Inspection on 10/12/08 for Ivyhurst Close (4)

This inspection was carried out on 10th December 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ivyhurst Close (4) 15/03/07

Ivyhurst Close (4) 21/07/05

Ivyhurst Close (4) 13/01/05

Ivyhurst Close (4) 07/12/04

Ivyhurst Close (4) 28/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ivyhurst Close (4) 4 Ivyhurst Close Aigburth Liverpool Merseyside L19 3PJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Perry     Date: 1 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Ivyhurst Close (4) 4 Ivyhurst Close Aigburth Liverpool Merseyside L19 3PJ 01514277927 01514277927 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Winifred Austin Type of registration: Number of places registered: Community Integrated Care care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 4 Ivyhurst Close is a bungalow property in a quiet cul-de-sac in the Aigburth area of Liverpool. It provides accommodation and personal support for two younger adults in single bedrooms. The home is supported with two members of staff throughout the day and one sleep-in member of staff at night. A number of aids are provided to meet the individual needs of residents and to promote their safety and comfort. The home is easily accessible by public transport and a mini bus is available to enable the residents to access community facilities. There is a large garden area to the rear of the property. The home is in good decorative order. Routine maintenance is carried out by the housing association that owns the property. Fees for accommodation at the home are agreed by the placing authority and are dependent upon a range of factors including the levels of need presented by individual residents. 2 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. Before we visited the home the manager filled out a form we sent and returned this. It had a lot of information about the home and how the people are supported to live their lives. We [the Commision] visited the home without telling the staff we were coming so that we could see how things work normally. We spent some time with the people who live there and watched how they spend their day and how the staff support them. Care Homes for Adults (18-65 years) Page 6 of 29 We looked at the records kept on people who live in the home and other records to do with how the home is run. We looked around the home to see if it was clean and a nice place to live. We also spoke with the manager of the home and a senior manager for the company. What the care home does well: What has improved since the last inspection? What they could do better: Although staff are very aware we have made some recommendations around the way staff can get information about how to report any concerns they may have if they think that people living in the home may be harmed in any way. This is so that they can be kept safe. We have made a recomendation that the staff files contain all of the information needed so that all staff details are easy for the manager to check. Care Homes for Adults (18-65 years) Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have regular and ongoing assessments that are highly personalized so that their individual care needs can be met. Evidence: The two people living at Ivyhurst Close have been in residence for over 15 years. We found the information supplied to both people and their relatives and supporters to be appropriately developed given their specific communication needs. For example the service user guide is written in plain terminology and explains the way the home is run clearly. There are pictures of both residents clearly enjoying the facilities, staff and activity in the home. This is important as both residents, who have severe communication needs, can relate to the documents and relatives can also relate to this level of personalization. The guide is updated on fairly regular basis. We looked at assessments carried out by staff including the Essential Lifestyle Plan (ELP). We found these to be highly personalized and they involved input from all concerned with the persons life including relatives. The assessments are written in the Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: first person and reflect a high level of understanding of the way both residents communicate and their individual likes and dislikes and care needs. The assessments are updated and include review and input from social and health care professionals. Although not relevant to this particular home the companies policy on admitting people new to the service is based on a period of assessment to ensure that the service is suitable to the persons needs. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service promotes effective communication with residents so that they are supported to make decisions in their daily life. Evidence: We observed that both people living in the home are well supported by the staff who were observed to be continually monitoring and seeking to understanding any needs. Both residents have severe communication difficulties but staff were able to show through the way they interacted as well as the depth of the documentation that they are able to support residents to make daily life choices. An example of this was the understanding carers had about how one person expressed a need for time by themselves and facilitated this by arranging time out for the person in their bedroom. We found the care documentation to be highly personalized and comprehensive. They included detailed assessments of how the person can be kept safe but can also be facilitated to get out and about and have quality time with community based activity. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Examples of the daily life of both residents are included in photographs and other records which shows innovation and tries to include the residents The plans include likes and dislikes and also include their personal aspirations. For example one resident likes the cinema and there is evidence as to how trips out are organized. Staff were able to give examples of training they had attended which was specific to the residents needs and the service promotes current practice through regularly supporting staff through supervision. We were able to speak to the manager of the home and the service manager who where able to discuss issues around safeguarding for example and how this could be best addressed through individual assessment of the people living in the home and the importance of staff continuity so that residents needs and wishes can be interpreted with consistency. The management were also arranging for personal allowances to be managed through separate bank accounts which has proved difficult due to issues around mental capacity but the planned arrangements follow good practice in this area. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported in their daily activity and there is planned activity so that quality of life is reinforced. Evidence: We found both residents to be supported to undertake a variety of daily activities. Many of these are based around physical care needs but there is also a structured program of social activity which includes trips outside the home. This is important so that there is some quality to the lives of individuals. We observed the interactions of the staff and found these to be focused on the residents in order to both reduce any anxieties and also to create positive interactions. For example both residents have particular needs around dietary intake with one resident needing to be fed by staff. This was managed with patience and care was Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: taken to make this a social occasion despite the resident having difficulties with swallowing. We asked staff about the planned activities over a week and both residents attend college and social clubs on various days and also go shopping with staff. The care records contain residents wishes and choices, likes and dislikes, around activities and the records indicate that these are facilitated. Both residents go on holiday yearly. Care records also contain reference to family visits. One resident goes to see his family on a weekly basis. