CARE HOME ADULTS 18-65
The Houghtons 6, Sandy Road Bedford Beds MK41 9TH Lead Inspector
Nicholas Allen Announced 11 May 2005 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. The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Houghtons Address 6, Sandy Road Bedford MK41 9TH 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) 01234 351248 Aldwyck Housing Association Margaret McNally Care Home 6 (6) Category(ies) of LD - Learning Disability registration, with number of places The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Nill Date of last inspection 6th May 2004 Brief Description of the Service: Houghtons is a purpose-built detached bungalow located in a residential area of Bedford. The home provides long term care for adults who have a learning disabilities. This includes those who have physical disabilities or who are over 65 years of age. The home is owned by the Aldwyck Housing Association.They also employ and manage the staff who work there. The organisation has over 30 years experience as a provider of housing and 15 years as a care provider. The home is close to a bus route on the A428 and there are shops, pubs, churches and leisure facilities within easy reach. The building has six single bedrooms, one for each person living there. There are a number of other rooms that everyone can use, these incliude a lounge, snozelan, kitchen/diner, shower room, bathroom and toilet. The people who live at the home are able to take part in the day to day tasks and access to all areas of the home is available for people who have to use a wheelchair. There are a number of other rooms most of which would be found in a family home. these include a laundry room and storage rooms. Staff who work at the home have access to a office/sleep-in-room and staff toilet/shower. The home has a large garden area that everyone can use and at the time of the inspection there was evidence of the home undertaking work to improve the garden. People who live at the home have access to a number of social and leisure activities. These are chosen by the people who live at the Houghtons and staff help to arrange them.
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This is an overview of what the inspector found during the inspection. The inspection was announced and lasted over 5 hours. At the time there were 6 people living in the home. During the inspection a tour of the communal areas of the home took place. This gave the inspector the opportunity to see for himself some of the things that people talked about. As well as looking at the building the inspector talked to the staff on duty, the registered and deputy managers and to those residents who wanted to contribute to the inspection process. The inspector also read a number of records and looked at the way care practices were delivered. Overall the inspection indicated that a good service was received at The Houghtons What the service does well:
During the inspection a number of people who lived at the home indicated that they were able to make decisions about their lives, and valued the support they received from staff. It was possible to see how this worked in a number of areas including any concerns/issues raised by those living at the home with staff. From reading some of the records it was possible to see that any issues raised by either the people living at the home or their families were dealt with quickly. Throughout the home there was both written and pictorial evidence of the staff helping and encouraged the people who live at the home to find positive ways of spending their time. To help with this process, in-depth and up to date plans of care were in place for those people living at the home. These plans showed everyone how people liked to spend their time and what kind of help they needed to achieve this. Everyone who lived at the home helped develop their own plans In order for staff to be able to offer the best help and advice it was necessary for staff to go on a number of training courses, this meant that every member of staff had to be offered training. For some staff the training was compulsory. This type of training is called NVQ and the home has to ensure as many staff as possible attend this training. A minimum number of staff must have their NVQ qualification and this will depend on how many care staff work at the
The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 6 home. At the time of this visit there was evidence that the Staff had the skills and competencies to meet the resident’s needs. To help the manager and staff provide good standards of care the housing association had developed a number of clear policies and procedures. The people who live at the home were able to shape the way the home provided care for them, they did this in a number of ways. At the time of this visit it was not practical to have group meetings but staff talked to individual people, sought their views and then looked at ways of changing things 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.
The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 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 The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 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) 2,3,5 The admission procedure for new residents ensured that all information about their care needs was obtained before they arrived. This enabled the staff to have a clear understanding of what they needed to do for them. Residents had clear information about the terms and conditions of their stay at the Houghtons. EVIDENCE: The residents had lived at the Houghtons for some time. They had received sufficient information about the home (a Service User’s Guide). The Statement of Purpose was freely available for everyone to read if they so wished. Everyone had individual written needs assessments. These were linked to the home’s care plan. This means that people knew exactly what type of service they would get The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 9 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) 6,7,9 The care needs of residents were identified and documented. Staff knew residents individual needs. Policies and practices enabled individuals to make decisions about their lives. Regular reviews of care plans ensured that any changes were regularly documented any action needed was taken. The risk assessment and management framework supported individuals to take responsible risks. This meant that overall people got the best care possible. EVIDENCE: Person centred plans were in place for each service user. The plan the Inspector case tracked included a behaviour support plan, communication profile, personal and social support. All residents had an allocated key worker. Care plans had been reviewed, and individuals took place in this process. Residents talked to the inspector and observations were made demonstrating a number of ways in which they made decisions about their daily lives, for example, there were a number of minor variations to the menu to
The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 10 accommodate everyone’s personal tastes to the lunch served on the day of the inspection. The policy of the home was to promote responsible risk taking and freedom of choice. Individual plans contained risk assessments and management strategies. Residents or their representative signed the risk assessments. The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 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 standard(s) 12,15,16 The home was run to make sure the people living there enjoyed their life and had opportunities to fulfil their potential. Residents were involved in their local community. They had opportunities to maintain family links. People living at the home indicated that they felt respected and valued as individuals. EVIDENCE: There was observed evidence of daily activity programmes. They were able to keep in regular touch with their families and friends. Personal relationships were supported and facilitated, and there were policies and practices in place to support this. There was reference to an individuals preferred form of address on their care plan. Those individuals who spoke to the inspector said they felt that their rights and wishes were respected and that they usually felt valued as individuals. There were occasions when individuals had disagreements between themselves. Staff helped residents resolve these issues before they escalated.
