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Inspection on 25/03/09 for Josephine Butler

Also see our care home review for Josephine Butler for more information

This inspection was carried out on 25th March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Key inspection report CARE HOME ADULTS 18-65 Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE Lead Inspector Mike Perry Unannounced Inspection 25th March 2009 10:00 Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Josephine Butler Address 34 Alexandra Drive Liverpool Merseyside L17 8TE 0151 727 7877 F/P 0151 727 7877 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) Mr Harold Smith Philip David Wade Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning diability or dementia - Code MD The maximum number of service users who can be accommodated is: 21 Date of last inspection 10th July 2008 Brief Description of the Service: Josephine Butler House is a large detached property set in its own grounds in the Sefton Park area of Liverpool. It is short walk from Sefton Park, Lark Lane, shops, pubs and public transport. The home provides care and personal support to younger people between the ages of 18-65 years that have mental disorder. The accommodation is provided on three floors with the communal areas: lounge, dining room, conservatory, games room and quite room on the ground floor. All the service users’ accommodation is provided in single bedrooms. Service users are able to access the first and second floor by the passenger lift. The home is staffed twenty-four hours a day by a Registered Mental Nurse and support workers. The service users are encouraged by staff to access various community facilities and to maintain their independence. The manager for the service is Phil Wade and the Registered Provider is Mr Harold Smith. The weekly fee is currently £450 per week and service users are given written terms and conditions showing what is included in the weekly fee. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection over one day. During this time we [the Care Quality Commission or CQC] spoke with the people living in the home and also to members of staff on duty as well as the registered manager. We also met with the Provider [owner]. A visiting health care professional was also consulted. Prior to the visit the manager completed a pre inspection information document called the annual quality assurance assessment [AQAA], which provided evidence of the daily running of the home. We looked at a sample of care plans and risk assessments for the people living in the home as well as inspecting staffing and other health and safety records. We did a tour of the building and all day areas and some [not all] resident’s bedrooms were seen. As part of the visit a pharmacist inspector checked how medicines were being handled to make sure the improvements seen at the last visit had been maintained. What the service does well: During the inspection we spoke to a person who had been admitted a few months ago as an ‘emergency’. There had been no time to visit the home before hand but the person felt that the process had been handled sensitively by the home and that the managers and staff had been very supportive over this period. Resident’s make decisions over aspects of their daily lives, such as choosing to spend time on their own in their bedroom or in the communal areas with other service users. Resident’s spoken with enjoy this freedom and feel relaxed in the home. Residents generally reported that staff are very caring. The general environment is very relaxed and sociable and this was observed throughout. One resident commented ‘The staff are fine and very helpful. The manager is very good and nice to talk to’. The care plans detail the needs and input from health care professionals. Discussion with residents confirmed that staff are very supportive and are Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 6 generally respectful and appropriate when carrying out personal care. A visiting health care worker was spoken with and felt that the staff generally promoted both good personal and health care. Residents were referred appropriately and reviews were maintained. Resident’s generally appeared clean and well presented and the dignity of residents was therefore enhanced. What has improved since the last inspection? There were five outstanding requirements from the previous inspection visit [unannounced random visit on 17th October 2008] and four of these have been met. We saw that the external grounds to the rear of the building have been improved so that they are now more inviting for people living in the home to make use of and enjoy the fresh air. We looked at the staff of a recent recruitment to the home and found that the required checks that needed to ensure that the staff are of good character and are fit to work in the home have all been made. This ensures that residents living in the home are protected by good staff recruitment standards. The manager has researched and produced a staff induction programme so that any new staff starting work in the home can be supported in the work they have undertaken. There has also been progress with ensuring that all care staff are completing a National Vocational Qualification [NVQ] so that they are able to demonstrate a basic level of knowledge and awareness. Currently over 50 of staff have this qualification. We saw some reports by the registered provider and these are now being completed. These are called regulation 26 reports and are a statutory requirement for the provider complete. These reports are important because they provide a means of the provider evidencing regular visits and auditing of the service as well as providing valuable feedback for the manager so that standards can be maintained. There has been some progress in getting residents to become more responsible and involved in making daily decisions about there lives. For example the biggest improvement here is getting some of the residents to self medicate. Overall the management of the medicines in the home has continued to improve and show consistent standards. