CARE HOME ADULTS 18-65
HWCGS Segal Gardens 436 Fleet Lane Parr St Helens Merseyside WA9 2NH Lead Inspector
Mrs Joanne Revie Unannounced Inspection 28th October 2005 10:00 HWCGS DS0000022458.V262762.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 HWCGS DS0000022458.V262762.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. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service HWCGS Address 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) Segal Gardens 436 Fleet Lane Parr St Helens Merseyside WA9 2NH 01744 28828 01744 25941 Www.segalgardens.com/hwcgscare@ukonline.co .uk HWCGS Ms Gillian Louise Gilmore Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 4 MD and up to 4 LD Date of last inspection 04/01/05 Brief Description of the Service: Segal Gardens is owned by the company HWCGS. This company was formed by a group of experienced carers all of whom work within the service in one form or another. The home provides care and support to four young people up to the age of twenty-five years old that have various mental health problems and/or learning disabilities/difficulties. Segal Gardens accepts referrals from all parts of the U.K. It is unique as it has two Managers who have achieved registered mental nurse status and who oversee the day-to-day running of the establishment. The home is situated in the Parr area of St. Helens. It is a detached bungalow with a separate detached extension. The extension is used for a variety of hobbies; horticulture, crafts, computer studies, ASDAN classroom and a quiet lounge for visitors and for care reviews. The service aims to support Service Users with all aspects of personal development .The aim is that they will return to their home town once they are 25 years old, equipped with the skills to live a more independent and fulfilling lifestyle HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced. Discussions were held with the manager, and a relative. Staff handover was observed. A tour of the property took place. A variety of records were viewed, details of which are included in the evidence section of the report. All four young people were at home and were observed undertaking different activities. A discussion was also held with a relative What the service does well:
The service promotes consistency of care for the young people by following comprehensive and detailed care plans, which contain clear instructions as to how support will be given. The staff have the knowledge and perception to provide care in a way, which supports each individual to reach his/her full potential. Two qualified registered mental health nurses, who have experience in this service and also have counselling qualifications, manage staff. Systems have been developed to assess individual needs and address them through the care planning process. A relative commented that they are” so good at problem solving- everything is addressed immediately, - very professional-, very caring (young persons name) is really flourishing” To support the young people, staff have developed skills in anger management techniques. The young person is encouraged to self reflect on episodes of anger, to encourage the development of avoidance techniques. This procedure has been useful in promoting personal development in social skills for the young people. In order to provide structure and support in their daily lives and develop decision-making skills each young person has a daily planner. A relative commented “ such a pleasant and comforting structure” when this subject was discussed On commenting on the atmosphere in the home, a relative said “its lovely in the evening, a real wind down time, with low lighting and relaxing music”. The staff have developed observational and recording skills in monitoring the young peoples behavioural changes and progress (however slight) A relative
HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 6 stated (when talking about the staff) that “ they are so, so good- everyone of them” The young people are offered a fulfilling choice of leisure activities that they have chosen. They were found to be appropriate for the young persons age. A relative stated that “ my (young persons name) was robbed of their teenage years but I feel (young persons name) is having a second chance at Segal, (young persons name) now has a future”. This is important as it shows the service recognises the need for young people to take part in every day life like their peers. Young people are supported to attend courses at the local college and take part in community life such as shopping, eating out, swimming etc. Individual activities include pastimes such as horse riding. Activities that can be offered on site include horticulture, and Arts and Crafts and Computers. Staff are qualified to support the young people to achieve recognised qualifications in topics and aspects of daily living These qualifications can be built on to achieve academic qualifications if desired. This is done through a process known as ASDAN. The service has a separate extension with a classroom for this purpose the idea being that the young people work in one building and relax and live in another. This helps to promote work/life ethics as experienced in daily life. The service is very good at assessing risk and involving the young people in decisions around this. Examples of this are holidays. The group had a holiday at Centre Parcs this summer but only when a visit had been undertaken to assess its suitability. Following this community meetings were held to decide who would sleep in which bedroom and which staff would be providing support. This is important as it means the young people have the chance to adjust to changes without shocks occurring which may be detrimental to their progress. Community meetings are minuted in simple English and makaton, which reflects very good practise. Simple questionnaires have been developed for young people to use before the meeting. With staff support this helps the young person to identify what they would like to raise at the meeting and therefore encourages participation. The service encourages families of the young people to remain involved and recognises how important families are in the young peoples lives. Each young person is supported to visit/ stay with family- (often with staff providing necessary support). Young people are prepared for home visits through a gradual process if necessary. The young people are supported to keep in touch by telephone in between times. A relative confirmed that she is always made to feel welcome even though she visits several times a week. (“ Everyone always has time for you, they’re never too busy to stop and talk or answer questions and if they don’t know they will find someone who does”) HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 7 The building is very homely, with all the usual home comforts such as TVs videos, music centres, Sky T.V. It is decorated and furnished to a very good standard .It has two eating areas and a communal lounge. Each young person has their own bedroom which they are encouraged and supported to personalise through choice of colour and personal items such as posters, personal computers etc, The home is equipped with two bathrooms which are close to bedrooms. The home also has a large garden What has improved since the last inspection?
