CARE HOME ADULTS 18-65
Homeleigh Middleton Road Crumpsall Manchester M8 4JX Lead Inspector
Steve O`Connor Unannounced Inspection 28th February 2006 10:00 Homeleigh DS0000021618.V279221.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 Homeleigh DS0000021618.V279221.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. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Homeleigh Address Middleton Road Crumpsall Manchester M8 4JX 0161 225 3609 0161 720 9660 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) Southfields Care Homes Limited Susan Lesley Bradbury Care Home 30 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (24), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (5) Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named person who requires personal care only by reason of learning disability is accommodated. Should this service user no longer reside at the home then the registration will revert to thirty places for mental disorder (MD). Five named persons are over 65 years of age but requiring care by reason of mental disorder excluding learning disability or dementia. Should any of these service users no longer reside at the home, the registration category for these places will revert to accommodation for people under 65 years of age with a mental disorder (MD). 28th September 2005 2. Date of last inspection Brief Description of the Service: Homeleigh is a care home providing 24-hour care and accommodation for up to 30 adults with mental health problems. The home is a detached 3 storey building set within its own grounds. Accommodation is spread over three floors with a combination of single and double rooms and also one self-contained flat. There is a smoking and non-smoking lounge and a dinning room set out in a cafeteria style with bench seating. The home is situated in the Crumpsall area north of Manchester city centre. It is close to local amenities and public transport links. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over the 28th February and 3rd March 2005. Time was spent talking with people, the manager, some of the staff on duty and observing how staff worked with people. In addition people’s files and other documents were inspected. A tour of the premises was also made. The previous inspection in September 2005 had identified a number of areas that the home needed to improve upon. The majority of these had been actioned by the home. This was the second inspection of the home under the new ownership of the main organisation. Representatives of the organisation have presented the CSCI with outline plans for the development and refurbishment of the home. The progress of the work will be monitored through the inspection process. The CSCI had not received any complaints regarding the home since the last inspection. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. What the service does well:
Of the core standards assessed during this inspection the home does well in the following areas. The home offers people support and information to assist them in making decisions that affect their lives. Staff support people in making decisions regarding such issues as housing, health, activities and routines. Information is provided and people are encouraged to make choices and to make no choice if they do not wish. There are no restrictions placed on people unless agreed through a risk assessment process that involves the person. People manage their own affairs as far as possible and support is provided to manage finances and medication. Talking to staff and the management team highlighted their commitment to providing and offering people the opportunity to take part in social, leisure and development activities. The issue of the impact of a persons’ mental health and the issue of motivating people to take up opportunities was discussed and highlighted the difficulties in providing this support. Many people could access the community independently and made their own choices of what they wanted to do with their day. However, the home was aware of the impact of
Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 6 long-term mental illness and of the effects of institutionalisation on how this may restrict people from taking up new opportunities. The Registered Manager has achieved the Registered Manager’s Award and has participated in a range of training events to maintain their skills and awareness. They have been pro-active in seeking appropriate training and development opportunities for the staff team to increase their skills and knowledge. Staff spoken to felt that they were supported and encouraged by the manager and that she was open to ideas and listened to their views and issues. What has improved since the last inspection? What they could do better:
The home is responsible for making sure that all the staff it employs does not pose any risk to the vulnerable people being supported. The home does have a system for gaining Criminal Record Bureau (CRB) disclosure and POVA checks but it was found that one member of the staff team did not have either check. It was also found that the home had misunderstood the guidance on starting staff before receiving a full CRB certificate. The home were required to ensure that all staff had a valid CRB certificate and that the policy on using the POVA first check is submitted to the CSCI. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 7 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. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 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 the following standard(s): No judgement was made. EVIDENCE: The core standard was assessed during the previous inspection. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 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 the following standard(s): 7 The home supports people to make decisions and choices that affect their lives. EVIDENCE: At the previous inspection the home was recommended to further develop its care planning systems so that they accurately reflect people’s needs and goals and the support the home provides. The home had made progress in developing a new system of care planning that identifies peoples’ social, leisure and independence skill goals. The actions and support required to help people meet these goals has been identified and a new recording system has been introduced to evidence when the support was provided. This information would then be used to assess whether the goals identified have been achieved or whether changes need to take place. It is recommended that the home continue with this work to make the care planning system more person centred on what the individual wants to achieve and to be more focused in the needs and goals identified and specific in the actual support provided.
Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 11 At the previous inspection the home was required to provide the staff team with training in how to understand and work with people whose behaviour may present a challenge. Through discussions with the staff and management it was found that the majority of the staff team had completed a training package that looked at understanding the nature and reasons for people to present challenging behaviour. Staff were still yet to undertake the second part of the training that would look at work practices around challenging behaviour. The inspector was informed that this was planned to start in March 2006. Whilst the home has provided the CSCI with a plan and provided the majority of staff with initial challenging behaviour training they are still required to provide all the staff team with such training and provide a plan for the completion of the remainder of the training package. A requirement will be made under Standard 35 of the National Minimum Standards (NMS). The home offers people support and information to assist them in making decisions that affect their lives. Staff support people in making decisions regarding such issues as housing, health, activities and routines. Information is provided and people are encouraged to make choices and to make no choice if they do not wish. There are no restrictions placed on people unless agreed through a risk assessment process that involves the person. People manage their own affairs as far as possible and support is provided to management finances and medication. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 15, 16, 17 The home offers people the opportunity to participate in social, leisure and community based activities. Links with families and friends are maintained based on peoples’ wishes. Routines are based on people’s preferences. The home provides meals that people want with sufficient choice and quality. EVIDENCE: Talking to staff and the management team highlighted their commitment to providing and offering people the opportunity to take part in social, leisure and development activities. The issue of the impact of a persons’ mental health and the issue of motivating people to take up opportunities was discussed and highlighted the difficulties in providing this support. Many people could access the community independently and made their own choices of what they wanted to do with their day. However, the home was aware of the impact of long-term mental illness and of the effects of institutionalisation on how this may restrict people from taking up new opportunities. Evidence was seen of planned activities and events that people had participated in and enjoyed. The home had taken over a new allotment plot
Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 13 and was encouraging people to become involved. As many people were reluctant to access community activities on their own the home concentrated on providing leisure activities in the home such as film nights, crafts sessions and other indoor activities. The new care planning system was being used to record when people were offered the opportunity to participate in an activity relating to their goals and further discussion was held as to looking at different ways that activities can be recorded and used to encourage people to try new activities such as the use of photographs. It was recommended that the home look at alternative ways that they can record the activities people participated in and use to support/encourage others to try new activities. The home supports people to maintain links with their families and friends based on people’s own wishes. People’s routines are based on their own preferences and the historical routines that they have developed over the years. Meals and drinks are provided between and at set times but can be taken when the person wants. People are encouraged to spend mealtimes together to reduce isolation and give staff the opportunity to speak to people and find out how they are feeling. People are encouraged to take care of their own domestic tasks and to maintain the cleanliness of the house. However, through discussions with staff it was found that it was difficult to get people involved as the staff team has always undertaken the cleaning and domestic tasks. All meals were taken in the cafeteria style dining hall. A set four-week menu has been devised with people’s input. Information regarding people’s dietary needs is available and alternative choices are provided to meet those dietary needs. People can come and talk to the cook about the menu and ask for alternatives if required. A record is maintained of what each person has for their meals and when meals have been missed. Food stocks were sufficient and stored correctly. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgements were made. EVIDENCE: The core standards were assessed at the previous inspection. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has the systems, policies, procedures and practices in place that allow people to raise their concerns and to respond to incidents/allegations of abuse. EVIDENCE: The home had a complaint policy and procedure in place. People had been issued with a copy of the complaint policy as part of the Service User’s Guide. The Manager maintained a record of all informal and formal complaints people made. The home had policies and procedures with regards the protection of vulnerable adults and whistle blowing. All staff had received a copy of the procedures as part of induction training. The home maintained records with regards peoples’ finances and transactions. Money was stored in the safe in separate bags for each individual. The person and a member of staff signed the financial record sheets when any monies were entered or withdrawn. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgement was made. EVIDENCE: The previous inspection required the home to make good repairs and problems identified around the building: to undertake an audit of repair and refurbishment and of the furniture available to people in their bedrooms. The audits had been carried out and action plans provided to the CSCI. Longterm refurbishment plans had been submitted to the CSCI. A tour of the building showed that all the issues identified had either been addressed or would be in the future refurbishment. The remaining core standards were assessed at the previous inspection. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 17 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, 34 and 35 The home has an established programme of training and development, however, the systems in place do not fully show that staff have received all the required training. The recruitment systems and practices do not fully ensure that staff have undergone the required checks. EVIDENCE: The home has an ongoing programme of NVQ training. Records were seen that showed that the deputy manager had NVQ level 3, three seniors had completed the Level 2, four support staff had level 3, five were currently studying and two were yet to be enrolled. Staff files were sampled to assess whether all the required checks and documentation required through the recruitment process had been obtained. Files were seen with completed application forms, references received and a contract of terms and conditions. The procedure for obtaining the required Criminal Records Bureau (CRB) and POVA (POVA) check was explained and files were seen with the CRB reference number and date of issue. It was found that a member of staff had started without a CRB certificate or evidence of a POVA First check. It was explained that after submitting a CRB
Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 18 application the administrative section of the organisation would apply for a POVA first check to ensure the staff was not on the POVA register. There was no evidence that either a CRB application or POVA First check had been made for this staff member. The registered provider must ensure that all staff have a valid CRB disclosure certificate. The use of the POVA First check was discussed and it was found that there was a misunderstanding in that it was believed that staff could start working as long as the required supervision was in place. It was also found that it was standard practice for the organisation to seek a POVA First for all staff. The CRB and Department of Health guidelines highlight that this check should only be made in exceptional circumstances, ‘it is stressed that providers of care must regard employment pending a full CRB Disclosure, and related requests for POVAFirst checks, as very exceptional measures to be used only when absolutely necessary. They are intended only to ensure that providers of care are able to recruit staff immediately where otherwise staffing levels do not meet statutory requirements. These provisions should not be used as a substitute for good workforce planning and management. The Commission for Social Care Inspection will take appropriate action if this provision is misused. The use of this provision will also be subject to other monitoring and review.’ (DOH, July 2004) The registered provider must provide the CSCI with its policy, procedure and conditions for undertaking POVA First checks. The home had a set Induction Programme for all new members of staff. The introduction of the Skills for Care Induction Modules was discussed and it was stated that the home was aware of the changes required. The Induction Programme must be reviewed and, were required, updated to ensure it meets the new Skills for Care Induction Modules. From discussions with the manager and staff it was shown that the home were committed to developing the skills and qualifications of the staff team and to give them support to develop their work ambitions. A range of training events had been held and was being planned. Some staff did mention that some training events had been cancelled (Mental Health training) and one staff had not undertaken either first aid or adult protection training. The home had given the deputy manager the role of training coordinator. She was in the process of undertaking a training audit of the staff team to establish exactly what training had been undertaken and when this was achieved. The home also maintained a training log for each of the staff team. Whilst the majority of records were being kept up-to-date, some did not reflect the training that staff had undertaken.
Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 19 The results of the training audit and any action plan developed to address any identified training needs must be provided to the CSCI. As has been mentioned previously in this report it was found that the majority of the staff team had completed a training package that looked at understanding the nature and reasons for people to present challenging behaviour. Staff were still yet to undertake the second part of the training that would look at work practices around challenging behaviour. The inspector was informed that this was planned to start in March. As the training had not yet been fully completed the requirement was reiterated under standard 35. Through discussions with the management and some of the staff team it was stated that if staff are not on the rota on the day of a planned training/development event then they are not paid for attending that event. The National Minimum Standards identify that staff should receive at least five paid training and development days (pro-rata) per year. It is recommended that the home’s training programme include the provision of at least five paid training and development days (pro-rata) per year. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People benefit from an open and inclusive management and are encouraged to be involved and their views listened to. The home has the systems, policies and procedures in place to promote peoples’ health and safety. EVIDENCE: The Registered Manager has achieved the Registered Manager’s Award and has participated in a range of training events to maintain their skills and awareness. They have been pro-active in seeking appropriate training and development opportunities for the staff team to increase their skills and knowledge. Staff spoken to felt that they were supported and encouraged by the manager and that she was open to ideas and listened to their views and issues. The home has introduced a new quality assurance system in which includes the production of a regulation 26 monthly report and a ‘mock’ inspection using the National Minimum Standards and scoring. The home are also introducing an Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 21 annual ‘Satisfaction Survey’ to gain the views of the people living at the home, relatives, carers and other relevant professionals. The home undertake the required checks for fire safety, electrical and gas appliances and water temperatures. Staff have received information regarding health and safety practices. The Regulation 26 report of the 28.02.06 stated that Moving and Handling training has been arranged for all staff. This will be assessed at the next inspection. Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 X 3 X X 3 X Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 23 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 YA34 Regulation 19 Requirement 1.The registered provider must ensure that all staff have a valid CRB disclosure certificate. 2.The registered provider must provide the CSCI with its policy, procedure and conditions for undertaking POVA First checks. 2 YA35 18 The Induction Programme must be reviewed and, were required, updated to ensure it meets the new Skills for Care Induction Modules. 1.The results of the training audit and any action plan developed to address any identified training needs must be provided to the CSCI. 2.All the staff team must have completed the Challenging Behaviour training course. 30/09/06 Timescale for action 30/04/06 3 YA35 18 30/04/06 Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It is recommended that the home continue to work to make the care planning system more person centred on what the individual wants to achieve and to be more focused in the needs and goals identified and specific in the actual support provided. It was recommended that the home look at alternative ways that they can record the activities people participated in and use to support/encourage others to try new activities. It is recommended that the home’s training programme include the provision of at least five paid training and development days (pro-rata) per year. 2 YA13YA12 3 YA35 Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection CSCI, Local office 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
© 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 Homeleigh DS0000021618.V279221.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!