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 7 What they could do better: There remains an outstanding requirement from the last inspection. This is around the understanding and training of staff and managers in abuse awareness and safeguarding procedures so that any concerns and allegations can be effectively dealt with. There has been some evidence of staff training by the provision of a training DVD but overall knowledge amongst staff and managers remains poor so that people living in the home may not be fully protected. Managers were still not aware for example of how to report any allegations through to the local safeguarding team in the local authority. There was some discussion with the manager regarding the inclusion of the residents in the development of the care planning in the home. On this visit the people we spoke to have not received copies of the care plan and there is no evidence to say they have been involved in drawing them up. This has been discussed previously. There needs to be more inclusion of the people receiving the care so that they can ‘own’ and have more say about how the care is carried out. The plans are written in very medical terms; for example ‘diagnosis of schizophrenia, anxiety, depression, risk of relapse and self neglect’. As these should be shared with residents we would advise more descriptive care planning which highlights the ‘effect’ of such disability on the daily life of the person and how care interventions can assist the person to adapt or how any barriers can be removed so that the person is better able to lead their life. The medicalisation of the care plans is possible acting as a barrier to staff sharing the plans with the people concerned who may be alarmed or not fully understand them. We discussed how independence for residents could be further improved with access to laundry facilities and being more involved in making meals and access to tea and coffee making facilities for example. One resident spoken with said: ‘The staff do everything for you. They are fine and very helpful. The manager is very good and nice to talk to. There is nothing to do though. I’m in bed now because there is nothing to do. There is no activity in the home. We have a day for the bath – only so many towels’. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 8 On the day of the inspection there were four staff in total on duty during the early part of the day and this was reduced to 3 in the afternoon. The staff compliment was made up of a domestic and also the senior carer was covering for absence of the regular cook. This effectively meant there was one nurse and one carer for 20 residents in the care home. We looked at the duty rota and there were at least four occasions over the last few weeks where care staff had covered for staff absences and there had been reduced numbers. Residents reported less staff contact and continuity when numbers are low [this can be an issue at weekends as well] particularly as current system is based on a lot of staff support for escorts, support with personal hygiene and cleaning rooms. These therefore are neglected. The management reported that the ability to cover the staffing rota was limited due to funding and that all requests had to be agreed by the provider. The use of agency staff was not allowed. If staff are on annual leave the shortages of numbers tend not to be covered consistently. A requirement has been made to address this issue as it is core to the planning and management of the care. We have made some requirements and recommendations around the management of health and safety issues in the home so that these are managed more consistently. These include the need for fire safety training for staff and the appropriate action following any issues identified on the risk assessments carried out in the home. This is to ensure that people living in the home are kept safe. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 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 Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People who use the 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 admission procedure at Josephine Butler would enable residents to be confident about the home being able to meet their needs. EVIDENCE: The previous AQAA [preadmission information] tells us that the nursing staff at the care home makes an assessment of the residents’ needs both prior to admission and during the admission process to ensure that the facilities offered are suitable and staff have the necessary skills to meet the service user assessed needs. From the information obtained an initial service user plan and risk assessment is developed showing how the assessed needs of the resident’s would be met. During the inspection we spoke to a person who had been admitted a few months ago as an ‘emergency’. There had been no time to visit the home before hand but the person felt that the process had been handled sensitively by the home and that the managers and staff had been very supportive over this period. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 11 We saw the persons care file and there were copies of assessments by social and health care professionals and the manager of the home had also completed his own assessment during the initial stages of admission so that a full picture of the resident is built up. The home produces a ‘service user guide’, which provides information about the home. This should be given to any prospective admission or any person admitted to the home so that they have up-to-date information about the care home and how it operates. When we spoke to the person concerned in the admission and they were not aware of the guide and the manager confirmed that this had not been given out. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate*quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care needs are monitored and planned safely but there should be a reflection by staff regarding some of the care practices so that greater choice and autonomy over daily life can be facilitated. EVIDENCE: The residents have care plans and risk assessments showing how their assessed needs would be met and how identified risks would be minimised. We looked at some of the care plans and these did not show that the particular residents had been consulted where possible about the content of the plan. We spoke to at least three residents about their care plans and none of them had received a copy of the plan. During the last inspection we found that some residents had signed care plans and had been involved to some degree but the evidence here is that this is inconsistent. The plans are reviewed at regular intervals and these reviews are detailed enough to track the progress of the resident over that period. There was some Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 13 discussion with the manager regarding the inclusion of the resident at these reviews of the care plan and this could be evidenced in the documentation [for example a signature]. This has been discussed previously. There needs to be more inclusion of the people receiving the care so that they can ‘own’ and have more say about how the care is carried out. The plans are written in very medical terms; for example: ‘has paranoid schizophrenia. Paranoid delusions and hostility’. Anther read: ‘diagnosis of schizophrenia, anxiety, depression, risk of relapse and self neglect’. As these should be shared with residents we would advise more descriptive care planning which highlights the ‘effect’ of such disability on the daily life of the person and how care interventions can assist the person to adapt or how any barriers can be removed so that the person is better able to lead their life. The medicalisation of the care plans is possible acting as a barrier to staff sharing the plans with the people concerned. Observation during the inspection and discussion with resident’s and staff showed that resident’s make decisions over their daily lives to varying degrees. There is a weekly activity plan, which show activities that each resident would like to do and whether it actually took place. This includes activities that the service users engage independently or with staff. This ‘weekly planner’ could be used more constructively however in terms of getting residents to forward plan their week as opposed to the current use as merely a document that care staff complete retrospectively following the completion of an activity. The manager said that this was the original intention of the form. Again this as been discussed previously. The weekly planner could be the ‘working’ care plan that residents are able to use in terms of their daily involvement. The use of the ‘planner’ by staff highlights the paternalistic and ‘protective’ element to the care in the home. Further evidence of this is the current care practice of only giving bath towels out at the time staff prompt residents to have a shower or bath. Residents do not have the choice therefore to make that decision for themselves with asking staff for a towel. There has been some progress in getting residents to become more responsible and involved in making daily decisions about there lives. For example the biggest improvement here is getting some of the residents to self medicate. We also witnessed one resident who has a daily checklist of activity around self care and motivation towards achieving certain chores and another resident was observed to be ironing. Some residents are also involved in setting of tables etc at meal times. We discussed how this could be further improved with residents having access to laundry facilities and being more involved in making meals and access to tea and coffee making facilities for example. One resident spoken with said: ‘The staff do everything for you. They are fine and very helpful. The manager is very good and nice to talk to. There is nothing to do though. I’m in bed now because there is nothing to do. There is no activity in the home. We have a day for the bath – only so many towels’. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 14 The registered manager organises monthly service users meetings so that residents can raise any issues in a group forum. All residents spoken to state that staff were approachable and would listen to their concerns. Some residents felt that suggestions made at meetings for trips out [for example] were not carried through, as there was a lack of funding for this type of activity. Again this was evidenced on the last inspection. Staff support resident’s to take responsible risks as identified in their service user plan. Some residents have kettles in their bedroom for which risk assessments have been developed to minimise risks. Another person is at risk of ‘wandering’ out of the home on occasions and may be vulnerable because of this. This has been assessed and an appropriate plan is in place. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy many aspects of life in the home but there can be improvements made to ensure both independence and quality of life can be further improved. EVIDENCE: Resident’s are responsible for maintaining their bedrooms with the support from their key worker to encourage they maintain daily living skills. This does not extend to laundry however as staff attend to this. Generally speaking the residents feel supported in this and the basic standard of cleanliness in residents bedrooms has improved since the last inspection although some we saw had clearly had no input on regular basis. For example one room had clearly had limited input in terms of assisting the resident to clean. Residents reported that staffing generally is adequate but there are still days when there are not enough staff [see staffing] to consistently maintain these programmes. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 16 One resident reported that his key worker had left and currently had not been replaced. Resident’s make decisions over aspects of their daily lives, such as choosing to spend time on their own in their bedroom or in the communal areas with other service users. Resident’s spoken with enjoy this freedom and feel relaxed in the home. Residents generally reported that staff are very caring. Most of the residents come and go during the day and seem comfortable with the local environment. Some attend a local day unit and one attends a local college. We spoke to one resident who was waiting to go out and reported that a member of staff escorts them. The service is close to a main road where service users could access a number of buses. Most service users have a bus pass. The general environment is very relaxed and sociable and this was observed throughout. There are areas of care where the independence of residents could be encouraged further. For example it was observed that drinks are supplied by staff at regular set intervals but there is nowhere for residents to make themselves a drink outside these times. Residents are ‘not allowed’ in the kitchen. Also, as mentioned, there are no accessible laundry facilities for residents so there is no possibility of developing any self-help skills in this area. These issues have been discussed previously. Resident’s weekly activity sheets show that some access a range of community