CARE HOME ADULTS 18-65
Mulberry House 120 Barton Road Luton Bedfordshire LU3 2BD Lead Inspector
Dragan Cvejic Unannounced Inspection 1st June 2006 09:00 Mulberry House DS0000039287.V297858.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 Mulberry House DS0000039287.V297858.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. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mulberry House Address 120 Barton Road Luton Bedfordshire LU3 2BD 01582 570569 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) Complete Care Services Limited Ms Wendy Snow Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31/01/06, 15/05/06 random inspection Brief Description of the Service: Mulberry House was located amongst a group of residential houses set back from the main road from Luton to Bedford in a residential area to the north of Luton. The home has access to local shops and public transport. The service was registered to provide residential care for eight adults with learning disabilities. The service had been developed and operated by Complete Care Services Ltd for a number of years. Mrs Wendy Snow was the registered manager. The home had been sympathetically converted to retain its homely characteristics. The building had two stories.The ground floor had two bedrooms, a toilet, a large communal lounge/diner, a kitchen with adjacent area that was used as an office. Located on the upper floor was a staff sleeping in room, a bathroom and six bedrooms. All of the bedrooms were for single occupancy and had en suite facilities. At the rear of the house was a garden with a small patio area. To the front of the property was a small garden. The average fees stated by the manager were £1200-1600. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection carried out during 6 hours. All but one service user were present and talked to the inspector. The manager, the deputy and 3 staff members, a visitor and one visitor’s comment card were also consulted about the service. Case tracking of two service users was the main methodology. This report also contains relevant elements from a random inspection that was carried out less than two months ago. What the service does well: What has improved since the last inspection?
The manager responded to the requirements set previously and created an action plan for meeting these. Thus, she was in the process of reviewing risk assessments. The idea of providing a summary of the problems and goals set in care plans onto one page in each file was excellent. New staff or any relevant professional with an interest in a particular user would get basic information from this newly created sheet. The service users’ files now contained the evidence of the involvement of external professionals in the care process, especially when sensitive areas of users’ lives were addressed. An example was a signed agreement of the goals suggested by the community outreach worker, the home’s staff and the service user. A new activity programme was complemented with newly created individual activity files. Service users filled in some entries themselves in these files. The manager was reviewing the local contract that listed house rules in a restrictive way, but the restrictions in practice were not imposed unless it was absolutely necessary to avoid high risk to service users. A combined review of this document and individual risk assessments, that was currently undergoing, was supposed to appropriately address all these issues and ensure appropriate recording. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 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. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 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 Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 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): 1,2,3,4,5 Quality in this outcome area was adequate. The home provided information to prospective service users in the booklet about the home, statement of purpose, illustrated service users’ guide and other individual documents, such as the home’s aims and objectives; but the documents were separate and could cause an omission by the reader when the information was needed to make an informed choice of home. EVIDENCE: The statement of purpose was basic and was complemented by separate documents addressing the home’ s aims, philosophy, house rules, Mission statement etc. These documents were scattered individually, but were all displayed on the notice board and were accessible to all. The service users’ guide, in illustrated format, was also displayed in the home. The admission form checked for two service users demonstrated that the home carried out a proper assessment and obtained as much information as possible for prospective service users. By engaging relevant external professionals, such as a community outreach worker, social worker and relevant medical professionals, the home ensured that service users needs were met. The home was able to meet specific needs, such as to ensure that users could choose male or female carers for particular support, help and elements of care. An example was a service user who wanted only female staff to help her with personal care, but wanted the manager to support her in her choice of activities. The files checked showed 3-month trial periods in the home, after initial visits and after the decision to admit a user.
Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 9 A copy of the contract from the placing authority was retained in the file. The home’s contract did not indicate all the required elements and was more akin to the list of house rules. The style of this document was also inappropriate and the manager accepted to review it. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area was adequate. Service users were not evidently consulted about their care plans, risk assessments and other documents, as dates and signatures were missing to show users’ involvement in their care process. EVIDENCE: Inspected care plans addressed all the major needs of service users. One of the files contained a well drawn up summary in the front of the file outlining the main needs, actions to meet them and summarised goals. This would allow all new staff to get a quick overview for the individual. Care plans, however, were not signed by service users or their representatives. The home encouraged service users to make decisions about their lives. A service user who had a break from college due to half term, chose to join the swimming group, but when she changed her mind, another plan was accommodated for. A file demonstrated how the home ensured engagement of an advocate for a service user who wanted this service. Preferences were recorded in files and, as an example, one service user preferred to be helped by female staff and this was recorded and observed in practice. He also confirmed that his wish was accommodated.
Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 11 Both files demonstrated, and the service users confirmed that their finances were dealt with as they wanted, mainly by their families, apart from their personal allowances, which they could control. Although service users stated that they felt the home as theirs, there was no evidence to confirm their participation in the running of the home. One of the inspected files showed how a service user was given medication to self administer, as he wished. When the staff checked medication according to the self administering risk assessment and found discrepancies, the agreement was cancelled. However, the care plan stated that, after a continuous education process the procedure would be reinstated and the experiment reintroduced with a new risk assessment. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 12 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): 11-17 Quality in this outcome area was good. The home encouraged service users to determine their daily life and routine and ensured that agreed programmes were recorded and implemented, allowing reasonable flexibility, and supported service users in reaching their set goals. EVIDENCE: Service users confirmed that the lifestyle was arranged according to their wishes and preferences. The new activity programme demonstrated that the education and occupation of service users was arranged for their benefit and as they preferred. This included their leisure activities: bingo, swimming, gym and holidays. Accommodation was already booked for the holiday in September. Service users spoken to confirmed that the activities and new programme recorded in individual activity files were meeting their expectations. A visit from the users’ friends was observed and showed that he knew all he wanted about the home and that his relationship with service users was very good. Several service users confirmed how well they keep family contacts. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 13 Service users were given the choice of with whom they wanted to be. Risk assessments explained the reasons for users that were incapable of using their room keys appropriately and for whom this provision was withdrawn. Three service users were delighted when they received more than one letter each, delivered unopened by staff to them. The manager helped a service user, on a one to one basis, with crosswords. She very much appreciated this one to one input, which helped her control her behaviour. A cooking rota was recorded on a menu and cleaning activity in activity records. The menu and cooking programme showed that users preferences were respected and that the home provided a balanced and nutritional diet. A service user with recently diagnosed diabetes confirmed that her dietary needs were fully met. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 14 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): 18,19,20,21 Quality in this outcome area was good. The staff encouraged independence, but also supported service users to meet all their healthcare needs by engaging external professional when needed. EVIDENCE: The files demonstrated that the home responded to the health care needs for each individual by the direct action of staff or by the engagement of relevant external professionals. The files containing minutes from specialists meetings with the homes staff recorded actions on how to respond to the identified needs, challenging behaviour, and to allow service users to remain in control of their lives. A service user proudly explained how she developed and stayed in control over her diabetes: “I have to be careful what I eat, I don’t eat sweets.” The home arranged a specialists input for a service user who experienced incontinence problems. A service user wanted to be present in the home life all the time and wanted to have the toilet door open while being in there, but staff gently explained and re-educated a user on how to express and how to enjoy the privacy and dignity of keeping the door closed. Another example was a discussion with a service user in private about the issues she wanted to raise with staff. Come to the side, we will discuss this in private, staff encouraged her to exercise giving and receiving respect. A service user was offered the chance to talk in private with a visitor. Another user was asked quietly and sensibly to get help for shaving.
Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 15 Medication procedure and recording was appropriate and staff showed competence in this area. The amount of medication carried over to the following month was not recorded on the MAR sheets. The file contained a statement of the inappropriateness to discuss wishes in case of death with a young service user who would be upset by this discussion. However, the manager stated that appropriate respect and extra support would be provided for any user with a terminal illness. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 16 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): 22,23 Quality in this outcome area was good. Service users were protected and knew how to complain if they wished, with a clear procedure and practical guidance by staff. EVIDENCE: The complaints procedure was provided in illustrative format for service users. The current complaint investigated by the home, and partly upheld, demonstrated the effectiveness of the procedure. A service user with communication problems confirmed that he knew how to complain if he wished. Incidents of verbal conflicts between service users who expressed challenging behaviour were recorded, analysed, and the suggested actions to reduce reoccurrence were recorded in their files. Staff reacted preventatively to minimise potential physical aggression among service users. Restrictive house rules also discouraged violence and potential physical attacks and justified their restrictiveness by protecting service users. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 17 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): 24,26,30 Quality in this outcome area was good. The home was suitable and offered a level of comfort that service users enjoyed. EVIDENCE: Premises were accessible and approprite for service userss needs. The home was arranged in a domestic style and offered the required space for service users both in communal areas and in their rooms. Located almost on the main street leading to Luton, it provided good access to the town and facilities in the community. The manager presented a renewal programme and commented on items already replaced. A service user was delighted with a new waterproof mattress supplied to his room. Another user was looking forward to the redecoration of his room. Two service users bedrooms complied with the requirements and users stated that they liked their rooms and had all they needed in them. The home was clean and bright and infection control measures were in place. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 18 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): 31,32,33,34,35, Quality in this outcome area was good. Appropriately chosen and well trained staff were able to meet the needs of service users. EVIDENCE: A staff member stated that he felt confident in his role, was clear of the expectations, knew users well and felt well equipped with training and support in his role. He confirmed that, lately, the atmosphere was much better, more professional, that old issues had been resolved and: It is pleasant to work here. A deputy manager commented: There are no two days the same here. It is nice to work here and to see the progress of service users. Almost all permanent staff were NVQ qualified and well trained for their roles. The pleasant atmosphere in the home also contributed to the staffs open and approachable attitude. A staff file showed that she was trained in Makaton, which allowed her to have improved communication with service users. The home also benefited from a staffing composition that mirrored the users group in relation to gender and age. The files showed and the staff confirmed appropriate recruitment procedure was carried out. The home used an umbrella agency for obtaining POVA and CRB disclosures and this delayed the start dates for new staff. The manager was going to explore other possibilities. Staff files contained application forms, two references and staff contracts. Training certificates were also kept in
Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 19 individual files and showed that the home ensured regular training for staff, both for new subjects and for refresher training. The manager reported the planned training for staff in the forthcoming period. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 20 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): 37,38,39,41,42 Quality in this outcome area was good. The management of the home encouraged safety in operational practice and ensured continuous improvement of services that promoted users safety, security and wellbeing. Some records were not up to date, but this did not jeopardise the quality of care provided to service users. EVIDENCE: The manager was qualified and skilled to lead the staff team and arrange the operation of the home in the best interest of service users. She prioritised the tasks, allocating priority to practical care and support to service users. She was in the process of reviewing risk assessments and contracts for service users. Many new procedures recently introduced brought progress to the home and facilitated better care and support for service users. New activity files addressed this area. New approach to risk assessments also improved standards of care and allowed users to explore their abilities deeper. The solving of the recent staffing issues related to professional conduct helped the home regain its balance and reinstate the positive and innovative approach of staff. The manager devised a quality assurance system from some existing
Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 21 programmes and using her own initiative. This will need to be tested in practice. Lists of personal possessions brought into the home were either not made, as in one file, or were not dated and recorded, as in two other files. The manager was made aware that the home should include service users into creating and reviewing policies and procedures. Safe working practices were in place, staff were well trained, and procedures, such as fire and infection control were in place. Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 22 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 3 4 3 5 1 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 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 3 3 3 3 X 1 3 X Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 23 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 YA5 Regulation 5 Requirement Timescale for action 15/07/06 2. YA6 15 3. YA8 24 4. YA16 12,13 The manager must review and form the contracts that contain all the required information, that explains what is provided and covered by fees and can, if desired, incorporate the house rules, a document currently used as a contract, into new home’s contract. Care plans must be working 15/08/06 documents and show that service users take part in planning their goals and reviews of the aims set. Care plans must contain dates and signatures and dated evidence of regular reviews. The home must provide 31/08/06 evidence of service users’ involvement into the management of the home, reviews of policies, of the statement of purpose and other documents related to their life in the home. Any restrictions imposed on 31/08/06 service users must be documented and it explained why they were imposed, be it in contracts, care plans, risk
DS0000039287.V297858.R01.S.doc Version 5.2 Mulberry House Page 24 5. YA41 Schedule 4 assessments or other relevant appropriate documents. The home must keep up to 15/08/06 date, dated and signed records of service users’ possessions brought into the home. 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 The manager should collate documents related to requirements for the statement of purpose to form a full statement containing all relevant information under appropriate subheadings. The home should record the amount of medication carried over to a new MAR sheet in order to allow monitoring of the stock. 2. YA20 Mulberry House DS0000039287.V297858.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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