Inspection on 27/07/05 for Josephine Butler

This inspection was carried out on 27th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Josephine Butler 20/04/10

Josephine Butler 04/02/10

Josephine Butler 25/03/09

Josephine Butler 10/07/08

Josephine Butler 19/09/07

Josephine Butler 17/05/06

Josephine Butler 20/01/06

Josephine Butler 15/12/04

Josephine Butler 23/09/04

Josephine Butler 14/04/04

Josephine Butler 17/06/03

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

CARE HOME ADULTS 18-65 Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE Lead Inspector Leila Mavroupoulou Unannounced 10:00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Josephine Butler Address 34 Alexandra Drive Liverpool Merseyside L17 8TE 0151 727 7877 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Harold Smith Mr Philip David Wade CRH Care Home 21 Category(ies) of (MD) Mental Disorder 21 registration, with number of places Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Residents between ages of 16-64 years. Date of last inspection 15th December 2004 Brief Description of the Service: Josephine Butler House 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 age of 18-65 years that have mental disorder.The accommodation is provided on three floors with the communal areas: lounge, dining room, conservtory, games room and quite room the ground floor. All the residents accommodation is provided in single bedrooms. residents are able to access the first and second by the passenger lift. The residents at the home requires little assistance with personal care except for supervision and encouragement. The home is staffed twenty-four hours a day by a Registered Mental Nurse and support workers. The residents are encouraged by staff to access various community facilities and to maintain their independence. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted 6 hours. During this time the inspector spoke to residents, staff, management, inspected some of the residents files, medication records and other records such as fire records, lift maintenance etc., which the home must keep for the health and safety of the residents. The inspector uses the findings from the records inspected, discussion with the staff and residents to assess the quality of care provided at Josephine Butler. What the service does well: What has improved since the last inspection? Some of the bathrooms have been repainted and the chairs in the lounge have been replaced. The car parking area at the front of the home has been re-surface. Since, the last inspection more information has been displayed in the reception area. The number of staff leaving work at Josephine Butler has reduced. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 6 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. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4, Residents are assessed prior to admission to ensure that the home is able to meet their needs. EVIDENCE: The home has a Statement of Purpose, which outlines the services and facilities provided at Josephine Butler House. It is easy to read and contains the necessary information to assist prospective residents in making a decision about the suitability of the home. The staff at the care home assesses the prospective resident needs prior to admission as evidenced in the residents file. This is to ensure that the homes has the staffing, skills and where necessary equipment and facilities to provide the necessary care to the resident. In one of the resident’s file it was noted by the inspector that a resident was admitted to the home whose needs was outside of the category the home is registered for without the Commission being notified. Prospective residents are encouraged to visit the home for a meal and to see the accommodation provided before making a decision as evidenced in the home’s Statement of Purpose. However, the home should keep a record of the resident visit to the home and details of any further assessment carried out to inform their decision or the resident’s care plan/risk assessment when the they are admitted to the home. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10 Resident files inspected showed that they had detailed care plans and risk assessments. However, these should be developed where possible with the resident or their representative/advocate to promote their choice and involvement in decision making over their daily lives. EVIDENCE: The residents files inspected showed that they had detailed care plans in place showing how their assessed needs would be met and risk assessments where necessary. However, there was no evidence that the resident was involved in the development of their care plan and its review. Discussion with the residents and staff proved that the resident do make decisions for themselves and on occasion decisions are made on their behalf. The home has information of advocacy services, which the residents could access if they wish. Currently, one resident has an advocate. The staff assists the residents where necessary to manage their finances. However, the home monitors some of the resident personal allowance, which should be recorded in the resident’s care plan. Discussion with the residents and staff confirm that the residents are supported in maintaining their independence and risks identified are minimised Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 10 as far as possible through discussion with the resident and recording in the resident risk assessment. The home has a policy on confidentiality of resident’s information. However, this should be discussed in staff induction and supervision to promote the resident’s interests. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15,16,17 The residents access various community facilities to promote integration in all aspect of community life. EVIDENCE: Discussion with the residents, staff, inspection the residents’ individual activity programme and observation demonstrate that the residents participate in a range of activities either on their own or with staff to develop new skills, maintain existing skills and to maintain relationships. Many of the residents make regular visit to their family and visit places where they can meet and make friends with other people who do not have the same disability. Currently, three residents attend college or day centres. Visitors are welcomed to Josephine Butler throughout the day and the resident can choose where to see their visitor. Observation showed that the residents are able to choose to be on their own or join in activities with the other residents. The staff encourages and support the residents to maintain and develop their daily living skills through being responsible for the cleanliness of their bedroom and their laundry. All of the residents access entertainment in the community of their choice. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 12 The residents commented that they were happy with the quality of food provided. The home has a set menu. However, alternatives meals are available for the resident that wish something different to that on the menu and a record is kept of food provided to residents. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18,19,20 The staff monitors the residents health to ensure that they receive appropriate treatment and support to promote good health. Improvements can be made in the administration of resident’s medication. EVIDENCE: The residents at Josephine Butler currently do not require any assistance with moving and handling and are able to manage independently all aspects of their daily lives e.g. eating, drinking, using the toilet, bathing, walking etc. nor do they require aids to assist them in the areas of daily living activities listed. Some of the residents maintain regular contact with the Community Psychairtric Nurse and their GP. Staff at the care home would accompany the resident to visit to outpatient clinic. Inspection of the residents medication records showed that some service user medication was unaccounted for as there was no signature to clearly show that it was administered and by whom. The homes’ medication recording could be improved. This highlight that the qualified nurses are not working in accordance with their professional guidelines (Code of Conduct). Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The home has a complaint and other procedures to protect the residents. However, the staff must be trained on how to deal with alleged abuse to protect residents and staff. EVIDENCE: The home has a complaints procedure and staff support and encourage the residents, to raise any concerns that they have either informally through discussion with the registered manager or formally by putting it in writing. Recently, there was an allegation of abuse in the care home, which identified a training need in the management of the home. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27,30 Effort is being made to improve the decoration within the home. However, the registered provider should consider doing one area of the home fully to make a significant impact on the quality facility provided in the care home. EVIDENCE: All parts of the home are easily accessible to all of the residents. Generally, the home is clean throughout. The communal areas on the ground floor can be used for different activities and are bright and well lit by natural light. The armchairs in the sitting room were recently replaced. The dining chairs should be risk assess as some are weak and a little unstable. The tour of the building showed that emergency lighting needed replacement on the ground floor, the steel rail on the staircase leading to the second floor needs to be secured to the wall, the florescent tube on the first floor landing is not working and should be replaced, window on first floor landing needs a window restrictor. The registered provider must review the lighting in the corridor and the bathroom areas to ensure the safety of the residents. The rear fire escape must be cleaned. The metal guard on the staircase needs cleaning. A detailed risk assessment has been carried out on the building. However, it has not been reviewed since 2003 and does not include the residents’ Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 16 bedrooms. This should be reviewed regularly to promote the health and safety of the residents. Some of the bedrooms are very personalised with the residents belongings such as music centres, televisions etc. Small electrical appliance tests are carried out on electrical appliances in the home. The laundry area is located away from the food preparation area and policies and procedures in place for the control of infection. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34, 35,36 The staff skills and knowledge needs to be improved to better the quality of care provided to the residents. EVIDENCE: The staff at the care home are approachable and observation of their interaction with the residents show that they have a good relationship with the residents. Many of the staff has successfully completed their NVQ level 2 and 3 in care and some staff are working towards the award. There is always a qualified registered mental health nurse on duty to provide the support with the necessary support and knowledge in meeting the health needs of the residents. In addition support can be obtained from the local mental health team and resident’s Community Psychairtric Nurse and GP. The sickness and turnover of staff have improved since the last inspection and observation during the inspection revealed that staff has the time to carry out uninterrupted work with the residents. Some improvements have been made in the home’s recruitment process such as Criminal Records Bureau checks being obtained prior to staff commencing employment. However, there are still gaps in the home’s recruitment records such as: no job description on staff file, only one written reference. The staff induction process must be reviewed to ensure that staff have an understanding of the residents needs, the philosophy of the home and the more frequently used policies and procedures in the home relating to resident’s care such as: Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 18 confidentiality of information, abuse, communication, etc. The registered manager informed the inspector that supervision pro-forma has been developed, but it has not been implemented. