CARE HOME ADULTS 18-65
Mondial 3 Old Road Clacton On Sea Essex CO15 1HX Lead Inspector
Marion Angold Unannounced Inspection 20th December 2005 1:50 Mondial DS0000017889.V276611.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 Mondial DS0000017889.V276611.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. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Mondial Address 3 Old Road Clacton On Sea Essex CO15 1HX 01255 420995 01255 420995 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 Robert Clarkson Mr Robert Clarkson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th May 2005 Brief Description of the Service: Mondial provides a service for three people with moderate learning disabilities, situated in the heart of Clacton, near to shops and other amenities. Mondial is a detached bungalow with three single bedrooms, all with en-suite toilets. Two of the bedrooms are on the ground floor, along with a bathroom, kitchen, lounge and conservatory. The upstairs accommodation includes a laundry and a room for the member of staff sleeping in at night. A large garden is situated to back of the house and there is a small front garden, with off road parking. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection started at 1.50 pm and finished at 7 pm, assisted by the Registered Manager, Mr Robert Clarkson and one of the staff. Part of the Inspector’s time was spent speaking with the three service users. A number of records were also inspected. Of the 17 Standards inspected on this occasion, 11 were met and the remaining 6 presented minor shortfalls. What the service does well:
One service user’s description of Mondial as a ‘family home’ fitted the picture presented during the inspection. Service users showed that they were relaxed in the company of the Manager and member of staff on duty. The Manager reported that the off duty member of staff also had a good rapport with the service users and this was confirmed in other comments during the inspection. Service users were supported to make decisions for themselves and to have contact with the important people in their lives. Service users showed in discussion that their routines were flexible and that they were taking part in activities, which suited them as individuals. Staff support for service users, outside the home, included evenings and weekends. The home was well-maintained, clean, tidy and comfortably furnished. Service users could not think of anything that had changed since the last inspection, but one said that the home was well run and that they were all well cared for. Service users were supported by competent staff, who were receiving appropriate training and supervision for their roles. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Mondial DS0000017889.V276611.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 Mondial DS0000017889.V276611.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 and 5 Service users had suitable information about their home and clearly stated contracts of residence. EVIDENCE: Again it was not possible to inspect NMS 2 because the three people at Mondial had been resident since it opened. Service users had their own information pack, containing a copy of the Statement of Purpose and the Service Users Guide, and access to another copy in the communal area. The document was clearly written and accessible. The arrangements made for service users to attend religious services of their choice must be included in the Statement of Purpose. One service user’s contract/statement of terms and conditions with the home was sampled and found to be satisfactory. In line with NMS 5.2 vi and viii, service users should have, as part of their contract, a copy of their care plan and details of any part of this that is to be provided outside the home. Mondial DS0000017889.V276611.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 and 7 Service users’ progress towards their personal goals would be clearer, if their care plans contained more specific detail. Service users were supported to make decisions for themselves. EVIDENCE: Daily records for service users were suitably maintained in separate page-aday diaries. All three care plans inspected followed a clear methodology. In order fully to evaluate and build on individual progress with their care plan, it would be helpful to provide more detail about identified needs and strengths and how staff were expected to support the service user in achieving their goals. This was discussed with the Manager and staff member in relation to specific issues and individual progress highlighted during this inspection. Risk assessments had been completed in July 2003 and not reviewed since that time. The Manager proposed transferring the risk assessment to service users’ files, so that they would be reviewed routinely with their care plans. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 10 Service users were provided with the information and assistance they needed for making day-to-day decisions about their lives. This was demonstrated in respect of a particular dilemma facing one of the service users at the time of inspection. Given the small scale of the home, service users had almost constant access to a member of staff and it was apparent during the inspection that matters of importance to them might be discussed as they arose. Service users were also assisted with budgeting and it was evident that one service user knew about the arrangements in place to assist them and the money they had saved. The circumstances in which a service user’s rights might be infringed were summarised in their contracts with the home. Mondial DS0000017889.V276611.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): 12, 15 and 16 Service users were taking part in appropriate activities and being supported to have contact with the significant people in their lives. They benefited from the family style of operations in the home. EVIDENCE: Since the last inspection, one service user had benefited from engaging in new activities outside the home. Service users were involved in training and occupational workshops on a regular basis and made use of community facilities, such as the library. They were used to taking themselves around Clacton independently, and one person regularly went further on public transport. Two service users were committed to regular church based activities. Staff support for service users outside the home included evenings and weekends although, of necessity, this involved an off-duty member of staff. For example, one service user was regularly collected from church late on Saturday evenings.
Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 12 The service user guide clearly set out the home’s positive approach towards visitors and supporting service users to maintain family links. Two service users spoke about their contact with family in the run up to Christmas. The Inspector was informed that the Manager and staff would celebrate Christmas Day with the service users. Routines were flexible to accommodate service users’ activities and one service user’s description of Mondial as a ‘family home’ fitted the picture presented during the inspection. One service user said they were free to go out as long as they made it known to staff where they were going. Although it was customary for service users to retire to watch TV in their own rooms from 9.00 pm, this arrangement was said to be flexible and to work well for them. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users benefited from the way individual support was given. EVIDENCE: One service user’s description of Mondial as a ‘family home’ fitted the picture presented during the inspection, the small team of staff providing stability and continuity to a group of users, who had lived together for a number of years. Service users indicated that they were satisfied with the way their baths were scheduled and the support they received with personal care. Conversation with one service user confirmed that they were wearing clothes of their choice. The service user guide made it clear that bedrooms were the private domains of the occupant. Service users’ weight was being monitored by the home, as recommended at the last inspection. One service user confirmed that they all had regular medical reviews. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Satisfactory arrangements had been made to protect service users from abuse. EVIDENCE: Staff had attended the Essex Vulnerable Adults Protection Committee’s protection of vulnerable adults training, and this had been reflected in clear, simple procedures produced by the home. One service user commented that they were all well cared for. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Mondial offered service users a homely environment, suitable for their needs, but a more flexible approach was needed to heating the home. EVIDENCE: Mondial was well-maintained, fresh, clean, tidy and comfortably furnished. Service users were aware that re-decoration of some areas was planned. In answer to his queries, the Manager was advised to consult the local fire safety officer about fire arrangements and training requirements for a small home. The home felt very cold on entry. The Manager explained that the central heating was programmed to go off between 11 am and 3 pm. This was a particularly cold day and one of the service users was at home. Following the Inspector’s observations, the Manager adjusted the heating. He was advised that the heating should be thermostatically controlled, so that the temperature does not fall below an acceptable level. Service users should also be able to control the temperature of their bedrooms. Mondial DS0000017889.V276611.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): 31, 32, 34, 35 and 36 Service users were supported by competent staff, who received appropriate training and supervision for their roles. Service users were protected by the home’s recruitment practice, although some essential records had not been retained on file. EVIDENCE: Service users demonstrated that they were relaxed in the company of the Manager and member of staff on duty. The Manager reported that the off duty member of staff also had a good rapport with the service users and this was confirmed in other comments during the inspection. The size of the staff team meant that staff had limited opportunity for taking breaks and holidays. In a three-week period, the people managing/staffing the home worked on average 48 hours a week for 2 weeks and 72 hours during 1 week. The Manager stated that, although they were all flexible to make this work, he was considering employing a fourth person to provide back up. Both staff files evidenced satisfactory recruitment procedures, although the Manager was advised to ensure that a full employment history was obtained from all prospective employees. Not all the documents required by The Care Homes Regulations 2001 Regulations 17, Schedule 4 and 19, Schedule 2 had
Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 17 been retained on these files, although they had been seen for the purpose of obtaining Criminal Record Bureau disclosures. Induction records evidenced that the newer member of staff had covered a range of topics in the introduction to their role. The Manager reported certain difficulties in accessing, for this person, training for the National Vocational Qualification in care Level 2, but they were due to register on 9/1/2006 for the next course. The other member of staff had nearly completed the National Vocational Qualification (NVQ) in care, Level 3. They reported that certain modules of this course had been tailored for people working in the field of learning disability. Since the last inspection, the Manager and staff had completed training in mandatory and practice topics, including moving and handling, food hygiene, protection of vulnerable adults, the Disability Discrimination Act and freedom of information. Further training had been planned. One member of staff needed to complete a course on food hygiene and the Manager agreed to check with the fire officer that they were meeting the training requirements with regard to fire safety. Supervision records evidenced appropriate bi-monthly supervision and annual appraisals for both staff. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 Service users benefited from a well run home and satisfactory arrangements for the protection of their health and safety. EVIDENCE: One service user commented specifically on the home being well run. It was evident from various discussions that the Manager led by example, taking equal turns in covering the 24-hour shift. Mandatory training had continued since the last inspection, although some gaps were identified. It was reported that all three people working in the home, including the Manager, had First Aid Appointed Person’s certificates. One certificate was displayed and dated 3/5/05, but the others were not available for inspection. Records evidenced fire drills and routine testing of fire alarms and the Manager agreed to check with the local fire officer that their arrangements met the requirements for a small home and seek his advice about training. The Manager reported that he was now qualified to safety-test portable, electrical appliances. Fridge temperatures were recorded daily. A
Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 19 member of staff produced the temperature probe they said was used to ensure certain foods were hot enough, although there were no records to support this. Although liquid soap was provided for hand washing, staff were advised, for the purpose of infection control, to remove any bars of soap from communal areas. Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 2 N/A 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 2 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X 3 X X X X 2 X Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 21 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 YA1 Regulation 4, Schedule 1 Timescale for action The registered person must 28/02/06 ensure that the Statement of Purpose includes the home’s arrangements for service users to attend religious services of their choice. The registered person must 28/02/06 arrange for staff to undertake training to meet Skills for Care training targets in all the mandatory health and safety topics. The registered person must 28/02/06 ensure that staff records include all the documents and information listed under Regulation 19, Schedule 2 and Regulation 17, Schedule 4 of the Care Homes Regulations 2001. This requirement has not been met within agreed timescales. The registered person must 20/12/05 ensure that the premises are sufficiently heated at all times. Requirement 2. YA32YA42 13, 18 3. YA34 17,18,19 4 YA24YA42 23 Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 22 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 YA5 Good Practice Recommendations The registered person should ensure that, as part of their contract, service users have a copy of their care plan and details of any part of this, which is to be provided outside the home. The registered person should ensure that service users are as involved as they can be in their care plans and that the plans are sufficiently detailed to reflect their progress in identified areas. 2 YA6 Mondial DS0000017889.V276611.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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