CARE HOME ADULTS 18-65
Liam House 13 Spencer Road Bournemouth Dorset BH1 3TE Lead Inspector
Stephanie Omosevwerha Unannounced Inspection 23rd May 2006 09:15
23/05/06 DS0000003956.V296889.R01.S.doc Version 5.2 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 DS0000003956.V296889.R01.S.doc Version 5.2 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. DS0000003956.V296889.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Liam House Address 13 Spencer Road Bournemouth Dorset BH1 3TE 01202 294148 01202 789983 liamhouse007@aol.com 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 Marvin Charles Stephens Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (11) of places DS0000003956.V296889.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Liam House is a home for adults of both sexes who have a learning disability. It is a large, semi-detached house situated in a central area of Bournemouth close to Boscombe and Bournemouth town centres. The home is conveniently located near shops and facilities and is not far from the sea. It has good access to public transport. Residents accommodation is provided in 7 single and 2 double bedrooms. Seven bedrooms are located on the first floor and two on the ground. The first floor also has 2 bathrooms with WCs and a separate WC. The ground floor has one bathroom with a WC. The communal space is located on the ground floor and consists of a lounge, separate dining room and kitchen. There is a small locked office where all the records are kept. Outside there is a small garden at the rear of the property that has a large storage shed, which contains the laundry facilities and 2 large freezers. The front of the property provides offroad parking. The home is staffed 24 hours a day, with 2 sleeping in staff at nights. Most residents attend day activities organised by different agencies outside the home although this is flexible and residents are also supported to spend time at the home. A pre-inspection questionnaire was submitted to CSCI, however, the registered person did not include information on the current scale of charges. DS0000003956.V296889.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place over 8 hours. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI and to address the requirements and recommendations made at the previous inspection. During the inspection various records and documents were sampled including service users’ care plans, health and safety records and staffing records. A tour of the premises was undertaken including all of the communal rooms, the garden and all service user’s bedrooms. The inspector was able to talk to 3 members of care staff who were on duty throughout the day. The proposed manager was also available throughout the day. The inspector met with all the residents on their return from their daytime activities and was able to speak to some residents on an individual basis and to the group of residents as a whole. Information sent to the Commission prior to the inspection was taken into account when writing the report, including a pre-inspection questionnaire and replies received from surveys sent to service users, relatives and professionals. Service users and relatives were generally satisfied with the service provided, although one relative felt that the recent changes in management had had a negative effect on the quality of the service provided. Only one professional sent back a completed questionnaire and they were ambiguous about the home and felt there was a general lack of communication from the registered person. What the service does well:
Service users benefit from a well-maintained environment that has appropriate lighting and heating. Furnishing and fitments are comfortable and domestic in appearance. Service users were observed to move freely around all of the premises. Service users have comprehensive care plans in place and their physical, emotional and social needs are well documented. These have been regularly reviewed ensuring any changes to resident’s care needs are noted and put into practice by members of staff. Clear written guidance is given to staff about how to manage conditions such as epilepsy, diabetes and ‘challenging behaviour’. Service users personal care and healthcare needs are well met by the home. Personal support is offered in a way that promotes service users independence and takes into account their likes and dislikes. Residents are supported to attend healthcare appointments promoting their good health.
DS0000003956.V296889.R01.S.doc Version 5.2 Page 6 Service users said they enjoyed the meals, which were varied taking into account individual preferences and offering healthy eating choices. What has improved since the last inspection? What they could do better:
The home does not have a registered manager and the inspector was made aware during the inspection that the proposed manager was resigning from this post. The lack of a registered manager has a detrimental effect on the running of the home, as there is no clear leadership, guidance and direction for staff to ensure residents receive consistent quality care. The home has failed to follow regulatory procedures on two occasions when recruiting staff. A statutory requirement notice was served to the home on 3rd May 2006 asking the registered person to provide evidence that staff were being recruited according to statutory regulations. The registered person has subsequently forwarded the required documentation and information to CSCI. The registered person must continue to comply with these regulations to ensure service users are not placed at risk. The home’s training and development plan does not currently meet the standards for induction or qualifications meaning there is a reliance on staff
DS0000003956.V296889.R01.S.doc Version 5.2 Page 7 experience rather than trained skills and competencies. This does not ensure the overall aims of the home are met e.g. staff are not currently up-to-date with training in protecting vulnerable adults and do not have specialist training in working with adults with learning disabilities. There is an outstanding requirement regarding the management of service users finances. Unfortunately, the registered provider was not available on the day of the inspection and the proposed manager was not aware of the current situation so no further evidence could be provided at the inspection to show this requirement was being met. A meeting has been subsequently set up with the registered provider to address this requirement. There was some evidence that members of staff did not always support service users’ choices particularly if they did not approve of the decision being made. It is important that service users are encouraged to make choices even if staff do not always agree with these. Staff need to ensure they do not influence service users decisions either intentionally or unintentionally by sending out negative messages about choices service users have made. Some practices in the home do not promote service users participation in household routines which limits service users’ opportunities