CARE HOME ADULTS 18-65
Mulberry House 120 Barton Road Luton Bedfordshire LU3 2BD Lead Inspector
Katrina Derbyshire Unannounced Inspection 30th August 2007 12:00 Mulberry House DS0000039287.V343105.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.V343105.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.V343105.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.V343105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st June 2006 Brief Description of the Service: Mulberry House is 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 people with learning disabilities. The service had been developed and operated by Complete Care Services Ltd for a number of years. The building has two storeys. The ground floor provides two bedrooms, a toilet, a large communal lounge/diner and a kitchen. Located on the upper floor is a staff area, a bathroom and six bedrooms. All of the bedrooms are for single occupancy and have en suite facilities. At the rear of the house is a garden with a small patio area. To the front of the property is a small garden. Copies of this report and others relating to this service can be provided on request. A copy of previous reports is available at the service. The fees for this home vary from £1200 per week, to £1600 per week, depending on the funding source and assessed need of the person. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 30th August 2007. During the inspection several areas of the home were visited and the inspector spent time with some of the people who live at the home in the communal area and their own rooms. The care of two people was examined by looking at their records and interviewing them and staff who look after them, alongside speaking with other people that live at the home. Comment cards were also received from 4 people living at the home that show their views of the service that they receive. Information from the home, through written evidence in the form of a Annual Quality Assurance Assessment has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: What has improved since the last inspection?
The manager had been working on documents known as risk assessments. We had made a requirement at the last inspection for this to be done. They are now clearer in explaining why any restrictions are in place, for example if the
Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 6 person does not have a key to their room. The document provides an explanation as to why and this usually relates to a health and safety matter. 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. The summary of this inspection report can be made available in other formats on request. Mulberry House DS0000039287.V343105.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.V343105.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The system in place for staff to assess the needs of prospective people is sufficient to ensure that they would have the information to know if they would be able to meet their needs. EVIDENCE: Documents seen within the records of a person recently admitted to the home, showed several assessments of their needs. Representatives of the Primary care Trust, Social Services and staff of the service had completed the documents. Each representative had completed their own assessment documentation and further evidence was seen to show all had been involved in the decision for the person to move to the home. Documents described in detail the needs of the person; this included any diagnosis that had previously been made, the behaviours of the person and their individual aspirations alongside any risks. People that live in the home and entries within the daily notes confirmed that they had also had the opportunity to visit, prior to moving in. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Opportunities for people to make decisions about their lives are satisfactory and make people feel in control of their own lives, however care planning systems are not sufficient to ensure all people receive continuity of care. EVIDENCE: The care plans examined showed that changes had been made since the previous inspection; this related to the involvement of the person in planning their care. In most entries there was sufficient direction to staff. However one person had moved into the home 10 days prior to this visit. A care plan had not yet been written for this person. Within their assessment of needs, there had been a risk identified relating to the possible safety of other people because of their actions. The manager advised that they had started to write
Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 10 some notes, these were seen but were not clear and gave no guidance to staff in how the person should be supported. An immediate requirement was made. Feedback received through returned comment cards to the Commission for Social Care Inspection indicated that staff enabled people to do the things that they enjoyed. One person spoken to said, “ l do like living here, it’s better than where l lived before”. Risk assessments were in place within the individual care files examined. Risks that had been assessed included diet, moving and handling and risk of leaving the home on the persons own. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this 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 have a sufficient level of access to local facilities so benefit from being part of the community and having their social needs met. EVIDENCE: Through speaking with people living at the home and all 4 returned comment cards to the Commission for Social Care Inspection, evidence shows that people are satisfied with the provision of meals at the home. Menus examined showed that a choice is available. The stocks of food kept at the home were examined. A good amount of protein, carbohydrates, fruit, dairy and vegetables were seen to be in place. The service has a mini bus that is used to provide transport for the people living at the home. Within the care records examined, entries were seen within the daily notes to show that people participated in a variety of activities and
Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 12 occupation. People attended varying day care services where they were able to participate in a curriculum of activity and development. Examples of these included cooking, art, music and social development. In addition information supplied by the manager showed that people attended church services, fetes, car boot sales and use the local media to see what is going on in the local area. Staff and people living at the home confirmed that they were supported to access pathways at Dunstable College, to develop within the education sector. The Annual Quality Assurance Assessment indicated that relatives are encouraged to come to the home at anytime, in instances where family may live a distance away, staff will support the person in maintaining contact through letter writing and telephone calls. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. We have made this judgement using a range of evidence including a visit to this service. Medication systems are sufficient to ensure people receive their prescribed medication. EVIDENCE: One person was seen to need help with moving around the home and going to the toilet at this visit. The person asked for assistance on two occasions, staff were noted to respond to him quickly and engaged in conversation with him whilst providing assistance. All 4 comment cards indicated that people felt they received the care that they needed. Care records examined contained documents from a variety of medical specialists. These documents for example hospital letters, showed that people received regular support from Doctors and Nurses. Staff confirmed that they assisted people to attend hospital appointments and the outcome of any
Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 14 medical intervention and subsequent guidance was recorded. Feedback through returned comment cards to the Commission for Social Care Inspection showed that people felt they received the medical that they needed. The storage, receipt and administration of medication was examined. The medication administration sheets were noted to be correct. The storage of medicines were seen to be in a locked facility. Records were seen to show returns of unused medication. Staff had also supported one person in their wishes to self medicate, until a multi disciplinary review meeting was held when the risk of the person not taking their medication felt that staff should resume the administration. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 15 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 & 23 Quality in this outcome area is poor. We have made this judgement using a range of evidence including a visit to this service. Managements understanding and the systems in place for safeguarding adults is poor and places people at risk from abuse and not receiving the multi disciplinary support from a safeguarding team. EVIDENCE: Entries were seen within the care records of one person, they were dated the 19th August 2007. They described that one person had started picking on another person that lived at the home ‘kicking and slapping him occasionally for sometime until staff had to intervene and separate them’. An incident form dated 20th August 2007 described a person being hit, this made them fall to the ground where they continued to be hit making them cry out. This had not been reported under the local Safeguarding protocols. A number was given to the manager at this visit so that they could access the appropriate referral form, so that a referral could be made. The manager stated that they were unaware of the Luton safeguarding co coordinator and did not have a copy of the policy. On review of information about the service after this visit, it was noted that this area had been raised previously by the Commission for Social Care Inspection and that the manager had at that time been in contact with the Luton Safeguarding co coordinator, following a requirement to do so. An immediate requirement was made relating to this at this visit. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 16 The complaints procedure was seen to use both pictures and words. Some of the information was out of date for example reference was made to the National Care Standards Commission, although this body ceased in 2004. Comment cards received indicated that people knew how to complain. Mulberry House DS0000039287.V343105.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The standard of cleanliness in this home is good to provide a pleasant environment for people to live in. EVIDENCE: The accommodation to people was provided over two floors and accessed via a staircase. The location was just on the outskirts of the town centre with all its amenities and the layout of the home was domestic. Furnishings and fittings were domestic and of a sufficient standard, however the dining room furniture was more similar to office furniture. The communal areas in the home were clean and tidy and people’s rooms contained personal items, which reflected their individual personalities. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 18 The communal areas of the home were clean and free from offensive odours at the time of inspection as were individual rooms of people’s seen by the inspector. Policies were in place regarding infection control. Hand washing facilities were sited in varying areas. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 19 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 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Systems in place for the recruitment of staff are not sufficient to protect people, as there is a higher risk that someone may be employed that is not suitable to work at the home. EVIDENCE: Examination of staff files was carried out to view recruitment practices in the home. The most recently recruited staff members to be employed at the home had started work prior to the home securing a criminal records bureau check. The manager had taken a copy of a CRB check that had been undertaken by a previous employer. Two staff members were on duty alongside the management in the home. Staff demonstrated a good level of knowledge and understanding of the people at the home and their needs. They were able to describe the information contained within the care records and how they should provide care and support.
Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 20 Training records viewed showed that staff had received training including medication, moving and handling, food hygiene and fire safety. Staff confirmed that the home supported them in undertaking training. However the induction of staff did not meet National Occupational standards and this needs to be addressed. Views received from through the comment cards show that they feel staff are able to treat them well; one person said, “I think the carers are lovely”. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 21 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): 39 & 42 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and safety systems are sufficient to provide an environment for people at the home, which reduce the risks associated with this area. Although the quality assurance system has not been implemented so people have not had the opportunity to influence the running of the home. EVIDENCE: Information supplied to the Commission for Social Care Inspection from the manager indicated that they have yet to complete their quality assurance audit, to gain the views of family, friends and professionals. She confirmed that the system had been devised by the company, but she had not yet commenced its use.
Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 22 Health and safety systems at the home were seen to be carried out in accordance with the guidance within the homes policy. The most recent fire and environmental health inspection reports show that the home had met the standards in these areas. In addition cleaning products were seen to be locked away, risk assessments had been undertaken for areas and activities in the home. Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 23 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 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x X X 2 X X 3 X Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 24 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 YA6 Regulation 15 Requirement A plan of care must be in place to ensure all risks, measures and guidance is clear to staff to protect people living at the home and staff from harm. (Immediate requirement issued) The complaints procedure must be revised so that it contains accurate information on where people can raise any concerns that they have. A copy of the local protocols for safeguarding adults must be accessed and the reporting of the incident on 19/08/07 must be reported following the guidance within it. This is to safeguard the people living at the home from abuse. (Immediate requirement issued) An appropriate CRB must be secured on all staff including a POVA First check prior to their commencement. This is to safeguard people living at the home, through reducing the risk of people who are unsuitable
DS0000039287.V343105.R01.S.doc Timescale for action 31/08/07 2. YA22 22(7) 30/09/07 3. YA23 13(6) 30/08/07 4. YA34 19 31/08/07 Mulberry House Version 5.2 Page 25 working at the home. (Immediate requirement issued to action by 31/08/07) 5. YA39 24(3) The views of people at the home and their representatives must be sought and then acted upon so that they have the opportunity to influence the running of the home. 31/10/07 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 YA24 Good Practice Recommendations Consideration should be given to the suitability of the style of furniture that is being used as the dining table and chairs. The induction of staff must meet Skills for Care inducation Standards to ensure people are supported by appropriately trained staff. 2. YA35 Mulberry House DS0000039287.V343105.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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
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