Inspection on 07/08/07 for Lifestyles

This inspection was carried out on 7th August 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lifestyles 29/07/08

Lifestyles 19/07/06

Lifestyles 02/02/06

Lifestyles 07/06/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Lifestyles 55-59 Wentworth Road Scarcroft Hill York YO24 1DG Lead Inspector David White Key Unannounced Inspection 7th August 2007 08:30 Lifestyles DS0000062824.V343658.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 Lifestyles DS0000062824.V343658.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. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 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.V343658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Lifestyles is owned by Dove Care Limited and is registered to provide 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 back of the house. The home is within walking distance of York city centre its amenities and leisure facilities. The current weekly fee at the time of the site visit on 7th August 2007 is £409 per week and there are no additional charges as the service users purchase their own extras. Activities and holidays are included in the fees charged. Current information about services provided at Lifestyles is available in the form of a statement of purpose and service user guide that explains the care and services on offer at the home. The most recent inspection report is on display in the home and copies can be obtained from the manager on request. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered proprietor in an Annual Quality Assurance Assessment (AQAA) of the home. Comment cards returned by three people who use the services, four health/social care professionals and one relative. This report follows an unannounced site visit undertaken on the 7th August 2007. This visit was carried out by one Regulation Inspector and took 7 hours with 5 hours preparation time. Time was spent talking to four people who live at the home; two members of care staff, the administrator and the registered proprietor. Records relating to people at the home, staff and the management activities of the home were inspected. During the visit care practices were observed, where appropriate, and time was also spent watching the general activity in the home. This helped in gaining an insight into what life is like for people living in Lifestyles. The registered proprietor who carries out the management responsibilities for the home was available for all of the inspection and the findings were discussed with her at the end of the site visit. What the service does well: People living at the home said that they are encouraged to make their own choices about their daily routines and this enables them to have control over their lives. One person using the service made comments that “this is the best care home in the world” and people feel that staff treat them well. People’s healthcare needs are looked after properly so that any health problems are dealt with quickly. One person said “if I am feeling unwell an appointment is made immediately for me to see someone” and health professionals made comments that the home was good at communicating with them and responding to concerns about people’s health. People who live at the home and a health professional describe the staff team as “kind”. There is low staff turnover so the staff team are settled and this means that people are receiving consistent care from people who know them well. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: One person living in the home could have a more detailed care plan to make sure that staff are clear about the type of support the person needs. People could be weighed in more private areas of the home so that their privacy and dignity is better maintained. People could be more involved in choosing meals that are provided. Better arrangements could be put in place to make sure that the numbers and skill mix of staff on duty at any particular time are suitable in meeting people’s needs. Better checks could be made on staff before they are allowed to start working at the home so that people are protected from unsuitable workers. Staff training and supervision could be better planned so that people can feel confident that staff have up to date training and skills to provide care in a safe way. Various health and safety practices could be improved so that people’s health is not put at risk. Urgent action needs to be taken to make sure that people are not at risk from scalding from hot water temperatures in a bathroom. A formal letter was left Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 7 at the site visit requiring the registered proprietor to deal with this problem immediately. 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. The summary of this inspection report can be made available in other formats on request. Lifestyles DS0000062824.V343658.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 Lifestyles DS0000062824.V343658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living at the home receive information about what the home has to offer and their needs are assessed before they move in to make sure that these can be met. EVIDENCE: Following the previous inspection visit the registered proprietor has made sure that each person has a copy of the terms and conditions of living in the home. Most of the people at the home have asked for staff to keep this information in their personal files although they can keep a copy of this document in their bedroom if they so wish. The registered proprietor is also developing a new booklet that will detail the care and services on offer at the home. Since the previous inspection visit the home has admitted two people. The care records for one of these people show that the admission had been arranged as an emergency placement. However relevant information had been obtained about the person before the management agreed to the admission to make sure the home was suitable for the person and so that staff had an understanding of the person’s