activities locally where they have the opportunity to meet others that do share the same disability. Currently, the service does not contribute towards service users holidays and this should be given some consideration. Again these issues were raised previously and remain as good practice recommendations in order to raise the quality of life for people in the home. One resident showed us his bedroom and escorted us around the home. He reported being comfortable in the home and felt at ease with the routine. People are provided with a key to their bedroom door to promote their privacy. There is good day space available and there is a large garden to the rear of the property. This has now been tidied up by the owners and residents are free to access it if required. On this inspection the residents generally reported that meals were satisfactory. The daily menu is displayed on a board in the dining room and staff reported that they ask residents on a daily basis what there preferences are. One resident was ‘fussy’ with choice of food but staff would cook meals she bought for herself. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People who use the 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 health and personal care is managed well so that people using the service feel their privacy and dignity is respected and their right to health care is maintained. EVIDENCE: Observation of residents showed that they require varying degrees of assistance regarding personal care ranging from ‘prompting’ to actually assisting to bathe. These individual needs are described in the care plans and staff spoken with were knowledgeable as to interventions needed. The care plans detail the needs and input from both health care professionals and carers in the home. Discussion with residents confirmed that staff are very supportive and are generally respectful and appropriate when carrying out personal care. A visiting health care worker was spoken with and felt that the staff generally promoted both good personal and health care. Residents were referred Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 18 appropriately and reviews were maintained. Resident’s generally appeared clean and well presented and the dignity of residents was therefore enhanced. The health care worker reported that the person he had come to review had improved since being in the home in that he had better standards of personal hygiene and his mood and confidence had improved. ‘He needed the very structured environment to be able to relax and feel un pressured’. Residents have regular review of their medication and mental health needs by the psychiatrist. Where necessary staff from the care home would accompany residents to outpatient appointment and visit to the chiropodist, optician or dentist. As part of the visit a pharmacist inspector checked how medicines were being handled to make sure the improvements seen at the last visit had been maintained. We found medicines stock and records to be well organised. Our checks of the records and current stock showed medicines were being given and recorded correctly. A clear system of stock control was in place that helped make sure medicines did not run out of stock and helped make sure all medicines could be fully accounted for. Medicines were regularly checked by the manager and any mistakes that were found were acted upon immediately to try and prevent them happening again. Regular checks on medicines help make sure they are handled safely. We looked at a sample of people’s care plans and found good information about their medicines. A detailed summary of each persons medicines was kept with the main records to help make sure staff knew what they were prescribed for. Care plans for people that were taking when required medicines were detailed about how and when they should be given, this helps make sure people only get them when they need them. Since our last visit two people had started to look after their own medicines and the manager said he was planning to do this with more people once they had been fully assessed. We spoke with both people that were looking after their own medicines and they said they were very happy doing this as it made them feel more independent and allowed them to take medicines at times that fitted into their own routines. We saw good paperwork to help support them to do this and staff carried out regular checks to help make sure they were managing their medicines safely. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel safe in the home and feel their concerns are listened to but there must be more awareness amongst both staff and management of the safeguarding procedures so that residents are fully protected. EVIDENCE: The service has a complaint procedure, which is displayed in a prominent position. The service user guide also lists the complaints procedure. A suggestion box is available to enable residents to raise their concerns or make comment about the service. The service has received no complaints internally since the last inspection. All residents spoken to felt safe in the home and felt that staff would listen to their concerns. The service has various policies and procedures in place to protect service users and staff from all forms of abuse. The local safeguarding adults procedures are situated in the office but both managers found difficulty in locating these and both had limited understanding of the contents. There has been some staff training in that the manager has been able to acquire a DVD which staff have seen. One staff spoken with was able to list some of the main kinds of abuse and said that the DVD had been useful to raise awareness. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 20 When questioned both manager and deputy had still had very limited understanding of the process to follow in managing an allegation of abuse. The manager was not aware, for example, of the local safeguarding contact [careline]. This is a key area that the managers now need to concentrate on in order to fully ensure that residents can be protected. The manager reported that more work is planned to ensure that all staff and managers are fully updated in time to meet the requirement date of May 2009. