reporting abuse, involving service users in risks assessment, keeping. All the homes policies are kept in the lounge area for staff and visitors and service users to access as they wish. The organisation intends to publish an annual quality audit, including service users views and staff views, in November. 73 High Road Version 1.10 Page 19 The home arranges regular fire drills and a weekly audit of their equipment by one dedicated member of staff. This checking is carried out with the involvement of service users who have been included in the fire drill decisionmaking. Fire safety and gas safety certificates were read, as was a food safety report by Fenland District Council. Emergency lighting is regularly checked. Hazards are identifies and reduced in very detailed and comprehensive risk assessment that is organised and managed by the home. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 3 3 2 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
73 High Road Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING
Version 1.10 Score 3 3 3 3 3 3 3 Page 20 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score 3 x 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 2 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 2 3 x 73 High Road Version 1.10 Page 21 NA 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 5 Regulation 17(2) & 17(3)(b) & Schedule 4(7) 13(6) Requirement The home must make arangements for service users contracts to be available for inspection and kept in each service users file at the home. All staff must be trained in the protection of vulnerable adults Timescale for action 01/07/05 2. 3. 23 01/08/05 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 2 Good Practice Recommendations The Registered Manager should develop with the Responsible Individual and with the homes staff an assessment tool that they should use to complete an indepth comprehensive assessment of need. The duty roster should indicate the member of staffs full name, their job title and a 24 hour reference to the time worked. Arrangements should be made for all staff to undertake and acheive an NVQ level 2 award in care. 2. 3. 41 32 73 High Road Version 1.10 Page 22 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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