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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) 19,20,21 Personal support was offered in accordance with individuals’ wishes, and in a way that promoted privacy, dignity and independence. Residents could, with appropriate risk management strategies in place, administer their own medication. Although at the time of the inspection none were Policies and practices for managing and administering medication were generally in good order. The result of this was that those people who lived at the home got regular support with any health needs they had. EVIDENCE: The individuals case tracked had health check documentation in place. There was a risk assessment in each file with regard to this area. Policies and practices for managing and administering medication were in place. For those staff involved with the administration of medication accredited training had taken place. An audit of medication was not undertaken on this inspection. Polices relating to the ageing process had been updated. There was evidence that these had been discussed with staff. The manager and deputy manager were reviewing the ways of introducing these to staff. The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 13 The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 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 There were clear complaints and protection policies and practices in place and evidence that the residents’ views were sought and acted upon. This meant that people living at the home could feel safe and protected from harm EVIDENCE: Of those residents who were able to, all explained the homes complaints procedure to the inspector. They said they felt comfortable in raising issues of concerns with staff. The Commission had received no formal complaints. Policies and practices regarding concerns, complaints and protection were in place. Staff spoken to by the inspector knew what to do if they had any concerns about an individual’s wellbeing, and had an awareness of the Whistle blowing policy. The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 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) 24,28,30 The home had a good standard of cleanliness in the communal areas inspected. There were no obvious hazards to safety and the building and grounds were well maintained and in good order. This provided a safe, comfortable and ‘homely’ environment, suited to the needs of those currently living at the home. EVIDENCE: The inspector conducted an inspection of the communal areas of the home. There was evidence that the home had been well maintained. The manager said that there was a problem with one of the dining room light fittings and that a new one had been ordered. The manager also said that a new kitchen was to be installed. The association employs housekeeping staff; it was their job to keep the home clean and odour free. There were sufficient bath/shower rooms available. The home keeps records of water temperatures and it was noted that they were being completed appropriately. The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36 Staff spoken to and observed during the visit demonstrated a good understanding of the needs of those people who lived at the home. There were sufficient staff members on duty to meet people’s needs. Staff should continue to complete their NVQ training. Other appropriate training was also being undertaken. Staff members were receiving regular management support and development meetings. Appropriate staff recruitment records were in place. As a result of this there were always enough experienced staff on duty to provide care for people who lived at the home. EVIDENCE: There was a requirement for standard YA31 regarding information, which must be kept at the home about staff members and their employment. The inspector case tracked 2 employees who had most of the information required available on file. All other records were in place. There was evidence of ongoing training. There was evidence of staff employed by an agency working at the home. These staff had worked at the home for some years. There was written evidence that the staff members case tracked had had regular management support and development meetings. Three staff members spoken to confirmed that there was always a senior staff member on duty, and that any issues or concerns were discussed as they
The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 17 arose. The staff also knew where the policies and practice files were. There was evidence on staff files that they had undertaken a number of appropriate health and safety and specific training courses. There was evidence seen of residents and staff having a positive and supportive interaction. The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 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) 37,39 The attitude of the staff and management was to run the home with the needs and wishes of the residents as the highest priority. People living at the home were regularly consulted in a number of ways. EVIDENCE: All the staff had attended in-service courses and certificated training. The manager said that she was keen to continue with training opportunities. The service had an annual budget that enabled staff development and training to form part of the overall development of the home There was evidence that the staff were competent and helpful and able to develop good relationships with residents. Records showed that staff not only supported residents with activities inside and outside the home but also with personal development issues identified in care plans. The Management and staff team provided a reliable, competent and flexible personal and social care service, which met the service user’s individual needs and wishes. The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 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 x 3 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 4 x 4 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 x 3 x Standard No 31 32 33 34 35 36 Score 3 3 x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Houghtons Score x 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 x x x I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 20 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations The Houghtons I51 s14918 HOUGHTONS v213940 110505 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Clifton House 4a Clifton House Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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