CARE HOME ADULTS 18-65
Kilburn Gardens, 53 53 Kilburn Gardens Collingwood Park, Station Road North Shields Tyne & Wear NE29 6HD Lead Inspector
Janine Smith Unannounced Inspection 8th November 2005 13.20 DS0000000357.V258166.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000000357.V258166.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000000357.V258166.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kilburn Gardens, 53 Address 53 Kilburn Gardens Collingwood Park, Station Road North Shields Tyne & Wear NE29 6HD 0191 2728714 0191 272 8714 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) New Prospects Association Limited Mrs Michelle Anne Coleman Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000000357.V258166.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users are also categorised as having physical disabilities. Date of last inspection 12th May 2005 Brief Description of the Service: 53 Kilburn Gardens provides residential care for three adults with a learning disability. Nursing care is not provided. The home is a bungalow on a housing estate in an outlying area of North Shields. The design of the house is in keeping with the other houses on the estate. Public transport is available a short distance away. The nearest local amenities are in North Shields. The home has a variety of aids and adaptations to assist people with physical disabilities. All of the bedrooms are single. There is a large bathroom, which has an assisted bath, a shower and toilet. There is also a separate toilet. The house has a reasonably sized garden at the rear and a small garden to the front. There is a ramp providing wheelchair access to the front door. DS0000000357.V258166.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took 3 ¾ hours and the home had not been given advance notice. An inspection was made of part of the premises and a sample of records. Two of the residents and three staff were spoken to. Some records held at the organisation’s head office were inspected the following day. What the service does well: What has improved since the last inspection?
Weekly ‘lifestyle’ meetings are now taking place between each resident and key staff. The aim of the meeting is to ensure that each resident’s wishes and needs are identified, acted upon and recorded. This was said to be working well and had helped to increase the staff’s awareness and knowledge of each resident’s needs. Redecoration has been carried out in some parts of the home. DS0000000357.V258166.R01.S.doc Version 5.0 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. DS0000000357.V258166.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection DS0000000357.V258166.R01.S.doc Version 5.0 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 the following standard(s): Standards 2 & 5 were assessed at the last inspection and were met. EVIDENCE: DS0000000357.V258166.R01.S.doc Version 5.0 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 the following standard(s): 6 and 8. The contents and presentation of the care plans have been improved, to ensure that the complex needs of the residents are readily identified in the records. Residents’ rights to make decisions about their day-to-day lives are respected by the staff team, which ensures that their lives in the home are fulfilling and satisfying. However, financial arrangements should be changed to give residents more control and benefit. DS0000000357.V258166.R01.S.doc Version 5.0 Page 10 EVIDENCE: A requirement was made at the last inspection to ensure care plans included full details of how service users’ care needs were being met. The senior carer on duty confirmed that weekly meetings were taking place between each resident and key staff. The aim of the meeting was to ensure that each resident’s wishes and needs were identified, acted upon and recorded. This was said to be working well by helping build up the staff’s awareness and knowledge. One record was examined and the improvements brought about by this system were noted. The inspector saw that staff consulted residents about their needs and wishes throughout the inspection. Residents’ Social Security benefits are currently paid directly to New Prospects, who then deduct care fees and pay the balance left over to residents in arrears. These arrangements should be changed to enable residents to receive their benefits direct and be invoiced for fees. DS0000000357.V258166.R01.S.doc Version 5.0 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 the following standard(s): 12 Links with the community are good and support and enrich residents’ social lives. EVIDENCE: A resident said that it was ‘good’ living here because she went on holidays and shopping. She had recently taken up trampolining and was enjoying this activity. She had also made a new friend through this hobby and was pleased about that too. It was confirmed through discussion with staff and by looking at records that all residents participated in a range of social activities. DS0000000357.V258166.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20. The health needs of residents are well met, other than more thorough monitoring of their weight. The systems for the administration of medication need some improvement for the safety and wellbeing of residents. EVIDENCE: Inspection of care records and discussion with the staff showed that residents are provided with the support they need to meet their personal and health care needs except for regular monitoring of their weight. This was still not being done at appropriate intervals because of the lack of a suitable weighing machine in the home. Arrangements to take residents to a local hospital or clinic to be weighed have not worked out. This remains an unmet requirement and a concern. Some of the residents have complex health care needs. The carers assist a resident who has a percutaneous endoscopic gastrostomy (PEG) at the request of Community Nursing staff. The staff had been trained to do this and four of the care staff team have had further training since the last inspection. The training has not included an assessment of each individual carer’s competence by the responsible community nurse. This should be done, in order to comply
