CARE HOME ADULTS 18-65
Homestead 7 Bedford Road Yardley Hastings Northants NN7 1HJ Lead Inspector
Mrs Helen Wilson Unannounced Inspection 25th October 2005 1600 Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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 Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Homestead Address 7 Bedford Road Yardley Hastings Northants NN7 1HJ 01604 696782 SEE BELOW postmaster@oakfieldjm.force9.co.uk 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) Oakfield (Easton Maudit) Limited Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24 August 2004 Brief Description of the Service: Providing single bedroom accommodation for up to four service users aged between 18 and 65 years, Homestead is located in a small village near to Northampton and Wellingborough and offers personal care to meet the needs of people with learning disabilities. Service users have the use of a large people carrier vehicle making easy access to colleges, local community facilities and the day service provision at the sister home Oakfield in Easton Maudit. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This inspection was carried out giving approx two hours notice of the afternoon visit on 25 October 2005 and included a tour of the premises and conversations with the staff member on duty and with service users. The registered manager from the sister home, Oakfield, was present during the visit as there is no manager in post at Homestead. A second return inspection visit was made to the main office at Oakfield to check records on 26 October 2005. The primary method of inspection used was ‘case tracking’ which involved selecting one service user and tracking the care received through review of the case records. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. What the service does well: What has improved since the last inspection?
Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 6 Arrangements have been made to change the home’s supplying pharmacist and to make improvements in the system for recording and administration of medication What they could do better:
Despite a recruitment drive in 2004 the home has been unable to recruit a manager and as a result, for an extended interim period, management oversight has been allocated to the manager of the sister home at Oakfield. The registered providers must contact CSCI regarding arrangements for the provision of a manager for Homestead. There are several requirements from previous inspection reports that have not been addressed and are listed in this report as outstanding with final dates now stated for compliance. These matters must be given urgent attention. The home’s Statement of Purpose and the Service User guide requires further revision and needs to be circulated to all service users and their families and/or significant others. From examination of case files there is no evidence of contracts/terms and conditions signed and agreed between the home and the service users or on their behalf by families/significant others. Care plans for each service user must specifically detail to staff how care is to be delivered to consistently meet care needs. Commercially bought medication and alternative remedies/treatments must be recorded and stock controlled within the home. Administration of all such medication or remedies must be detailed on the medication administration record sheets of individual service users. Staff files were not available for inspection at the home. Arrangements must be made to have files on site for all staff working at Homestead. Supervision sessions for all care staff must be held regularly and at a minimum of six times per year. Policies and procedures must be specific to Homestead as they are based on Oakfield processes that can not always be applied to this home. The home must carry out an annual Quality Assurance review process involving the views of service users, families/significant others and relevant agencies and professionals. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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 Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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): 1,3,4,5 The published written information about the home is unclear and does not accurately describe its services. The home has failed to set up contractual agreements for service users. EVIDENCE: The home’s Statement of Purpose and the Service User guide requires further revision and needs to be circulated to all service users and their families/significant others. From examination of two case files there is no evidence of contracts/terms and conditions signed and agreed between the home and the service users or on their behalf by families/significant others. Service users are given the opportunity to visit the home prior to deciding to live there permanently. Three people have been resident at Homestead for several years. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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): 6,9 The home is failing to ensure reviews are held at appropriate intervals... EVIDENCE: From the case file examined there was no evidence of recent reviews of changing care needs or revised care plans Care plans are lacking detail of how staff are to specifically support and provide levels of assistance to meet individual service user needs. Over reliance is placed on individual staff member’s own knowledge of service users’ abilities and needs. There was evidence in case file records of thorough risk assessments for activities and handling of equipment by service users. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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): 11,12,13,16,17 The home succeeds in ensuring service users have access to community facilities and a range of activities. EVIDENCE: Staff and service users were at ease with each other during the preparation of the evening meal and eating round the kitchen table in a family type setting. All three service users at home during the visit appeared happy and confident with staff. Two people told the inspector that they enjoyed living at the home and that their activities at the day centre and college were very good. Two service users go regularly to local pubs for drinks. One service user was on holiday with family members. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 12 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): 18,19,20,21 The home has failed to adequately guide staff by means of clear care plans on the methods to be used in providing care and support to individual service users and this may potentially lead to inappropriate working practices. EVIDENCE: Care plans for each service user must specifically detail to staff how care is to be delivered to appropriately meet care needs. Present care plans gave directions such as “ needs a very high degree of physical intervention from staff…..” and this may result in inconsistent and inappropriate care being provided by staff. Proactive arrangements have been made to change the home’s supplying pharmacist and to make improvements in the system for recording and administration of medication Commercially bought medication and alternative remedies/treatments must be recorded and stock controlled within the home. Administration of all such medication or remedies must be detailed on the medication administration record sheets of individual service users. The home has begun a process of identifying the known final wishes relating to illness and death arrangements by initially writing to service users’ families/supporters.
Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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): EVIDENCE: These standards were not assessed. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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): The home is in good order and service users live in homely and comfortable surroundings. EVIDENCE: The house is comfortable and well furnished and the atmosphere of the home is relaxed. Communal rooms and bedrooms are appropriately furnished, clean and well maintained. The level of lighting in the front lounge was dim and, as agreed with the manager present, should be checked to ensure it is appropriate to meet the needs of people living at the home. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 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): 31,32,33,34,35,36 The home operates a robust recruitment process and provides ongoing training for staff that ensures service users are well supported. Regular supervision sessions must be carried out for all staff. EVIDENCE: Staff files were not available for inspection at the home. Arrangements must be made to have files on site for all staff working at Homestead. A return visit was arranged for files to be examined at the main office at Oakfield in order to complete this inspection. Recruitment records show robust selection and that references and Criminal Record Bureau disclosure checks have been completed. Staff records evidenced appropriate induction and specific basic training is provided to all care staff. Three staff are currently undertaking National Vocational Qualification Level 2 and one person is working towards a National Vocational Qualification Level 3 qualification. From written minutes of staff and residents’ meetings it was noted that there had been occasions when, due to shortages of staff, service users had remained at the main home, Oakfield, until returning in the late evening for bed. The manager present during this inspection confirmed that there had been a period when some staff had left the home’s employment but that new staff had now been rostered as replacements to the home.
Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 16 Routinely staffing levels are planned to have one person on shift supporting and caring for four people with a second staff member allocated on occasions for planned activities. All four service users are away from home to weekday day services returning with a staff member. The manager present during the inspection stated it was intended that staffing levels would be increased to two staff to facilitate more individualised activities for service users. The staff member on duty confirmed that employment contracts and job descriptions had been issued. It was confirmed that one supervision session had been held in July 2005 but no further regular sessions arranged. Supervision sessions for all care staff must be held regularly. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 17 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): The vacant post of manager for the home must be filled to ensure that all standards expected of this registered facility are met. EVIDENCE: There are several requirements from previous inspection reports that have not been addressed and are listed in this report as outstanding with final dates now stated for compliance. These matters must be given urgent attention by the registered providers. Despite a recruitment drive in 2004 the home has been unable to acquire a manager and as a result, for an extended interim period, management oversight has been allocated to the manager of the sister home at Oakfield. The registered providers must contact CSCI regarding the provision of a manager for Homestead. Policies and procedures are not specific to Homestead as they are based on the main home, Oakfield, processes. For example the emergency/crisis procedures relates to staff reactions where there are several people on shift to
Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 18 provide on site back-up and in the situation of Homestead’s current staffing operation are not appropriate or workable; these procedures must be linked to a lone working procedure. Staff files were not available for inspection at the home. Arrangements must be made to have files on site for all staff working at Homestead. Regular maintenance checks are evidenced by reports from outside contractors re electrical, central heating installation, etc. Service users are also able to confirm that they know what to do if the fire alarms are activated. There is no formal Quality Assurance review process involving the views of service users, families and significant others; this has been the subject of inspection report requirements since June 2004 and remains as noncompliance that must be addressed. Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 19 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 1 X 1 3 1 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 N/A N/A 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 3 3 1 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Homestead Score 1 2 2 2 Standard No 37 38 39 40 41 42 43 Score 2 2 1 1 1 1 2 DS0000012823.V255196.R01.S.doc Version 5.0 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA38YA37, Regulation 8 Requirement The Registered Providers must in writing contact CSCI regarding arrangements for the provision of a manager for Homestead. The Statement of Purpose and the Service User guide requires further revision to be specific to Homestead and must be circulated to all service users and their families/significant others. This is a partially unmet requirement from June 2004 inspection. There must be evidence of contracts/terms and conditions signed and agreed between the home and the service users or on their behalf by families/significant others. Care plans for each service user must specifically detail to staff how care is to be delivered to appropriately meet care needs. Commercially bought medication and alternative remedies/treatments must be recorded and stock controlled within the home. Staff files must be held at Homestead and be available for
DS0000012823.V255196.R01.S.doc Timescale for action 31/12/05 2 YA1 4,5 31/12/05 3 YA1 5 31/12/05 4 YA6YA5, 15 31/12/05 5 YA20 13(2( 15/11/05 6 YA41 17(2) Schedule 31/12/05 Homestead Version 5.0 Page 21 4 7 YA36 18(2) inspection. Regular, recorded, formal supervision sessions must be held at least six times per year with each member of staff responsible for the provision of personal care to service users. Policies and procedures to guide staff must be specific to Homestead and its operation. This is a partially unmet requirement from June 2004 inspection. A quality assurance process must be established that publishes an annual review of the home’s performance. Written confirmation that this process has been developed and initiated to include the views of service users, families/significant others, relevant agencies and professionals must be forwarded to CSCI. This is an unmet requirement from June 2004 inspection. 31/12/05 8 YA40 12 31/12/05 9 YA39 24(1,2,3) 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Homestead DS0000012823.V255196.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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