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements to the environment of the home which has made it more comfortable and homely for people to live in. EVIDENCE: The home has improved the general environment over the past few inspection visits. The external building has been painted and has much improved with new windows being installed throughout. This has given the building a much more positive look and internally the bedrooms have benefited from being protected from the elements in terms of warmth and freedom from drafts. Some of the bedrooms have been decorated. The owner reported that all of the bedrooms will have been upgraded by the summer. The general improvement was clear to observe although one or two bedrooms seen are still clearly in need of the decoration programme being completed. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 22 Day and communal areas were also improved in that all areas were clean and there have been some new furnishings [conservatory for example]. The home has many benefits as it has large and spacious day areas and the building its self has an interesting character. There remains some work to be completed: • The bedroom on the top floor had a large damp patch in one corner indicating problems with the roof / gutter outside. Staff reported that this has had work completed but the problem still remains. This has been an ongoing issue. The carpet in this room is in poor condition. Some bedrooms were still not clean. For example one bedroom with stained carpet and stained and dirty radiator. There was debris on the floor indicating the room had not been clean for some time. The key workers are responsible for maintaining bedrooms with residents and this needs to be monitored closely so that basic hygiene standards are met. Again these were reflected on the last report and, although again improved on this visit overall, remains an issue. • Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There needs to be more consistency around the numbers of care staff on duty so that residents assessed care needs can be addressed at all times. EVIDENCE: On the day of the inspection there were four staff in total on duty during the early part of the day and this was reduced to 3 in the afternoon the manager was also called to come into the home because of the inspection visit]. The staff compliment was made up of a domestic and also the senior carer was covering for absence of the regular cook. This effectively meant there were one nurse and one carer for 20 residents in the care home. We looked at the duty rota and there were at least four occasions over the last few weeks where there had been reduced numbers. The manager confirmed this. Staff stated that the effect for residents care was that some of the individual personal care programmes had to be missed and that the ability to take residents out [who needed escort] was obviously diminished. Another effect could be the lack of input to assist residents in maintaining their Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 24 bedrooms [see comments previously], which is reliant on sufficient key workers to both prompt and monitor standards. Residents reported less staff contact and continuity when numbers are low [they reported that this can be an issue at weekends as well] particularly as the current system is based on a lot of staff support for escorts, support with personal hygiene and cleaning rooms. These therefore can be neglected. Both managers report a lack of social activity in the afternoon and input in the morning with programmes described above. The management reported that the ability to cover the staffing rota was limited due to funding and that all requests had to be agreed by the provider. The use of agency staff was not allowed. If staff are on annual leave the shortages of numbers tend not to be covered consistently. Staff files were checked in terms of the recruitment process for the home. There has been improvement here as the files were more comprehensive in detail and the required checks that need to be made prior to staff being employed have been. The manager has organised a basic in house induction programme following a previous requirement. Staff reported that the manager does some in-house sessions. These are brief but cover some mental health issues. There has also been some progress in that all staff have commenced or are due to start NVQ training and currently the percentage of staff with this qualification has improved to over 50 evidencing a good level of knowledge so that staff can be confident about carrying out their duties. Staff interviewed were unaware of the Code of Conduct that should be issued to all care staff from the General Social Care Council [GSCC] and this needs to be included in the induction package. The manager has acquired copies of these. This is important so that care staff can be aware of the value base they need to work with. There are still gaps in the training of staff and the manager still needs to build on this. The issue of the lack of any budget for training is the key element in developing standards as there is difficulty planning properly due to uncertainty about the financial constraints. The provider has not taken up the recommendation on previous inspection reports for the manager to be a given realistic budget. Staff spoken to during the inspection were enthusiastic about the home and had again demonstrated a clear interest in the resident group. The general comments received from residents were positive about the staff and found them to be supportive. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 25 Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers of the home have displayed an ability to meet statutory requirements but there is a need to further improve in some areas so that the home can be seen to be acting in the best interests of the people who live there. EVIDENCE: Phil Wade is the Homes Registered Manger. He has a nursing qualification in mental Health [RMN] and has had a long history for working in the private sector. He was manager of a care home prior to Josephine Butler. He is able to provide some evidence of managerial update over recent years by the completion of an eight-week management course. Phil was doing an NVQ at level 4 management but has not completed this and it would still be recommended [manager has also identified this]. Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 27 The strength of the manager is that he provides a very good role model for the approach to care in the home and is trusted by both residents and staff alike. The home does seek out the views of the residents by holding regular resident meetings and the use of quarterly satisfaction surveys. There is currently no external quality audits for the manager to gain any feedback about the service although the in-house audits continue to improve – particularly with respect to medicines for example. The last inspection report required the provider to complete monthly audits [called regulation 26 visits] and produce a report for the manager as part of the overall quality processes in the home. These are now being produced regularly and can act as a valuable tool for feedback for the manager. The manager expresses a desire for the service to continue to improve and some areas have improved overall the home has met all but one of the requirements from previous inspections for instance and this is evidence of the managers commitment. Both manager and deputy were open to the inspection process and were keen to progress things further. The main barrier to an improved overall quality rating or home is the standards around safeguarding which must now be addressed urgently. Health and safety records were inspected. There were some issues that need to be checked and tightened up on: • Monthly risk assessments are carried out so that any hazards can be identified. These records were seen and it s observed that some issues had been identified such as faulty step on the fire escape and missing rails at the front of the building. These had been identified over a number of reports [eg missing rails from august last year] but there had been no management action regarding these. This needs to be addressed as there is little point in identifying hazards if there is no action plan to follow up. Fire safety was assessed. The nominated fire officer for the home has completed some training but this was in 2005 and therefore needs updating. Records do not indicate any fire lectures having taken place. We would recommend more in-depth training for the fire officer if he is to carry out fie training in the home. The electrical safety certificate was seen and this was recommended to be inspected in January 2009 and is therefore due. • • All of the above need to be improved so that residents can be assured of a safe environment Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 28 Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 29 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 3 3 X 4 X 5 N/a INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 X X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Version 5.2 Page 30 Josephine Butler DS0000025114.V375009.R01.S.doc Are there any outstanding requirements from the last inspection? Yes 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 YA23 Regulation 13(6) Requirement All management and staff must have training in the management and awareness of abuse so that residents can be assured of being fully protected from any risk of abuse. ( Previous requirement date of 1/10/08 not met) There must be an effective staff team with sufficient numbers to support residents assessed needs at all times. This will ensure that residents care needs can be met. The findings of the monthly risk assessments of the general environment must be actioned consistently so that residents can be assured of a safe environment. This is particularly with respect to the findings around the external fire escape and the missing rails at the front of the building. All staff must receive updates in fire safety and this must be recorded. This is to ensure all staff are aware of fire safety and DS0000025114.V375009.R01.S.doc Timescale for action 30/04/09 2 YA33 18(1)a 01/05/09 3 YA42 13(4)C 01/05/09 4 YA42 23(d) 01/06/09 Josephine Butler Version 5.2 Page 31 can maintain safety in this area. 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 YA1 Good Practice Recommendations All prospective residents and people moving into the home should have a copy of the service user guide to provide necessary information about the home and how it operates. The residents care plan should be held by them and should be drawn up with their involvement. The plan should be in language that is easily accessible [plain English] and avoids medical terminology that may be confusing and disabling. The manager should reflect on some of the care practices in the home which can reduce choice and control for residents including use of the weekly planner There are areas of care where the independence of residents could be encouraged further: It was observed that drinks are supplied by staff at regular set intervals but there is nowhere for residents to make themselves a drink outside these times. There are no accessible laundry facilities for residents so there is no possibility of developing any self-help skills in this area. 5 YA14 The planning and support of residents [including financial] to engage in a holiday should be seriously considered so that residents can experience and learn from social activity external to the home. The key worker support of residents in terms of maintaining the standard of cleanliness in their bedroom needs to be more targeted and consistent. DS0000025114.V375009.R01.S.doc Version 5.2 Page 32 2 YA6 3 YA7 4 YA11 6 YA16 Josephine Butler 7 YA23 There needs to be more in depth and external training available for staff so that awareness of safeguarding issues and reporting of allegations of abuse is more clearly understood. The planned upgrading work with respect to decorating the bedrooms needs to be completed as discussed. The damp patch in the top floor bedroom still needs to be further assessed and any remedial work needed should be carried out. A copy of the code of conduct issued by the General Social Care Council [GSCC] should be given to all care staff. The registered person should ensure that the registered manager has a training budget to enable them to prioritise staff training and ensure that all staff have an ongoing training programme appropriate to the work that they are to perform. The registered person should complete their NVQ level 4 Management qualifications to satisfy the National Minimum Standards of 2001. The electrical safety certificate was seen and this was recommended to be inspected in January 2009 and is therefore due. We would recommend more in-depth training for the fire officer if he is to carry out fire training in the home. 8 YA24 9 YA34 10 YA35 11 YA37 12 YA42 Josephine Butler DS0000025114.V375009.R01.S.doc Version 5.2 Page 33 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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