for developing independent living skills. For example the main responsibilities for cooking and cleaning are undertaken by staff employed specifically to do these activities. The registered person needs to check that the environmental health authority has been consulted with regards to the home having suitable arrangements for maintaining satisfactory standards of hygiene in the home. This includes the arrangements for storage of food that is currently being kept next to laundry facilities. There is currently no programme of self review in the home and feedback from service users has been very limited providing little indication as to how the home is to develop its services or improve its quality. One of the home’s bathing adaptations needs to be repaired so all service users can access the bathroom facilities. Some minor amendments are needed to service user contracts to ensure they know which bedroom is specifically allocated to them. Communication would also be enhanced by making documents such as the service user guide into more accessible formats so residents could better understand them. 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. DS0000003956.V296889.R01.S.doc Version 5.2 Page 8 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 DS0000003956.V296889.R01.S.doc Version 5.2 Page 9 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): 1, 2 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Previous evidence indicates professionals assessments of service users needs were carried out prior to admission to ensure the home could provide appropriate care. Information about the home’s service and facilities is available to prospective residents, although this would benefit from being in a more user-friendly format. EVIDENCE: A sample of 2 service users’ files was examined as part of the inspection. There was evidence that care management assessment and plans had been completed prior to admission. Some residents had lived in the home for a number of years and there had not been a new admission to the home since 2003. The home has an admission policy and the proposed manager indicated an appropriate introductory period would be provided to any prospective residents. A Statement of Purpose and Service User Guide are available to provide written information about the home’s services and facilities. There is an DS0000003956.V296889.R01.S.doc Version 5.2 Page 10 outstanding recommendation, however, to develop the Service User Guide in a more accessible format. There is an outstanding recommendation that service users’ contracts specify the room that is to be occupied. A sample of contracts was viewed at the inspection and this had not been implemented so this recommendation is repeated in this report. DS0000003956.V296889.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Detailed care plans are in place providing staff with good information about individual support needs. These have been regularly reviewed ensuring any changes to resident’s care needs are noted and put into practice by members of staff. Service users are supported to make some decisions in their daily lives, although staff need to develop a greater awareness of how their actions can impact upon and influence service users choices. The home must re-organise the way service users finances are managed to ensure it meets regulatory requirements. Assessments were in place to minimise risks to service users, which were carried out individually taking into account each service users abilities to manage tasks independently. DS0000003956.V296889.R01.S.doc Version 5.2 Page 12 EVIDENCE: The two service users whose files were sampled had detailed care plans. These contained information regarding health needs, communication, personal care, community access, mobility, money management, domestic tasks, social, leisure and recreational activities and relationships and sexuality. Plans also contained clear guidance to staff about the support required e.g. how to deal with ‘challenging behaviour’. Both service users’ care plans had been reviewed in March and any changes to care plans had been recorded. Staff spoken with said they were able to access the care plans and demonstrated a good knowledge of individual resident’s care needs. There was some evidence that service users were encouraged to make decisions in their daily lives. For example, service users were consulted about menu choices and outings in residents’ meetings. Observation during the inspection showed that one service user was supported to go out shopping and purchase the goods of his choice. Another resident was currently looking forward to moving on to more independent accommodation. Discussion with members of staff indicated they had reservations about this decision. It is important, however, that service users are supported to make choices even if staff do not always agree with these. Staff need to ensure they do not influence service users decisions either intentionally or unintentionally by sending out negative messages about choices service users have made. There is an outstanding requirement regarding the management of service users finances. Unfortunately, the registered provider was not available on the day of the inspection and the proposed manager was not aware of the current situation so no further evidence could be provided at the inspection to show this requirement was being met. A meeting has been subsequently set up with the registered provider to address this requirement. A sample of individual service users financial records was checked during the inspection. These were satisfactory and recorded details of all transaction for which receipts were kept. The inspector noted that service user’s pin numbers were being kept in the front of their individual files and recommended for better security that these were locked in a separated filing cabinet. A sample of individual risk assessments were seen on service users files including finances, community access, slips/trips/falls, and medication. These were based on promoting service user choice rather than imposing unnecessary limitations e.g. one service user said he could go out into the community independently whilst others needed to be supported by staff. DS0000003956.V296889.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory daytime activities were organised outside the home and improvements to day care organised by the home had been made providing a more structured and fulfilling weekly programme. The home has good access to the local community and residents are able to use the local facilities and amenities. The home welcomes visits from family and friends and service users are supported to maintain their personal relationships. Service users were able to exercise individual choice and had freedom of movement in the home, although increasing service users participation in household routines would provide further opportunities for developing independent living skills. Service users enjoyed the meals, which were varied taking into account individual preferences and offering healthy eating choices.
