Inspection on 21/06/05 for Mulberry House

This inspection was carried out on 21st June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mulberry House 07/07/08

Mulberry House 04/01/08

Mulberry House 30/08/07

Mulberry House 01/06/06

Mulberry House 31/01/06

Mulberry House 16/02/05

Mulberry House 22/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Mulberry House 120 Barton Road Luton LU3 2BD Lead Inspector Leonorah Milton Unannounced 21st June 2005 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 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 Stationary 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 I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mulberry House Address 120 Barton Road Luton LU3 2BD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 570569 Complete Care Services Ltd Ms Wendy Snow Care Home 8 Category(ies) of LD Learning Disability - 8 registration, with number of places Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16.02.05 Brief Description of the Service: Mulberry House was located amongst a group of residential houses set back from the main Luton to Bedford road in a residential area to the north of Luton. The home has access to the 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 had effectively managed the home. 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 usual for table-top activities and a laundry room. Located on the upper floor first floor was the office, a bathroom and six bedrooms. All of the bedrooms were for single occupancy and had en suite facilities. At the rear of the house a garden with a small patio area. To the front of the property was a small garden. Satisfactory arragements were noted at this inspection to meet servicer users assessed needs. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 4.20 hours. Some aspects of the inspection were curtailed because the manager was not available for the late afternoon and the five service users in residence left the home after the evening meal to attend a social club. The methods of inspection included conversations with four service users a member of staff and the manager, a complete review of the documentation in relation to the care of one service user, a personnel file and sundry records about the other service users’ care. A tour of the building was carried out and the evening meal was taken with the service users and staff. The comments of other staff on duty were also taken into account. What the service does well: What has improved since the last inspection? The induction programme for new staff had been reviewed to ensure that it met the recommended standards for those who work with adults with learning difficulties. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 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 I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,5 The home had ensured that it was able to meet service user’s needs before admission to the home. Private contractual arrangements were not consistent with the service user guide and showed that service users’ lifestyles could be curtailed. EVIDENCE: There had been no further admissions to the home since the previous inspection. The case file seen at this inspection showed that an extremely detailed assessment of need involving input from the placing authority and healthcare specialists had ensured that the home had obtained sufficient information to enable it to determine that it was able to properly care for the service user. The service user guide did not detail the “rules to abide by” detailed in private contractual arrangements: “Any breakages to property, fixtures and fittings sustained to property and other person’s property will be paid for by the persons in the incident”. The document also identified that “rewarded behaviour had to be earned” and that outings and social events would be jeopardised by unacceptable behaviour. The home cannot arbitrarily impose such conditions on service users. Any strategies for behaviour modification must be assessed and agreed by appropriate healthcare specialists and the placing authority. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 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 standard(s) 6,7,8,9. Service users had been consulted about their care needs and provided with sufficient support to meet them. EVIDENCE: Written care programmes were based on a person centred model that identified consultation with service users and identified their preferred lifestyle. Appropriate guidelines and risk assessments were in place in relation to the management of inappropriate behaviours or those that challenged. Records also indicated that there had been monthly meetings with service users to gauge their opinions about the day-to day lifestyle at the home and to plan routines and recreational activities. Some service users had been able go on unaccompanied trips out of the home according to ability and risk assessment. Conversations with service users also showed that they were aware of fire safety and evacuation procedures and other safety considerations within the home. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 12,13,14,16,17 Service users had been supported to achieve fulfilling lifestyles within and outside of the home. EVIDENCE: Service users had been supported to develop their education and personal development through attendance at colleges of further education and specialist day centres. Outside activities had included meeting with others at social clubs and also ad hoc when accessing local leisure facilities. Service users confirmed their attendance at these venues and were enthusiastic about the opportunities available to them at these activities. One service user evidently derived a great deal of satisfaction at her attendance at activities organised by a local church. One other also mentioned church attendance. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 11 Mealtimes appeared to be a social occasion. Menus showed a varied and nutritious diet. Service user stated that they enjoyed their meals and shared in the preparation of such as part of their daily living programmes. Daily routines promoted independence and two service user commented that they could do what they liked. These arrangements however were compromised by the rules previously mentioned in the summary to this report and the lack of door locks to at least two bedroom doors. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 Service users had received appropriate support to ensure that their health care needs were met. EVIDENCE: Service users were appropriately supported according to their plan of care. Records indicated that service users had been referred for routine medical treatments and to healthcare specialists as need be. There was evidence to show that the home liaised regularly with a local healthcare resource that provided specialist services to people with learning disabilities. The services of their outreach team had been sought in relation to developing strategies for the management of behaviours that challenge. Records showed that the home had been vigilant in referring a service user with sudden weight loss. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Service users were able to voice their concerns in the confidence that they would be listened to. Protection of service users had been compromised by the failure to carry out sufficient checks on employees before employment. EVIDENCE: Three service users who contributed to the inspection stated that they could talk to staff if they were worried. Service users had been provided with a pictorial guide to the complaints procedures. The home’s written protection procedures were not reviewed at this inspection but had been assessed at previous inspections as satisfactory. Staff awareness of protection issues must be based on appropriate training about procedures to prevent abuse and also the local authorities procedures including the sequence for reporting of allegations of a serious nature. The manager stated that no one on staff had undergone such training. It is a priority therefore that training be arranged without delay. The personnel file for one member of staff showed that she had been recruited without reference to the Protection of Vulnerable Adults Register or a criminal records check. Whilst this employee was related to an employee elsewhere in the organisation the principal remains that robust recruitment checks must be applied to all applicants for employment. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 14 It was evident that some service users had purchased furniture and soft furnishings for their bedrooms. It was reported that everything in one bedroom belonged to the service user. This however was not reflected in the property list that had not been updated since 2003. There was also insufficient evidence that the service user had made an informed choice about such purchases. There must be evidence that service users have agreed to purchases made on their behalf, so that such purchases have not replaced the proprietor’s responsibility to provide basic furnishings. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 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 standard(s) 24,25,26,27,28,30. The premises had been adapted to meet the needs of adults with learning difficulties but there had been a lapse in fire safety precautions that could result in significant harm to anyone using the building. EVIDENCE: The building was domestic in design and in its fittings and décor. Service users’ private and communal space was large enough to meet their needs. Areas of the building seen at this inspection were clean, orderly and well decorated. The carpets in the activity area adjacent to the kitchen and on entry to the lounge were deteriorating. It was explained that these were scheduled for replacement in the near future. One service user had many electrical pieces of equipment. In order to use these a multi-socket adaptor had been utilised. It had been a requirement from the previous inspection that a qualified electrician check these arrangements. The room also contained a plethora of other personal items and piles of paper. It was reported at this inspection that the fire officer had Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 16 advised the service user about the risk of fire but as yet the service user had been unwilling to change these arrangements. It was noted at this inspection that the use of the multi adaptor was hazardous because another adaptor had been plugged into the multi-adaptor at this inspection. An immediate requirement was issued at this inspection to make these arrangements safe to remove the risk of fire. It was noted that some of the furniture in one bedroom was of an inferior quality. These items were chipped and broken. Other bedrooms had furniture and linen that had been purchased by the occupant. The proprietor must provide each bedroom with basic furnishings of an acceptable standard. The previous report had also required that checks be carried out on the delivery of the hot water supplies with regard to any risks of Legionella bacteria. The manager reported that a regulator had been fitted to the boiler to lower the temperature of the hot water delivery but that checks re the risk of Legionella had not been carried out. It is a priority that this too is carried out without delay. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,3536. The staffing arrangements were sufficient to meet service users’ needs. EVIDENCE: Rotas indicated that were adequate numbers of staff on duty to support service users in house and also on trips out of the home. The members of staff on duty were observed to interact positively with service users and each other. Although there was a relaxed and informal atmosphere in the home the business of supporting service users was conducted in a professional manner. Staff had been supported by a recognisable senior team and through regular supervision and staff meetings. Conversations with two staff indicated that had received training in relation to their roles and were working towards NVQ awards. The induction training had been reviewed in line with LADAF standards. The recruitment of the most recent employee as stated previously had not included the necessary checks. It was also noted that the format for references did not require the referee to sign and date the form. It was not possible therefore to assess properly who had given the references or when they had been made. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38, Service users benefited from a well-organised service that was managed by a skilled and qualified person. EVIDENCE: It was evident from conversations with service users that Mrs Snow was well acquainted with them and understood their aspirations and needs. The members of staff who contributed to the inspection spoke highly of her management skills and the support systems for themselves. Strategies were in place via meetings with service users and also with the staff to enable both groups of people to be consulted about the operation of the home. Records indicated that the proprietor had visited the home regularly in accordance with the legislation to monitor the conduct of the home. The manager reported that she was continuing to review the operational policies to ensure that they were maintained in line with current best practice and legal requirements. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 19 The processes for a quality audit involving service users and other stakeholders were overdue. Mrs Snow stated that she had been revising the format of the questionnaire and that the review was scheduled to commence in the near future. Record keeping was of a good standard. Omissions included those already mentioned in relation to purchases made on behalf of service users. Records of incidents/accidents will also need to be maintained individually to maintain the confidentiality of each service user. A business plan had been developed for the service but the financial planning to implement the plan was not included. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 x 1 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 3 x x Standard No 11 12 13 14 15 16 17 x 3 3 3 x 2 3 Standard No 31 32 33 34 35 36 Score x 3 3 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mulberry House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x 2 2 2 I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 21 No 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 5 Regulation 5(1) Requirement Any rules detailed in service users contracts in relation to payment for breakages and curtailment of recreational activities must be agreed with each individuals placing authority and the involvement where necessary of healthcare specilists Service users must be provided with keys to their room inless their assessment of risk indicates otherwise. Recruitment procedures must include refernce to the POVA register and a CRB check. Staff must be provided with training in relation to the protection of vulnerabel adults from abuse and receive guidance about the local authoritys reporting procedures. Service users bedrooms must be provided with basic furniture of an acceptable standard that is suficiently robust. The format for references must include a section to indicate who is providing the reference and when . There must be evidence to show Timescale for action 31.08.05 2. 16 23(1)(a) 30.09.05 3. 4. 23 23 19(1)(b) 13(6) 30.07.05. 30.09.05 5. 26 16(2) 31.10.05 6. 36 19(4)(b) (i) 13(6) 31.08.05. 7. 23 31.7.05. Page 22 Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 8. 42 13(4) 9. 42 13(4) 10. 42 13(4) that service users have made an informed choice about payment from their personal monies for purchases of furniture and furnishings. The registered person must 30.09.05. ensure that risk assessments are carried out to meet standard 42.6, with particular reference to the regulation of water temperatures and design solutions to control the risk of Legionella, and also the provision and maintenance of window restrictors. In the case of water temperatures and window restrictors the risk assessment must determine the frequency of recorded checks that must be carried out. Also the water temperature risk assessments must include the unregulated hot water tap in the kitchen, which must be assessed in the light of the service users’ abilities and need to use the kitchen as part of their normal activities. ( Previous timescale of 01.06.05 had not been met in full). The registered person must 21.07.05 make safe the electric sockets (multi-adaptor leads) in bedroom 4. ( Previously notified at the inspection by immediate requirement) A risk assesment must be carried 21.07.05 out on the numbers of electical equipment in bedroom 4 and the need for safe electrical connections.(Previously notified at the inspectikon by immediate reqiurement.) 11. 12. Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 23 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 6 Good Practice Recommendations The registered person should consider modifying the service users’ plans to ensure that it is clear that all the required areas are covered and that all the information that is relevant to the plan and needs to be reviewed along with the assessment document and the plan has a cross referencing in respect of the plan. Also consideration should be given to: the way a service user and their representative’s involvement is evidenced in the plan, where this may include reference to documents introduced as part of the person centred planning process; and the way the plan is kept up to date to reflect changing situations, such as the possibility that a service user’s needs cannot be met and the plans for handling this.(Carried forward from previous inspection) The registered person should obtain an advocate who can represent independently of the home and the placing authority a service user who has no representative and whose needs it might not be possible to meet at the home. The advocate has a role in ensuring the service user’s rights are met even if they cannot communicate directly with the service user and activating complaints procedures when they are not(Not assessed in full) The registered person should either include in each service user’s plan under the medical section or cross reference to a separate sheet details of the medication that they take, including the reasons, possible side effects, medication that it cannot be taken with, when it was first prescribed and if there is a review date ( Not assessed in full). 2. 7 3. 20 Mulberry House I51 S39287 Mulberry House V223173 210605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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