Inspection on 03/02/06 for Homestead

This inspection was carried out on 3rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Homestead 15/03/09

Homestead 11/03/07

Homestead 25/10/05

Homestead 24/08/04

Homestead 16/04/04

Homestead 19/01/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Homestead 7 Bedford Road Yardley Hastings Northants NN7 1HJ Lead Inspector Mrs Helen Wilson Unannounced Inspection 3rd February 2006 08:15 Homestead DS0000012823.V282213.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 Homestead DS0000012823.V282213.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. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 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.V282213.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 October 2005 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 four people with learning disabilities. Service users have the use of a 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.V282213.R01.S.doc Version 5.1 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. The inspection was unannounced on a Friday morning prior to the service users leaving home for their day centre sessions. One staff member was on duty with all four service users having had breakfast and some time was spent talking with each person. In order for the inspection to be completed the Assistant Care Manager from the sister home Oakfield came over to meet with the inspector. Specific case files and records were checked and conversations held with people living at the home and staff. The primary method of inspection used was ‘case tracking’ which involved selecting one service user and tracking how his care needs were being met through review of the case records. The case files for one service user were checked to identify how his care needs were being met. Requirements from previous inspections were rechecked to monitor progress made. What the service does well: The home is similar to a family-style arrangement with each person helping to keep their own bedrooms tidy and everyone making suggestions for meal planning and then together going food shopping each week. Two of the people living at Homestead were able to say that they were happy living there and they liked the staff members. The others were unable to voice their thoughts on this topic but appeared relaxed and involved with the staff member on duty. The staff member on duty with the service users was approachable and comfortable with each person and appeared motivated and interested. Service users’ bedrooms were personalised with belongings, posters and photographs, music and television equipment. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 6 The menu plans show a range of homely nutritious food, food supplies were appropriate to meet the menu, and service users said they liked the meals. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 The home’s aim to be a small house offering community-based, more independent lifestyles, is not being fulfilled. EVIDENCE: The home’s aim, as a small house offering opportunities for individuals to lead community-based, more independent lifestyles, is not being achieved because of the lack of staff allocated to the home to provide care, transport, facilitate differing activities and give individuals personal choice about how they spend their time. All service users, because there is only one staff member on duty at a time, have to go everywhere as a group. This institutional practice outweighs any advantage to individuals of living in the homely environment of Homestead. Although the service users appear to be used to the routine arrangements of the home they would have limited ability to show concern or question the institutionalised habits that have developed. The home has admitted a new service user in the last few weeks and there is no documentation in the case file to evidence that this admission was assessed, discussed with or sanctioned by the Placing Authority prior to the transfer from the sister home in Easton Maudit. The case file did not evidence any assessment or reviews of his care needs on which the decision was reached that that a move was indicated. The care plans were those that existed while he resided at the larger home and no up to Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 9 date plans had been set up detailing how this person’s care needs were to be met specifically at Homestead. From examination of one case file there is no evidence of contracts/terms and conditions signed and agreed between the home and the service user or on his behalf by family/significant others. This was a requirement of the previous report due for compliance by 31 December 2005 and therefore unmet. Homestead DS0000012823.V282213.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): 6,7,8,10 The home’s care planning process does not appropriately involve the people living there. EVIDENCE: A requirement of the previous inspection that care plans had to be reviewed and updated by 31 December 2005 has not been met. The inspector was told that the process of reviewing care plans has almost been completed although there is no updated or signed evidence of any newly written plans in the case files checked during the visit. From discussion with staff and the people who live at Homestead it was clear that the care plans are being drawn up without the service users or key staff involvement and then only when finalised are presented and read to the individual service user. This is not appropriate care planning. Time first needs to be spent in discussion and negotiation with service users, and with their keyworkers/representatives, to prepare person-centred plans for care that ensures individualised support and personalised goals for achievement. The process of revising care plans must be completed but must also involve the service users in the review and decision making re their care. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 11 The case file for the new service user admitted in recent weeks did not evidence any prior assessment or reviews of his care needs that identify that a move was indicated to this smaller home. There were no up to date plans setting out how this person’s care needs were to be met specifically at Homestead, the only care plans available to guide staff were those in existence for the larger home at Easton Maudit. Case file records and discussion with staff showed that the care needs of the differing service users cause instances when individual needs for staff support/attention impinge on others’ lifestyles. The arrangements for safe-keeping of valuables belonging to service users are not appropriate. For each service user there were a number of gift vouchers lying loose and unrecorded in a drawer. The Assistant Care Manager was asked to remove these for safe-keeping and make records for each person of these valuables. Homestead DS0000012823.V282213.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): 11,12,13,14,15,16,17 Service users are not enabled to be individuals or choose the way they wish to spend their time. EVIDENCE: There is routinely only one staff member working at the home and this means that all service users have to go out en masse, accompany individual people being transported say to evening classes, etc. This arrangement is unacceptable and is institutionalised practice where individuals have no choice to remain at home with staff or pursue their own interests. From records it was also noted in the past few weeks that the two service users were late and missed part of their college class due to the urgent care needs of another person before being able to set out together in the vehicle. The service users spend five week days out of the home at day services arranged at Easton Maudit. There is no evidence of an individual development plan for any service user for separate lifestyle or involvement within the community for example in a newspaper round or work experience at the corner shop, etc. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 13 Contacts with family are encouraged and supported. The menu plans show a range of homely nutritious food, food supplies were appropriate to meet the menu, and service users said they liked the meals. Service users explained that they sat with staff and planned what food they wanted at the beginning of a week and then the shopping was bought. Homestead DS0000012823.V282213.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): EVIDENCE: These standards were not assessed at this inspection. Homestead DS0000012823.V282213.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): 22,23 Service users are confident that staff resolve any problems. EVIDENCE: The home has an established policy and procedure for raising complaints. No complaints or concerns are recorded since the last inspection. Service users are aware of how to speak out about any problems to staff. One person said that everything is sorted out by staff if there is any problem. Families are given a copy of the home’s complaint procedures as part of the admission process. Staff were able to show that they had knowledge of protection of vulnerable adults and how this would be reported. Homestead DS0000012823.V282213.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): 24,25,26,27,30 The environment is clean and homely with service users’ belongings much in evidence. EVIDENCE: The home was clean and fresh throughout. The bathroom needs some attention to the tilework, bath sealant and toilet seat. The Assistant Care Manager said she would report this for maintenance work. Bedrooms are individually personalised, furnished appropriately and clean. One first floor bedroom wall has a long, deep crack in the plasterwork and the Assistant Care Manager understands this is under investigation. The lounge and dining kitchen give a homely environment for service users. Homestead DS0000012823.V282213.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): 32,33,36 There are insufficient staff members on shift to meet the individual needs of service users. EVIDENCE: The staff member on duty with the service users was approachable and comfortable with each person and appeared motivated and interested. There are insufficient numbers of staff allocated to each shift at the home to transport, facilitate differing activities and give individuals personal choice about how they spend their time. Service users are taken together everywhere to drop some people at college, taken together to shop for food, etc because only one carer is rostered on each shift at the home. Arrangements have started for some staff members to be given formal recorded supervision sessions but must be maintained to comply with the requirement of the last inspection report. The previous report requirement remains partly unmet. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 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 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): 37,38,39,40,41,42,43 There are significant areas and standards that remain unmet from the last and previous inspections and these directly affect the care provided to service users and the way the home operates. Urgent attention must be given to all requirements of this report. EVIDENCE: Following the last inspection in October 2005 a meeting was held at CSCI with the Registered Providers to discuss management arrangements for Homestead. CSCI asked for a written proposal in detail of how the home might be operated and managed to comply with all requirements of registration. A first response was lacking in detail and full proposals have not yet been submitted. The requirement of the previous report remains unmet and is restated. The home holds valid insurance cover until a renewal date in August 2006. A range of policies and procedures relevant to Homestead is in place. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 19 Financial records for two people stated that small amounts of cash are held on their behalf but no monies were found. Larger amounts said to be held in the home’s petty cash tin for people could not be verified as this was not on site. There was no record made of several gift vouchers held for each service user. Records documented that fire alarm tests have been carried out at three monthly intervals and the fire alarm indicator board checked in January 2006. There is no recorded evidence of the emergency lighting having been checked. There is no evidence that a formal Quality Assurance review process is in place despite this being the subject of previous inspection report requirements. The requirement from two previous reports remains unmet and is restated. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 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 Standard No Score 1 2 2 2 3 1 4 3 5 1 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 2 25 3 26 3 27 2 28 N/A 29 N/A 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 X 35 x 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 X 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 1 1 1 3 2 2 2 Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 21 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. This is an unmet requirement due as at 31/12/05 from the previous report and restated for full compliance. 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. This is an unmet requirement due as at 31/12/05 from the previous report and restated for full compliance. Care plans for each service user must specifically detail to staff how care is to be delivered to appropriately meet care needs. This is an unmet requirement due as at 31/12/05 from the previous report and restated for full compliance. A quality assurance process must be established that publishes an annual review of the home’s performance. DS0000012823.V282213.R01.S.doc Timescale for action 15/03/06 2. YA1 5 15/03/06 3. YA6YA5 15 15/03/06 4. YA39 24(1,2,3) 15/03/06 Homestead Version 5.1 Page 22 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 previous reports of June 2004 and 31/12/05 and restated for full compliance. 5 YA33 18 The home must employ appropriate numbers of care staff on each shift at the home sufficient to provide personal care, transport, facilitate differing activities and give individual service users personal choice about how they wish to spend their time. Records must be available for all monies and items such as gift vouchers held on behalf of service users for safekeeping and the records must detail disbursement of these items. Written confirmation that the home’s emergency lighting system has been regularly checked to comply with Fire Protection recommendations must be forwarded to CSCI. 15/03/06 6 YA41 17(2) Schedule 4. 15/03/06 7 YA42 13(4) 15/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA3636 Good Practice Recommendations The process started for regular, recorded, formal supervision sessions of all staff should continue. Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 23 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 © 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 Homestead DS0000012823.V282213.R01.S.doc Version 5.1 Page 24 - 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. 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