DS0000003956.V296889.R01.S.doc Version 5.2 Page 14 EVIDENCE: Suitable daytime activities were recorded on service users files and these included day centres, college courses and work placements. Discussion with service users on their return from their daily activities confirmed they were happy with their individual arrangements. The home currently provides day time care for one service user, and the inspector was pleased to see the home had been working on a more structured day care pattern. The service user had been enrolled on an adult literacy class twice a week and told the inspector he was looking forward to beginning this. Observation on the day of the inspection showed the service user was taken out shopping with a member of staff and they also had lunch out. Service users spoke about accessing a range of facilities in the local community including shops, post office, banks, leisure centres, pubs, cafes and beaches. The home has good access to public transport and service users confirmed they could catch the bus to the local town centres with staff support. There was evidence that personal relationships were supported and details of relatives were recorded on service users files. Service users were able to visit and spend time with their families, although not all service users had relatives living locally. Feedback from relatives surveys also confirmed they were welcome to visit the home and could see their relatives in private. A member of staff told the inspector that a service user who had moved out of the home had recently been to visit and was being encouraged to maintain contact with some of the residents he had close friendships with. Observation during the inspection evidenced that service users had unrestricted access to all communal areas of the home. On their return from day centre activities service users choose whether to spend time in the kitchen, dining room and lounge or in the privacy of their bedrooms. Staff were seen chatting and interacting with the service users. Service users responsibilities for housekeeping tasks were identified on their care plans e.g. “X is a capable assistant in the kitchen, can dry up and tidy bedroom”. There was some evidence that service users could get involved in daily routines such as making up lunch boxes and helping with the shopping. The main responsibilities for cooking and cleaning are undertaken by staff employed specifically to do these activities, which means there are less opportunities for service user participation. It is recommended that ways of further involving service users in household chores be explored to promote independent living skills. A member of staff had responsibility for catering in the home. She said that service users were consulted about their preferences when drawing up the menus and that service users were involved in shopping. Records of menus showed that a varied and balanced diet was offered. An alternative choice was
DS0000003956.V296889.R01.S.doc Version 5.2 Page 15 offered if residents didn’t like the main meal. Service users told the inspector they enjoyed the food in the home. DS0000003956.V296889.R01.S.doc Version 5.2 Page 16 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): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is offered in a way that promotes service users independence and takes into account their likes and dislikes. Clear guidance is available for staff on service users’ physical and mental health ensuring resident’s well being. The home’s system of administering medication is satisfactorily managed promoting service user’s good health. EVIDENCE: Personal care needs were well documented on service users’ care plans. These included information on washing, oral hygiene, hair care, shaving, continence and dressing, giving staff clear guidance about individual support needs. Discussion with service users confirmed they were generally happy with the support they were given. Staff spoken with demonstrated a good understanding of resident’s care needs and said personal preferences were taken into account.