needs. A needs assessment is being carried out for the person and this is ongoing. Following the completion of this Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 10 assessment a care plan will be drawn up from this describing how the identified needs are to be met. The registered proprietor who manages the home on a daily basis said that visits are made to see any person who is thinking about moving into the home beforehand. This helps with the decision-making about the person’s suitability to live in the home. People who live at the home said that they usually get on with each other. However they did say that in the past one person who was at the home had been aggressive towards a number of people living there and has since moved on to alternative accommodation. They made comments that the atmosphere in the home was now more relaxed because of this. One person did say that they had difficulty in living with some of the people at the home and had asked their care manager to look at possible alternative placements. The care records for this person show that measures are being taken to meet the person’s wishes. Lifestyles DS0000062824.V343658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People are encouraged to make their own choices about how they live their lives and overall this is supported by improvements to the care planning systems although in some areas the way care is planned and agreed needs to be better recorded. EVIDENCE: People living at the home said that they feel they can choose their daily routines and said that they make their own decisions about what to do during each day. Some people who prefer to get up later in a morning are able to do so and there are no restrictions on when people go to bed. Every person spoken to said that since the new owners had taken over they are able to “make far more decisions for ourselves” and they valued this. Each person has a care plan that describes their needs and provides information for staff about what they need to do to meet the identified needs. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 12 The care plans include information about each person’s likes and dislikes and their hobbies and interests. Staff made comments that the care plans have been improved so that they are simpler to understand. People said that they have a key worker who discusses their care with them and the care plans are regularly updated to reflect any changing needs. However although people said that they are involved in this process there is no written information in their care records to show this. Most people’s care records contain sufficient information about the support that each person needs. However, the care records of one person with mental health problems contain only a very basic care plan that does not include any detail about the person’s mental health needs. Although there is some detailed information from the placing authority about the person’s mental health needs and required level of support, this information had not been transferred into the person’s care plan. This could lead to staff not being aware of signs that the person was becoming unwell and could lead to delays in addressing any health needs. Care plan reviews take place on a periodic basis and involve the person at the home, relatives and other people who are involved in their care. There is a range of risk assessments in each care plan to support people with their independence and safety. This information describes how decisions about restriction on choices for people have been made. People did say that they are in agreement with any limitations that have been put on them; however there are no written records in the care plans to show this. Daily meetings are held with people who are at the home to plan the day and to discuss any other aspects of the home. Lifestyles DS0000062824.V343658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People enjoy a range of activities to suit their personal needs and have involvement in the local community. EVIDENCE: People feel that they are now more involved in decision making about the home since the new owners took over. One person said that the home is now “more relaxed and friendly, and we feel more trusted and are able to do things on our own”. People have opportunities for personal development and to pursue leisure interests. Some people have paid employment and others do voluntary work in the local community. One person does voluntary work in a local charity shop and from speaking to them it is clear that they benefit from doing this. Another person is a grounds man for the local football team. One person has Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 14 expressed an interest in attending college courses and staff have been supportive in finding out information about the courses on offer and how to access these. Most people are independent and go out on their own. Some people attend the local pubs and one person said that he is a member of the dominoes team at one pub. Others enjoy fishing and some people have a bicycle to help them get around the local areas. One person said they had a bus pass that enabled them to have free travel. Some people had enjoyed a holiday in Skegness earlier this year. Visiting arrangements are flexible and people said that they are able to see visitors in private. Five people had gone on leave to stay with family at the time of the site visit. The care records provide information about people’s food likes and dislikes. In the daily meetings the menus for the day are discussed and any changes are made as needed. People made mixed comments about the quality of the food. One person said, “I can’t fault the food, it is always healthy” and another “the food is good and there is always an alternative if you do not like what is on offer”. However another person said that the food choices are “always the same”. One person did say that they did not get breakfast if they got up late, however staff and other people living in the home said that people can have breakfast whenever they get up and this could be observed at the time of the site visit. People who live at the home did say that it is staff who mainly decide the menu choices and they do not have a lot of say in what the food options are. This needs addressing so that people are more involved in decision-making about their food choices. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People’s personal and healthcare needs are met although more consideration needs to be given to maintaining their dignity and privacy. EVIDENCE: People’s individual plans describe the personal and healthcare needs of each person and the type of support they need. Most of the people living at the home are able to attend to their own needs and support is given to those who need assistance. Comments received from a person using the service said, “this is the best care home in the world, staff treat us so well”. Another person said, “I am extremely happy and feel well looked after”. Each person has a General Practitioner (GP), a dentist and access to other healthcare services. A health professional made comments that the home has good links with the local learning disability service and supports people with their appointments and in attending review meetings. Another health professional said that the home contacts other services with any queries about issues so that appropriate actions can be taken to meet people’s needs. One Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 16 person said that they have six-monthly reviews with their GP to review their health and any medication that they may be taking. Another person at the home said that appointments are arranged immediately if they start to feel unwell. At the time of the site visit a daily meeting was being held in the lounge area. Following the meeting some weighing scales were brought out and people were weighed whilst others sat and watched on. One person described this as “embarrassing”. This issue was discussed with the registered proprietor who will be taking action to address this practice so that the privacy and dignity of each person is maintained in future. Medication is administered using a safe, recognised system, which minimises the chances of mistakes happening. Medication Administration Records are up to date and there are proper arrangements in place for the receipt and disposal of medications. Some people administer their own medication and risk assessments are in place to support people to be able to do this safely. All staff who administer medication in the home have received the appropriate training. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living at the home feel confident that their concerns would be acted on properly and procedures are in place to safeguard them from harm. EVIDENCE: The home has a complaints procedure that is on display in the home. People know who they would need to speak to if they have any areas of concern and have confidence that the registered proprietor would deal with any matters properly. Some concerns were raised with social services by a relative about some issues relating to the care practices in the home. One matter alleged that an aspect of care practice was abusive and so was referred to the appropriate authorities and investigations into the allegation remain ongoing. The registered proprietor has been asked to investigate the other areas of the complaint. The registered proprietor said that this has not happened as yet as the details about the nature of the complaints are unclear and she has written to the complainant and the care manager to seek more clarity about this. Staff receive adult abuse awareness guidance as soon as they start working at the home and other forms of training are provided and updated so that staff are clear about how to recognise and respond to abuse. One person who previously lived at the home had acted inappropriately towards a member of staff and proper actions had been taken in response to this. Appropriate Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 18 actions had also been taken when this same person had been aggressive towards another person living at the home. Individual risk assessments are in place to identify and minimise risks from behaviour that challenges the service. One person has a history of leaving the home and going missing and measures are in place in the person’s care plan to instruct staff on what they need to do if this happens to promote the person’s safety. Some staff have had anger management, challenging behaviour and deescalation training so that they have the knowledge and skills to calm down difficult situations. Lifestyles DS0000062824.V343658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Improvements have been made to the environment and this has made the home more comfortable and pleasant for people living there. EVIDENCE: Accommodation is over three floors and can be accessed by stairs only and there is no ramped access to the home so the home is not suitable for people with mobility problems. One person living at the home does use a wheelchair but is able to walk up and down the steps leading to the entrance of the home and has a ground floor bedroom. There is a seated patio area to the rear of the building where people can sit and there is a garden shed that is currently used as a smoking area. There is also an allotment at the back of the building and some of the people at the home grow vegetables in there. People said that they like their bedrooms and these are personalised to suit their tastes. None of the bedrooms have en-suite facilities but bathrooms and Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 20 toilets are located close to bedroom areas. Each person has their own bedroom key to offer them independence and privacy. There is a range of communal space where people can sit and watch television if they choose to do so. Several improvements have been made to some aspects of the environment since the previous inspection visit. Several bedrooms have been re-decorated as well as the large sitting room and hallway and some new flooring