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are managed on an individual basis and privacy and dignity is maintained. Evidence: We saw that both residents were supported to maintain a good standard of personal hygiene and were appropriately dressed so that their dignity is preserved. Both have very complex and dependent physical care needs at all times and the care records detail this very well so that care staff can be clear about what care is needed. Personal care is carried out in residents bedrooms so that privacy is respected. One example is that both need specialist aids for mobility and have assessed needs around the management of pressure so that skin care is important. As well as being detailed on care records we observed good use of wheelchairs, bed rails and support mattresses [in the case of one person] and the provision of a disabled shower so that this area of care can be well supported. Both received regular care reviews and there is good liaison with health care Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: professionals such as district nurses [one resident was waiting for a visit on the day of the inspection] and dietitians. The care staff were able to fully explain the care needs around the management of the PEG feed [special tube that enables the person to be fed directly into the stomach]. Both care staff had also received training from health care professionals. Care records detailed regular hospital visits for one residents who needs to have regular blood checks. Medication is managed by staff who receive training to carry this out. One resident has medication requirements involving possible invasive techniques and staff have been trained by health care professionals. Staff reported that all training is updated. Staff displayed a good understanding of needs around medication and the administration records seen were clear and contained information around when to give PRN [medication given when necessary] so that all staff could be clear and consistent about this. The medicines are audited on a regular basis by the service manager to ensure consistent standards. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good policies and staff are aware and trained so that any concerns residents may have can be addressed and therefore residents are protected. Evidence: We spoke with care staff about how residents and supporters could make concerns known or complain. We were shown the complaints procedure which is in all of the information available and is clear and easy to follow for relatives or supporters. Staff explained how they could understand when residents were upset or concerned over something and this awareness was supported by the care documentation which lists the ways that individual residents communicate. This is important because the two people concerned cannot communicate verbally so heightened awareness amongst staff is vital. Staff explained that the low turnover of staff personal means that a good level of trust and understanding is built up. There have been no complaints or concerns listed since the last inspection. Staff reported that the company give training around safeguarding procedures and how to protect residents from abuse. The training files and training plan supported this. The training is varied and is supported by external sources. Staff were clear about how to recognize abuse and understood to need to report any concerns internally through line managers. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: The policies and procedures were discussed with the manager. Some information is not clear. The whistlblowing policy does not reference the locally agreed social service policy document and talks about the company starting an investigation process rather than referring to social service as the lead agency in any investigation. This needs to be clarified so that any staff are clearly following correct procedures. We feel that the local careline contact number could be more readily available in the daily information file as this would serve as a regular reminder for all staff. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained so the people living there are comfortable and safe. Evidence: The home is located in a residential area of Liverpool and is close to all amenities. Both residents have access to transport to enable them to access the local community and also have dedicated staff time so that they are supported in this. The home is single level and has many features such as ramped access and disabled bathroom facilities to ensure ease of access. We found the general environment to be homely and well personalized - bedrooms reflecting the individual characters of the people living there. This means that the home is planning the environment around the needs of the people who live there. There is a clearly outlined maintenance schedule which identifies ongoing safety checks and decorating programs. Since the last inspection there has been new flooring in most areas. This continual program ensures that the home is safely maintained. We found all areas to be clean and well managed so that residents are living comfortably. Care Homes for Adults (18-65 years) Page 21 of 29 Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and trained appropriately so that people living in the home are supported. Evidence: There are two people supported in the home and these have been resident for a number of years. They are supported by two care staff who have flexible duties and provide all care and support all activities. Staff spoken with felt that they were very well supported by the management and that there was enough staff to carry out the care needs of the residents. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. We observed the staff to be warm and supportive in their interactions with the residents and further evidence of this was seen via the survey returns completed by relatives regarding the staff attitude and general care. All staff receive training. Four of the six care staff have already completed a National vocational Qualification (NVQ) and other staff have training development planned in.Staff files seen and staff spoken with evidenced ongoing support around training which is monitored through regular supervision sessions with the manager. This shows Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: that the staff have the basic skills to care for people in the home. We found that some staff have more specialist training based around the care needs of the residents such as medication and PEG feeding. We looked at one staff file (last person recruited) and found that the checks required for each staff prior to employment had been made and that staff were recruited thoroughly. This ensures that staff employed in the home are fit and safe to work with vulnerable people. We did not see any application form on file and it would be recommended that at copy of this is placed on the file so that the manager has ease of access. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well which promotes the best interests of the people living their. Evidence: The manager is Freda Austin. We spoke at length and she was able to give a clear outline of the current needs of the service in supporting residents with learning disability and also outline how future developments would fit in with best practice. Freda has been manager for a number of years and has provided consistent input. She updates herself by attending ongoing training. We asked how the service seeks the views of the residents, particularly given the communication issues, and promotes their interests. We were told about the regular surveys completed by relatives and also the relative and advocate involvement with the ongoing reviews.These are useful ways for people to provided feedback about the service and feel more involved in the running of the home. The manager discussed the various internal audits that are carried out including Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: regular environmental checks and also visits by senior management who also complete a monthly audit (Regulation 26 report) which provides further feedback for the manager.These were seen and are completed to high standard. We found that the management of health and safety in the home was good. The pre inspection information (AQAA) completed states that all safety certificates are up to date and some of these were spot checked on the inspection. This ensures that the environment for people is safe and maintained. We spoke to the manager about the difficulties around ensuring protection for people who found difficulty in expressing their concerns and found that the manager and also service manager were open and constructive in their analysis of these difficult issues, particularly around staffing at night time. They displayed a willingness to promote the best interests of residents. Past inspection reports show that the home applies consistently good standards over a long period of time and continually reviews the needs of the residents to promote their welfare. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 23 The whistlblowing policy needs to be updated to reflect the local safeguarding policies and procedures [Sefton and Liverpool] around investigation of alleged incidents. The local careline contact number for the reporting of any allegation should be made available in the daily information folder in use. 2 34 We did not see any aplication form on the staff file seen and it would be recomended that at copy of this is placed on the file so that the manager has ease of access. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!