DS0000003956.V296889.R01.S.doc Version 5.2 Page 17 Service users plans contained detailed information about their health needs including their physical and mental health. G.P. details were clearly recorded and all visits to healthcare professionals were noted. Clear written instructions were available to staff on how to care for particular conditions e.g. monitoring mental health and a protocol from managing diabetes. Advice was also included about when to seek professional advice e.g. referral to psychiatrist and contact details for the district nurse. Staff told the inspector they were continuing to ensure residents kept medical appointments and were supported to attend these. The medication cupboard was checked as part of the inspection. The home has a locked cupboard in the office and uses a monitored dosage system. A sample of records was checked and these were found to be up-to-date and accurate. None of the residents have been assessed as able to manage their own medication, although some take responsibility for their medication when they are out at their day-time activities and this is appropriately risk assessed. A consent form signed by the service user giving permission for staff to administer their medication was observed on the files that were case tracked. The inspector noted that staff were booked on a course for training in the safe handling of medication on the 30th June 2006. DS0000003956.V296889.R01.S.doc Version 5.2 Page 18 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): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place and service users can access advocacy/professional support to ensure their views are listened to. The home has appropriate guidance for staff about the protection of vulnerable adults, although training in this area would further ensure staff had knowledge of the correct procedures to follow. EVIDENCE: The home has a satisfactory complaints procedure that is available in a format accessible to residents. This is displayed on the notice board in the dining room. Residents were able to articulate their views to the inspector and were aware they could speak to other professionals e.g. care managers about any concerns that they had. The home has policies and procedures concerned with the protection of vulnerable adults. These included Adult Protection and Prevention of Abuse, Dealing with Aggression and Whistleblowing. Staff have to read the policies and sign to confirm they have understood them. Discussion with the proposed manager identified that staff still need to undertake adult protection training and he agreed to try and co-ordinate this with the local authority. DS0000003956.V296889.R01.S.doc Version 5.2 Page 19 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, 27 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained providing a comfortable and safe environment for those living there, working there and visiting. The home provides an adequate number of bathrooms but needs to ensure that adaptations are kept in a good state of repair so the facilities can be accessed by all service users. A good standard of cleanliness is kept in the home, although some reorganisation is needed for the storage of food to ensure it is kept away from laundry facilities. EVIDENCE: A tour of the premises was carried out as part of the inspection. All communal areas were viewed including the lounge, dining room, kitchen, laundry room and garden. The inspector observed the premises had suitable lighting and heating. Furnishings and fittings were well maintained and domestic in appearance. Recent purchases of garden furniture and various garden
DS0000003956.V296889.R01.S.doc Version 5.2 Page 20 ornaments had enhanced the appearance of the garden making it inviting to the residents. All service users’ bedrooms were seen. These had been clearly personalised to the occupant’s taste and had plenty of space for personal possession. Residents told the inspector they liked their bedrooms and were happy with their living environment. The inspector noted that a bath seat in the upstairs bathroom was not currently working, although the manager said arrangements had been made to repair this. In the meantime, residents who normally used this bathroom were accessing the downstairs bathroom. On the day of the inspection the home was seen to be very clean and tidy with no offensive odours. The home employs a domestic assistant who works Mondays to Fridays who is responsible for keeping the home clean. There are separate laundry facilities in an outside storage shed. It was recommended at the last inspection that all perishable food was stored in airtight boxes or moved into the kitchen away from laundry facilities, however, the inspector observed perishable food was still being stored near the laundry facilities. This recommendation has been repeated in this report. DS0000003956.V296889.R01.S.doc Version 5.2 Page 21 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, 34, 35 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff team have various background experience and demonstrate an awareness of service users needs, further training opportunities would develop a range of skills for working with service users in the home. The registered provider has failed to follow regulatory procedures on two occasions when recruiting staff. These are now being complied with and must be maintained to ensure service users are not placed at risk. Some progress had been made in identifying and addressing the staff team’s training needs. Further courses need to be organised to ensure staff have the trained skills and competences for working with adults with learning disabilities. A formal supervision system has been introduced into the home, which needs to be maintained by the registered provider to ensure staff have opportunities to express their views and gain feedback on their performance. DS0000003956.V296889.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has a small team of 6 members of care staff and a domestic. There is a mix of male and female staff and age groups. All staff have some previous experience, some have experience in a nursing environment and others in care homes for the elderly or domiciliary care work. There is currently only one member of staff who has achieved an NVQ qualification, however, a further 2 members of staff have almost completed NVQ Level 2. Once they have completed this training, the home will meet the target of having 50 of care workers qualified in the home. Observation of practice showed staff were approachable and appeared comfortable with the residents. Service users told the inspector they liked the staff. Analysis of service user feedback surveys showed 2 service users felt they were always treated well, 2 felt they were usually treated well and 1 felt they were sometimes treated well. One relative commented on their survey form “the staff are very good and helpful”. There was a breach of recruitment procedures at the previous inspection. Since that inspection, further evidence submitted to the CSCI showed a further breach of recruitment regulations had taken place resulting in a Statutory Requirement Notice being served. Not all staffing records were made available to the inspector at the inspection, although subsequent to the inspection, the registered provider forwarded the information and documentation to CSCI to comply with the Statutory Requirement