has been fitted in one person’s bedroom. Furnishings and fittings have been updated in the lounge and dining room and new flooring has been fitted in one lounge and in a corridor area. People living at the home said that they are “well pleased with the improvements” and the registered proprietor said that the refurbishment of other parts of the home is ongoing. Some work needs doing in the kitchen where the flooring needs renewing and this work is about to start and in some areas of the home light bulbs are no longer working and need to be replaced to make sure there is adequate lighting in all parts of the home especially as two people living there have some visual impairment and may be at risk from tripping or falling. There is a separate laundry area where those people who are able to do their own washing do so and staff support others who need assistance with this. The home is generally clean and tidy. Staff and people who are using the service attend to the upkeep of the home and the cleaning arrangements for the day are agreed in the daily meetings. People at the home said that they are satisfied with these arrangements and feel involved in the upkeep of the home. The home has a recording book that informs the registered proprietor when jobs need to be done and there is an ongoing maintenance programme. Lifestyles DS0000062824.V343658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Better staffing levels would help in making sure that all people’s needs are met. Improvements are needed in the recruitment procedures to make sure that people are safeguarded from harm at all times. EVIDENCE: The duty rotas show that there are two staff on duty through the day and one waking member of night staff with one member of staff sleeping on the premises. At the time of the site visit there were initially two people on duty. However one of these staff was a newly appointed person who had started working at the home only a week earlier and was being supervised. This person was limited in what they were able to do and this placed additional demands on the other member of staff who as well as seeing to the needs of the people at the home was also attending to the breakfast meals, medication responsibilities and chairing the daily meeting with the people at the home. The duty rotas need to be better organised so that the staffing skill mix is suitable in providing the correct level of support to meet all the needs of the people at the home. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 22 Comments received by health professionals and a relative indicate that there are times when staffing levels are insufficient. People living at the home said that staff are “kind”, however, one person made comments that “there is not enough staff on occasions so we have little individual time with them”. Staff also said, “staffing levels could be better”. As well as the care duties staff along with people living at the home are also responsible for the cleaning duties and staff do most of the cooking for the meals. The registered proprietor agrees that the staffing levels need to be improved and has tried to recruit new staff through various means with little success. She will continue to try to recruit people to the home. In the meantime existing members of staff are working additional hours with their agreement to cover vacant shifts so that minimum staffing levels are met. Whilst the current staffing levels are adequate in meeting the basic needs of the people at the home, improvements in the numbers of staff would improve the quality of care and services on offer for people living at the home and reduce the burden of work for the existing staff team. Although the staff files show that on the whole proper recruitment procedures are followed in one case a recently appointed member of staff had been allowed to start working at the home before the Criminal Record Bureau (CRB) check or POVA (Protection of Vulnerable Adults) First check had been returned. This practice does not safeguard people at the home. The registered proprietor acknowledged that this practice was not acceptable and gave assurances that it would not happen again. A new member of staff said that they are receiving ongoing supervision from a senior member of staff and this could be seen at the time of the site visit. Staff receive a range of training to support them in their jobs and this includes National Vocational Qualification (NVQ) in care training, medication, abuse awareness, challenging behaviour management, fire safety, first aid and foundation training in mental health. However some staff need more up to date training in infection control and health and safety so they are aware of current safe working practices. Some people who are living at the home have received in-house training on fire safety and food hygiene and this is good practice. Although staff said that issues and matters relating to the home are discussed informally through verbal discussions there are still no formal arrangements in place for staff supervision. More formal supervision arrangements would be helpful in providing staff with individual support to do their jobs, in identifying any training needs and in addressing any management issues. Lifestyles DS0000062824.V343658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is managed in a way that involves people living at the home to be involved in decision-making about how the home is run. There are some shortfalls in aspects of health and safety that could put people at risk. EVIDENCE: The registered proprietor is a registered mental nurse and has completed the Registered Manager’s Award to develop her management skills. She is responsible for the day-to-day management of the home and is supported by a deputy manager. People living at the home and staff made comments on how much the home has improved since the home changed ownership. They now feel that they are Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 24 able to make their own decisions about how they live their lives, are encouraged to be more