DS0000000357.V258166.R01.S.doc Version 5.0 Page 13 with good practice. This has been done where the carers have been trained to administer rectal diazepam, which some residents may need in an emergency. A random sample of medication records and the system for storage and handling medication was looked at and found to be appropriate, other than: - The administration record had been signed in some cases indicating medications had been given when they had not. A mistake had recently been made where a resident was giving the wrong dosage of a medication due to confusion when the dosage was recently changed following a hospital appointment. Steps have been taken to avoid this happening again. DS0000000357.V258166.R01.S.doc Version 5.0 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 the following standard(s): 23 More care needs to be taken to ensure that residents’ personal monies are properly accounted for. EVIDENCE: The Team Leader on duty stated that no complaints have been received since the last inspection. The carers help residents with their finances by holding money on their behalf and making deposits and withdrawals from their banks accounts. Records are kept of transactions and there are audit procedures and other safeguards in place. A check was made of the cash amounts held for two residents. One amount did not tally with the record. A receipt was not available for a recent purchase. DS0000000357.V258166.R01.S.doc Version 5.0 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 the following standard(s): 24 The house provides a suitable environment for residents with physical disabilities. EVIDENCE: Redecoration has been carried out since the last inspection. The lounge carpet, which looks worn, has not yet been replaced but quotes have been obtained. DS0000000357.V258166.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. The number of staff and type of staff on duty throughout the day and night is sufficient to meet the needs of residents. Staff morale is high resulting in an enthusiastic workforce, which works positively with residents to improve their whole quality of life. Thorough checks are carried out before new staff are employed, which helps to ensure that residents are protected. Training is provided to the staff team to ensure that they have the skills necessary to support the residents they care for. DS0000000357.V258166.R01.S.doc Version 5.0 Page 17 EVIDENCE: Examination of staff rotas and discussion with members of the staff team provided evidence that an adequate number of care staff work in the home. On the day of inspection there were four care staff on duty. Through the night there is one waking night carer and another sleeps on the premises to provide assistance if necessary. The records of one recently recruited member of staff was examined. Vetting procedures were fine. A new member of staff confirmed that they were receiving induction training to Learning Disability Award Framework (LDAF) Standards. The Team Leader confirmed that five (42 ) of the care staff team have now achieved a National Vocational Qualification (NVQ) at Level 2 or above. Two members of staff are also training to become NVQ Assessors. She also stated that other training has been carried out in recent months covering the following areas, medication, epilepsy, personal communication, moving and handling, infection control and PEG feeding. Evidence of training was found in some of the staff records examined. DS0000000357.V258166.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The Manager provides clear leadership, which ensures that the home is well run and the staff team are fully aware of their roles and responsibilities. The organisation regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents. There is a thorough approach to health and safety, which ensures the home provides a safe environment for residents, however, some documentation was not available to show that the electrical wiring and appliances have been checked for safety. DS0000000357.V258166.R01.S.doc Version 5.0 Page 19 EVIDENCE: There was evidence that the home is run well by the Registered Manager, Ms Michelle Coleman, who has worked at the home for a number of years. The home has a quality assurance programme in place, which includes seeking the views of residents on a regular basis. The Team Leader on duty said that improvements were being planned. These included regular audits of the home by a manager from another service and the development of a new system for involving residents in decisions about their lives in future. These looked like they would be very positive developments. New Prospects has a training programme in place to ensure that the staff are given training in moving and handling skills, fire safety, first aid, infection control and good hygiene. Evidence of maintenance and servicing contracts were seen in respect of some of the equipment and systems in the home, which ensures that they are maintained safely. But up-to-date documentation could not be found for the portable electrical appliances and electrical wiring in the home. The entries in the Fire Log Book showed that there have been lapses in the routine checks on the fire extinguishers and emergency lights. DS0000000357.V258166.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 X DS0000000357.V258166.R01.S.doc Version 5.0 Page 21 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 YA19 Regulation 12(1) Requirement Residents weight must be monitored at appropriate intervals and a record kept. The previous timescale of 30/4/05 has not met. The care staff must follow correct procedures when administering medication, that is, by indicating on the medication administration record when a medication has been given or the reason why it has not. The previous timescale of 31/5/05 has not been met. The lounge carpet must be replaced. (Previous timescale of 31/1/05 not met.) A competent person must carry out tests on the portable electrical appliances annually. A qualified electrician must carry out a periodic inspection of the electrical wiring. Checks on the fire extinguishers and emergency lights must be carried out and logged at monthly intervals as
DS0000000357.V258166.R01.S.doc Version 5.0 Page 22 Timescale for action 28/02/06 2. YA20 13 31/12/05 3. 4 YA24 YA42 23(2)(d) 23(2)(c) 31/12/05 31/12/05 recommended by the Fire Brigade. 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 Refer to Standard YA7 YA20 Good Practice Recommendations Social security benefits should be paid directly to residents and residents invoiced for their care fees. Where care staff are delegated by nursing professionals to carry out tasks in relation to a PEG or to administer rectal diazepam, the training for the named care workers must be fully documented and the record must incorporate an assessment of the care workers competence, together with all subsequent re-assessments. Carers should take the current medication administration record (MAR) with them when supporting residents during hospital appointments. The doctor should be asked to record any medication changes directly onto the MAR and sign and date this. More care needs to be taken when recording and accounting for personal monies. Receipts must always be obtained when purchases are made on behalf of residents. 3 YA20 4 YA23 DS0000000357.V258166.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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