All young people spent part of Christmas day at home with their families. Although this is not necessarily an improvement, it is an achievement as it is the first time that this has happened and it provides further evidence of the progress that has been made Further evidence was seen of the young peoples progress. The service has implemented questionnaires, which are sent to a local college. These are specific to one person who is now able to use public transport on his own. Part of this also includes attending college alone. Therefore the service believe it is vital that all progress made away from the home is recorded and monitored so any changes can be quickly addressed. This is very good practise. Staff have shown that they have the skills to help young people who are known to self-harm. A relative stated “ the self harm has now stopped, I cant believe it I used to worry so much when (young persons name) was in the hospital incase the staff couldn’t manage and (young persons name) wasn’t safe- That’s stopped now- I trust each and every one of them ”. Since the last inspection the service has been accredited to take student nurses on placement. This shows that the service has been assessed and is recognised as a good learning environment. A student nurse who was on placement at the home has developed a document called an” OK Health Check”. This covers all basis aspects of health such as sight. Hearing, weight etc. This shows that the young people are having their health checked regularly and that the managers are welcome to new ideas . ASDAN training has been continued and a new topic on Recycling has been added which the young people were learning about. This is appropriate as Recycling is a topical subject in every day life and helps to promote awareness of the world around us. The garden of the home has been developed further since the last visit. Decking platforms have been built and a swing and trampoline have been purchased for the young peoples enjoyment. One young person enjoys spending a great deal of time outside and mobiles, which produce movement and sound, have been purchased for her pleasure. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 8 Staff training for new staff has been developed further. A new induction course has been implemented which explores all the services procedures and policies. This reflects good practise as it equips new staff with the skills required to ensure the service runs smoothly. The manager has undertaken training in portable appliance testing. This means that all electrical appliances can be checked yearly for safety to reduce the risk of a fire or accident occurring The separate extension has now been completed and furnished to a good standard. A classroom area is available upstairs with a separate well-equipped computer room. 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. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 9 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 HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 10 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): EVIDENCE: No standards were assessed from this section during this visit HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 11 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): 6,7,9 Individual care plans exist for each young person, which clearly reflects their needs. Staff understand the importance of ensuring all needs are well documented. The young people are encouraged and supported to take charge of their own lives The young people are encouraged to live independent lives within a strong risk assessment framework EVIDENCE: A discussion was held with a relative and two care plans were viewed. These were comprehensive documents, which are developed, as the young peoples needs become known or change. Each plan was found to be individual and specific to the young persons needs and lifestyle. Questionnaires have been developed for one young person asking the local college how well he is progressing outside the home. The young people are supported with aspects of their behaviour which may restrict them from becoming independentappropriate documentation has been developed which reflects this. Staff are writing clear daily records, which showed that they, are monitoring each one of the young persons needs on a daily basis. The young person had signed some parts of the plan but other parts had missing signatures. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 12 Viewing menus and the plans showed that the young people are encouraged to make decisions about their own lives. Each undertakes separate different activities according to their preferences and needs. Community meetings are organised for young people and staff to express opinions. Templates have been produced in plain English and makaton to encourage the young people to think about what they would like to say. Minutes are produced following the meeting, which are also in plain English and makaton. This reflects very good practise Viewing newsletters also evidenced that the young people are involved in its formation and that they are encouraged to include news items Each young person has a comprehensive risk assessment included in the plan of care. Risk is managed very well by the service. The assessments viewed were found to be specific to the young persons needs. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 13 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): 12,13,15,17 The young people are supported to take part in activities that they like. Staff have the skills and knowledge to ensure opportunities are given for personal development. The service supports families to stay in close contact with the young people. The Young people are encouraged to eat a healthy diet of their choice EVIDENCE: Daily planners were viewed which have been developed for each young person. These were found to be specific to the young persons needs and preferences and were produced in a language that they would understand. Evidence was shown that the young people are supported in developing these. During the visit photographs and a discussion with the manager showed that the young people are learning about recycling as a group topic as part of the ASDAN training. Care plans and viewing the daily planners showed that all the young people access the local community in one form or another. Some independently and others with staff according to needs. One young person is now able to use public transport independently. A discussion was held with a relative who commented positively on the activities offered.
HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 14 Viewing the care plans showed that the young people are supported to maintain family links in a variety of ways. Some visit family weekly, others visit less frequently but have overnight stays. If needed staff will support the young people to reach their destination and provide telephone contact during their stay. A discussion with the manager showed that the service believes that family contact is vital if the young person wants it. One young persons transport costs are funded by the service to enable visits to happen .The young people are supported to stay in contact by telephone also. The manager hopes to develop Internet services so that email facilities will be available for each young person. The service has a website and photos of group activities are quickly displayed for families to view Menus were viewed which showed that a nutritional diet is offered to the young people. Were appropriate they are encouraged to help with meals. Although a format exits for menus the young people are encouraged to choose their meals the day before. One young person is supported to be vegetarian. Care plans showed that a healthy diet is taken into consideration for all the young people. Menus are displayed in an appropriate language HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 15 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): 19 Changes in the young people health needs and emotional needs are quickly recognised and addressed EVIDENCE: A discussion was held with a relative and the manager. Two care plans showed that an “ OK” health check had been developed since the last visit. This document acts as a medical questionnaire and assesses sight, hearing, weight etc. A student nurse who was on placement within the home developed this. Care plans showed that the young people are supported to visit health professionals such as physiatrists etc. Both managers are qualified mental health nurses. Anger management tools exist for those young people who have issues with anger. Care plans showed that young people are supported to reflect on incidents to assess how future incidents could be prevented as part of a self-awareness exercise. Observing staff handover showed that staff are very perceptive and detect small changes in behaviour HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 16 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): 23 Young people are protected from abuse however this could be further enhanced through staff training. Staff have the skills and knowledge to protect young people from self-harm EVIDENCE: Staff files and a discussion with the manager showed that two staff had attended protection of vulnerable adults training through Knowsley council. The service has been trying to access suitable training in this area for some time. Links have now been made with a training company who are developing a training package, which will be specific to the service. A copy of Knowsley’s local guidelines were available in the office for reference. Viewing care plans and discussions with a relative showed staff have the skills to monitor young people who are at risk of self-harm. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 17 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): 24,30 The young people live in a comfortable well maintained home which is kept clean and pleasant and is welcoming EVIDENCE: A tour of the environment was undertaken and a discussion was held with a relative and the manager. The home presented as a comfortable place to live. The relative confirmed that she thought this was true. A discussion with the manager showed that the service continues to develop the environment. Cleaning staff are employed on weekdays. The young people clean their own room on a Saturday with support as part of their daily planner. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 18 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): 34 The service has robust recruitment procedures to protect the young people in their care. EVIDENCE: Two new staff files were viewed and a discussion was held with the manager. Both files contained all the information required to meet the Care Home Regulations 2000. A copy of the new induction programme was viewed and discussed. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 19 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): 42 The service tires hard to comply with Health and Safety legislation however issues relating to documentation need to be addressed EVIDENCE: Copies of key legislation were viewed. Staff have received fire prevention training. All fire equipment is tested regularly. Gas safety and electrical safety certificates were viewed and were current. A Fire risk assessment was viewed that had a review date of 2004. The manager stated that Young people respond to the fire alarm by congregating at the meeting point. Accidents are recorded appropriately but need to be stored differently to comply with Data protection. Staff have had first aid and food hygiene training. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 4 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 4 16 x 17 Standard No 31 32 33 34 35 36 Score X X X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
HWCGS Score x 4 x x Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000022458.V262762.R01.S.doc Version 5.0 Page 21 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 YA42 Regulation Schedule 12, 4 (c), Requirement The service must ensure that review dates are included on the fire risk assessment Timescale for action 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. 1 2 3 4 Refer to Standard YA6 YA15 YA23 YA42 Good Practice Recommendations The service should try to ensure that all parts of the care plan are signed by the young person The manager should carry through the intention to make email services available to the young people The service should carry through its intention to develop Abuse awareness training which is specific to the home Completed Accident forms should be stored separately on personal files to comply with Data Protection legislation. HWCGS DS0000022458.V262762.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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