independent, feel safer and have confidence that any matters of concern will be properly dealt with. Staff said they feel “exceptionally well supported” in carrying out their jobs. Since the previous inspection visit some questionnaires have been sent out to people using the service and relatives seeking their views about the care and services on offer. The comments from these provide positive feedback about the home. Daily house meetings enable discussion to take place with people using the service to seek their opinions on the care they receive and they meet up with their key workers to discuss their care. Some health and safety practices help to maintain a safe environment. Fire safety is well maintained through regular fire safety checks and regular staff training. The registered proprietor has carried out a fire risk assessment of the premises to identify any environmental factors that could trigger a fire and control measures that need to be put in place to reduce fire risk. Health and safety documentation is up to date. There are other areas of health and safety that need addressing to help to maintain people’s safety. Since the previous inspection visit a system has been put in place to test and maintain the regulation of water temperatures and this includes checks to prevent risks from Legionella. However a random check of one bathroom in one part of the house (area 59) found the water temperatures to be 77.4 degrees and this is excessively high and unsafe. The hot water temperature monitoring records show that on a number of occasions the person making the checks had found similar findings but had not reported these and so no action had been taken to rectify the problem. This could have lead to a person being at serious risk from scalding. The registered proprietor was immediately notified of this and took appropriate actions to make sure that people were not at any immediate risk from having access to the hot water in the bathroom concerned. Arrangements are being made for a specialist company to come and look at the systems to find the cause of the problem so that the matter can be rectified. A formal letter requiring a prompt response to address this matter has been sent to the registered proprietor. During a look around the kitchen on inspection of the fridge contents a jar of chicken paste and some noodles had been opened but were not dated so it was unclear when they needed to be eaten by to prevent any risks to people’s health. As previously mentioned under the heading of staffing, proper recruitment procedures must be followed at all times to prevent possible harm to people and some staff are in need of up to date health and safety training so that they are aware of up to date safe working practices. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 25 The home employs an administrator who is responsible for the financial arrangements at the home. The administrator stores monies on behalf of people at the home and keeps up to date individual records of incoming and outgoing monies. Most people have their own post office account where their benefits are paid into. People can have access to their monies at any time. Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 26 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 1 X Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 15 Requirement All people using the service must have an up to date, detailed care plan. This will help in making sure that they receive person centred support that meets their needs. People being weighed must be done so in a way that maintains their privacy and dignity. Staffing levels and skill mix must be sufficient and appropriate at all times in order to make sure that the needs of each person living at the home are being met. In all future recruitment a Criminal Record Bureau (CRB) must be obtained before newly recruited staff begin working at the home. • The registered provider must assess the risk to people using the service from excessive water temperatures in one bathroom area (as Timescale for action 07/09/07 2. YA18 12 (4) 07/08/07 3. YA32 18 (1) 07/08/07 4. YA34 YA42 19 07/08/07 5 YA42 13 (4) (a) 07/08/07 Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 28 identified at the time of the site visit) and take necessary actions to minimise any identified risks. An immediate requirement letter was issued at the time of the site visit on 07/08/07. • The registered provider must put in place better arrangements for the monitoring and reporting of hot water temperatures so that excessively high temperatures that have been identified as part of the monitoring process are reported and can be acted on to reduce risks to the safety of people at the home. 07/10/07 6 YA35 YA42 13 • The registered provider must make arrangements for all staff to receive training where appropriate in the following areas: • • Infection control Health and Safety Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 29 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 YA9 Good Practice Recommendations Risk assessments should be signed by people using the service to indicate that they are in agreement with any actions that are being taken that may place restrictions on them. People using the service should be more involved in menu planning so that they have more choices in what they eat. Light bulbs that are no longer working should be replaced to maintain adequate levels of lighting for people living at the home. The kitchen flooring should be replaced to maintain the safety of people when using the kitchen. More formal supervision arrangements should be put in place to support staff in meeting the needs of people at the home. Food safety practices should be followed so that foods that have been opened are dated so that it is clear when they need to be eaten by to prevent health risks to people. 3. 4. YA17 YA24 5. 6. YA24 YA36 7. YA42 Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Lifestyles DS0000062824.V343658.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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