Notice. There was evidence that the proposed manager had identified the training needs of the staff team. He had set up a training plan and there was evidence that staff had recently attended training in fire and first aid. The inspector was shown certificates confirming staff had attended these courses and feedback from staff also confirmed they had recently undergone training in these areas. The proposed manager had booked further courses in health and safety, food hygiene, infection control and medication awareness. There is still a need to provide training in adult protection and an outstanding recommendation for the registered person to explore training that follows the Learning Disability Award Framework. The proposed manager had begun supervision sessions with members of staff, however, since he has now resigned from this post, the registered provider needs to ensure these continue to be carried out in order to maintain the standard in the home. DS0000003956.V296889.R01.S.doc Version 5.2 Page 23 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of a registered manager has a detrimental effect on the running of the home, as there is no clear leadership, guidance and direction for staff to ensure residents receive consistent quality care. There is currently no programme of self review in the home and feedback from service users has been very limited providing little indication as to how the home is to develop its services or improve its quality. Some improvement had been made to the health and safety practices in the home, although the home needs to check it complies with other agencies requirements to fully promote the welfare of the residents. DS0000003956.V296889.R01.S.doc Version 5.2 Page 24 EVIDENCE: The home does not have a registered manager and the inspector was made aware during the inspection that the proposed manager was resigning from this post. A subsequent meeting has been set up with the registered provider to discuss future management of the home. The home does not currently have a quality monitoring system and nothing has been done since the previous registered manager carried out a residents’ survey in March 2005. The home must develop an annual development plan to provide action points/targets to further improve the quality of service in the home. This should be based on feedback about the service provided from service users, relatives and other interested parties. Records showed that generally certificates were in place demonstrating that equipment and facilities were regularly serviced and maintained. No evidence could be found to show when the home had last been inspected by the Environmental Health officer. The proposed manager agreed to check this out. The inspector examined fire records and found these were now being kept upto-date. It was also noted that staff had completed fire training in April 2006. There is an outstanding recommendation that the names of service users taking part in fire drills are recorded to facilitate monitoring. It is also recommended that the registered provider nominates a member of staff to oversee health and safety issues in the home in the absence of a manager to ensure that there is no further slippage in health and safety practices. DS0000003956.V296889.R01.S.doc Version 5.2 Page 25 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 2 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 3 25 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 1 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 1 X X 2 X DS0000003956.V296889.R01.S.doc Version 5.2 Page 26 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 YA7 Regulation 20 Requirement The registered person should not pay money belonging to any service user into a bank account unless the account is in the name of the service user(s) and is not used in connection with the carrying on or management of the care home. (Previous timescale of 31 January 2005 not met.) The registered person must ensure staff support service users to make decisions with respect to the care they receive and ensure they do not influence service users decisions either intentionally or unintentionally by sending out negative messages about choices service users have made. The registered person must make arrangements to ensure staff are trained to prevent service users being harmed or suffering abuse or placed at risk of harm or abuse. Timescale for action 01/07/06 2 YA7 12 01/07/06 3. YA23 13 01/08/06 DS0000003956.V296889.R01.S.doc Version 5.2 Page 27 4. YA27 23 The registered person needs to ensure that adaptations are kept in a good state of repair so the bathroom facilities can be accessed by all service users. This specifically refers to the bath seat in the upstairs bathroom. The registered provider needs to achieve the target of at least 50 of care staff achieving a NVQ 2 qualification in care. The registered person must obtain all the information in respect of care workers in the home identified in Schedule 2 of the Care Homes Regulations 2001. The registered person must appoint a person to manage the care home and provide the Commission with the relevant details. 01/08/06 5. YA32 18 31/10/06 6. YA34 19 30/06/06 7. YA37 8 01/08/06 8. YA39 24 The registered person must 01/01/07 ensure effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. The registered person must ensure the environmental health authority has been consulted with regards to the home having suitable arrangements for maintaining satisfactory standards of hygiene in the home. 01/07/06 9. YA42 16 DS0000003956.V296889.R01.S.doc Version 5.2 Page 28 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 It is recommended that the service user guide would benefit from being available in a format accessible to service users with learning disabilities. (This was repeated from the inspection report dated 10/05/05.) It is recommended that the service users contract specifies the room that is to be occupied. (This was repeated from the inspection report dated 10/05/05.) It is recommended that the arrangements for keeping service users pin numbers are made more secure and these should be locked in a separate filing cabinet. It is recommended that ways of further involving service users in household chores be explored to promote independent living skills. (This was repeated from the inspection report dated 05/12/05.) It was recommended that all perishable food was stored in airtight boxes or moved into the kitchen away from laundry facilities. (This was repeated from the inspection report dated 05/12/05.) It was recommended that the registered person find out information about the availability of courses to ensure the home’s training programme follows current regulatory requirements e.g. LDAF. (This was repeated from the inspection report dated 05/12/05.) It is recommended that a member of staff is nominated as being responsible for Health and Safety checks in the home as well as the manager to ensure that these are carried out in his absence. (This was repeated from the inspection report dated 10/05/05.) It is recommended that the names of service users taking part in fire drills be recorded to facilitate monitoring. (This was repeated from the inspection report dated 05/12/05.) 2. YA5 3. 4. YA7 YA16 5. YA30 6. YA35 7. YA42 8. YA42 DS0000003956.V296889.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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