CARE HOME ADULTS 18-65
Lifestyles 55-59 Wentworth Road Scarcroft Hill York YO24 1DG Lead Inspector
Mary Slattery Unannounced Inspection 2nd February 2006 10:15 Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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 Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lifestyles Address 55-59 Wentworth Road Scarcroft Hill York YO24 1DG 01904 645650 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) Dove Care Ltd. *** Post Vacant *** Care Home 19 Category(ies) of Learning disability (19), Mental disorder, registration, with number excluding learning disability or dementia (19) of places Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 7th June 2005 Brief Description of the Service: Lifestyles is a care home providing personal care, support and accommodation for up to 19 service users with learning disabilities and mental disorder. The home comprises of three large terraced houses linked together with a variety of communal rooms, single and double bedrooms and a patio garden at the rear of house. The home is within walking distance of York city centre. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection carried out on the 2nd February 2006. The inspection took 5 hours plus 2 hours preparation time. A tour of the premises was carried out, which included some of the service users private accommodation. A selection of the homes’ records were looked at and time was spent observing the activity in the home, talking and listening to service users and staff. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish if they corresponded with their experiences of life in the home. The registered person was available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well: What has improved since the last inspection?
The dining room and some of the service users bedrooms have been redecorated and a new single bedroom had been commissioned. This has reduced the number of double bedrooms. The heating and hot water systems have been serviced and are now fully operational ensuring that each part of the home is warm. There has been increased contact with care managers and a number of service users care and placements have been reviewed.
Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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 Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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): 1,2 and 5. Information is available in the statement of purpose to inform people about what the home provides. EVIDENCE: The statement of purpose needs to be reviewed to reflect the changes made to the accommodation and the details of the staff that are now employed. There is an assessment tool available for use but there have been no new admissions to the home. New contracts and terms and conditions document need to be put in place and agreed with each service user. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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): 6,7,8, 9 and 10. The service users are supported in making decisions about their lives. Progress needs to be made to develop good care plans. EVIDENCE: There has been little progress made on the development of the service users care plans since the last inspection. It is important that each service user has a comprehensive care plan in place which identifies their needs, goals and aspirations. Risk assessments have not been carried out and there was no clear guidance for the staff and the service users to make sure that people are safe and that any restrictions on their movements are clearly defined. The majority of the service users are able to contribute to the development of their own care plans and are aware of the importance of risk assessments and the reason why restrictions are placed on their movements. The daily records kept by the staff and, in some instances, the service users gave information about the type and level of care and support they have, the
Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 10 risk they take in their daily lives, the social and occupational activities and how any problems were rectified. The service users and the staff meet each day to discuss the day’s events and to make future plans including choosing the décor for the communal areas around the home. The issues discussed and the outcomes should be recorded thus contributing to the quality monitoring of the service. The service users and the staff have been party to the review of the homes’ confidentiality policy and procedure and they are fully aware of the importance of the sharing of information with people outside of the home. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed at this inspection. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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): 18, 19 and 20. There are systems in place to support the service users with their physical and emotional needs. EVIDENCE: The home operates a key worker system and the service users told me that they receive the help and support they need with all aspects of their lives from their key worker. They have the opportunity to discuss any concerns they may have and to develop new skills and manage difficulties in an agreed way. Some of the service users make and attend their own health care appointments and share the outcomes of these with their key worker. Records of all health care issues were in place and evidence to show that regular reviews of health care needs are carried out. Where service users wish and are able, they administer their own medication. The appropriate arrangements and facilities are put in place to ensure that medication is kept safe. The medication system and facilities were inspected and gaps were found in the administration records, the codes were not used correctly and medication had been signed for before being administered. Staff would benefit from medication training.
Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 13 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. The service users know that their concerns and complaints will be taken seriously. EVIDENCE: The service users said that the staff listen to them and help them sort out any complaints they may have either about the home or issues in the community. All complaints and concerns are recorded including the outcomes of any actions taken. The views of the service users are sought and recorded about all aspects of their lives in the home - these records were available at the inspection. There is an adult protection policy and procedure and the staff currently working in the home are competent in using the local authorities reporting procedure. POVA training must be made available to all staff. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 14 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, 25 and 30. Parts of the home have been redecorated but work needs to be done to improve the overall safety of the environment. EVIDENCE: The home was warm, bright and free from offensive odours. The dining room has been decorated and new flooring has been laid. The service users told me that there are plans for both sitting rooms to be redecorated and a number of service users had had their bedrooms redecorated. Work has been done to improve the hot water and heating throughout the house and a new single bedroom has been commissioned thus reducing the number of double rooms. The fire detection equipment had not been tested each week and there were no records of the detection of any faults or of the actions taken to rectify any fault. A fire risk assessment had not been completed and therefore was not available for staff. There had been no risk assessments of the premises and the equipment. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 15 A fixed wiring certificate and a Gas Safety certificate were not available for inspection and no information regarding the use and storage of substances used that are considered hazardous to health in line with COSHH regulations. Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 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, 34, 35 and 36. The service users would benefit from an increase in the staffing levels. EVIDENCE: There are 2 staff on duty at all times during the day and at times 3, there is one member of staff on waking night duty and one member of staff sleeping in on call. Where service users need to keep health care appointments and need staff support, this is provided by increasing the numbers of staff on duty. 1 member of staff has completed NVQ level 3. 3 members of staff have completed NVQ level 2. Training planned to take place includes mental health and medication. Staff need to have training in food hygiene, fire safety, health and safety and POVA. Four of the staff files were inspected and the required records and evidence of all the required checks were in place in one of the files. The other 3 files had no evidence of a current CRB and POVA check. All staff would benefit from having regular formal supervision to assist them in the development of their role and to identify any specific training need.
Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 17 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, 38, 39, 40, 41 and 42. An action plan needs to be implemented to make sure that all the homes’ polices and procedures are current and that the required records are in place. EVIDENCE: The registered proprietor is responsible for the day-to-day management of the home and has completed the Registered Managers Award. The service users said they were able to contribute to the running of the home and they were consulted about any proposed changes. There is no established quality audit or monitoring system in place. All of the policies and procedures need to be reviewed and changed to reflect the current services, the facilities and the aims and objectives. The home has a health and safety policy and procedure in place but arrangements need to be made for staff to attend fire safety, food hygiene and health and safety training. The required safety certificates need to be in place as detailed in the section relating to the environment.
Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 18 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 1 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 1 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 3 3 1 1 1 X Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 19 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 YA1 Regulation 6(a)(b) Requirement The registered person is required to review and update the statement of purpose and service user guide to reflect the current service provided and the details of the staff. The registered person is required to provide each service user with a current terms and conditions document. The registered person is required to have a care plan in place for each service user and keep the care plan under review. The registered person is required to undertake robust risk assessments and record the findings in the service users care plans. The registered person is required to keep accurate medication records to evidence that service users have received their prescribed medication. The registered person is required to have a fixed wiring certificate and a gas safety certificate in place. To test the fire safety equipment as required. To carry out risk assessment of the
DS0000062824.V275528.R01.S.doc Timescale for action 30/03/06 2. YA5 5(1)(c) 30/03/06 3. YA6 15 (1)(2) 30/04/06 4. YA9 13(c) 30/04/06 5. YA20 13(2) 28/02/06 6. YA24 13(4)(a) 30/04/06 Lifestyles Version 5.1 Page 20 7. YA42YA32 18(1)(c) 8. YA41YA40 17(2)(3) premises and equipment and to have information about the use of the COSHH available for staff. The registered person is required to make arrangements for staff to undertake the following training: adult protection, food hygiene, fire safety, health and safety and medication. To make arrangements for all staff to have formal supervision. The registered person is required to review and update all the homes’ policies and procedures and to have the required records in place. 30/05/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lifestyles DS0000062824.V275528.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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