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39, 42 The registered manager needs to recruit permanent qualified nurses to enable him to delegate various functions to them. Thus enabling him to devote time to identifying ways of improving the quality of the service provided to the residents. EVIDENCE: Discussion with the registered manager indicated that he has not had the opportunity to access training courses due to staffing level. The registered person must ensure that the manager is given the resources to maintain their skills and knowledge to enable them to carry out their role confidently and effectively. The home has developed a quality assurance system, which has partially been implemented by sending out questionnaires to the residents. However, the evaluation of the questionnaires has not been completed. The staff at the care home is provided with training in moving and handling, food hygiene and infection control. However, the registered manager should consider reviewing the way in which staff training is recorded to improve Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 20 awareness of which staff have received training and their due dates of renewal. The home maintains records of weekly fire alarm tests, fire drills emergency lighting tests etc. and the home’s fire equipment are serviced regularly. The home carries test the temperature of the hot water monthly at outlets used by the residents. However, the registered person must ensure that risk from Legionella is minimised by appropriate system being installed. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 21 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 3 2 x 3 x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Josephine Butler Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 2 x F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 14 Requirement The registered person shall ensure that a service user is not accepted into the care home unless their assessed needs could be met and that the service user falls within the homes registration category. The registered person shall ensure that the service user plan is developed with the service user or their representative and review it at regular intervals. The registered person must record any limitations agreed with the service user as to the service users freedom of choice, liberty of movement and power to make decisions. The registered person shall ensure that all staff understand the homes policy on confidentiality of information and adheres to their professional code of conduct. The registered person shall ensure that the home maintains an accurate record of all service users medication received into the care home, administered and returned to the pharmacist. The registered person shall F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Timescale for action 15th September 2005 2. 6 15 30th September 2005 30th September 2005 3. 6 17 4. 10 18 30th September 2005 5. 20 13 15th September 2005 6. 23 10 15th Page 23 Josephine Butler Version 1.40 7. 24 23 8. 25 23 9. 31 37 10. 34 19 undertake from time to time such training to ensure tht he has the experience and skills necessary for managing the care home such as: Protection of Vulnerable Adult The registered person shall ensure that the environment is safe for the service users. The following items requires repairing or attention: some of the dining room chairs are unsteady. The window on the first floor landing requires a window restrictor. The handrail on the stairs needs securing. Light fitting in bathroom on second floor is broken. Fire escape to the rear of the building requires cleaning. First floor corridor light not working. Ventilation fan in bathroom on second floor not working. Plastering in corridor right of room 2 door needs painting. Plaster in right of room 15 needs painting. Light fitting in second floor bathroom corridor needs replacing. Ceiling in bathrooms and toilets on first floor needs painting or replacing. Call system from the second floor cannot be heard on the ground floor. The registered person must ensure that the risk assessment of the building is current and reviewed at regular intervals. The registered person must ensure that staff are aware that the Commission must be notified of all significant incident to service users and in the home without delay by telephone initally and then followed in writing. The registered person must ensure that staffing records comply with statutory F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc September 2005 30th September 2005 15th September 2005 15th September 2005 15th September 2005 Page 24 Josephine Butler Version 1.40 requirements. 11. 35 18 The registered person must ensure that staff are appropriately inducted into their role and provided with the necessary training to carry out their roles and responsiblilities safely. The registered person must ensure that there is a training budget to provide the required training and update of staff knowledge to meet the needs of the residents. The registered person must ensure that staff are appropriately supervised. The registered person must ensure that systems are in place to prevent the risk of Legionalla occurring. The registered person must ensure that current risk assessments are in place of the entire building. 15th September 2005 12. 35 10 &18 15th September 2005 13. 14. 36 42 18 23 15th September 2005 15th September 2005 15th September 32005 15. 42 23 16. 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 7 10 26 42 Good Practice Recommendations The registered person should record instances where the service users make decision over their daily lives. The registered person should discuss the homes policy on confidentiality of information in staff supervision to ensure their understanding. The registered person should ensure that each staff on duty has a master key to gain access in an emergency to the resident bedroom. The registered manager should review the method of recording staff training, to make it easier to identify staff training completed, what staff training is outstanding and F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 25 Josephine Butler the date when training should be renewed. Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 3rd Floor, Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Josephine Butler F52 F02 S25114 Josephine Butler V242440 270705 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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