CARE HOME ADULTS 18-65
Mulberry House 120 Barton Road Luton Bedfordshire LU3 2BD Lead Inspector
Leonorah Milton Unannounced Inspection 31st January 2006 13:50 Mulberry House DS0000039287.V281278.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 Mulberry House DS0000039287.V281278.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. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 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.V281278.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21/06/05 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 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. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focussed on the core standards not assessed at the first visit. During this inspection the documents that showed the arrangements for the care of one service user were assessed. Discussions took place with this service user and one other about their lifestyles in the home. Both of their bedrooms were visited. Discussions also took place with one member of the support team and the deputy who was in charge during the absence of the manager. A partial tour of the building took place. Five service users were in residence at this inspection. Four were at home as the visit commenced. Most were engaged in the main occupation for the afternoon, watching the television. One had chosen to watch her television in the privacy of her room. They appeared to be relaxed and content with this occupation. It is recommended that this report be read in conjunction with the report of the inspection carried out in August 2005 for a complete overview of the standard of the operation between these dates. What the service does well:
The lifestyle in the home was conducted in a relaxed and informal atmosphere that in most instances encouraged service users to express themselves. The two service users who contributed to the inspection stated that they liked living in the home and described the staff as “nice and all right”. One person who had been transferred recently from another care home said that she preferred living at Mulberry House because the staff were much nicer to her than at her previous home. Both people said that they enjoyed their meals, and going out on shopping trips. One who had resided in the home for sometime was enthusiastic about last year’s holiday and was looking forward to this year’s. The service user was unaware of plans in hand to provide her with a surprise birthday party and a long wished for trip to Paris. A letter from her parent showed that her family were satisfied with the arrangements for her care. Record keeping was of a good standard, so that it was possible to track how service users had been supported.
Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 6 Areas of the building designated for the use of service users were domestic in appearance and were well decorated and furnished. Service users stated that they liked their bedrooms and were pleased to be able to choose colour schemes. The standard of the medication records were worthy of note and ensured that members of staff were fully aware of when and why to give medications prescribed to take on an “as required” basis. What has improved since the last inspection? What they could do better:
The observation of dialogue between service users and members of staff showed inconsistencies in the ways that service users were treated. One member of staff displayed a persuasive approach and had a calming influence, whilst another adopted an authoritative manner. The conduct of one other member of staff, although well meaning, exacerbated a situation, because attention was drawn, in the presence of other service users and members of staff, to the service user’s lack of co-operation about a relatively minor issue. The manager must ensure therefore that personnel are aware of service user’s rights to self-respect and personal dignity. Training for staff must cover these aspects and basic communication skills. There was insufficient evidence to show that a recently appointed person had received an adequate level of introduction into the responsibilities of their role. Given the incident witnessed in the lounge there was a need for personnel to receive proper guidance. There was insufficient written guidance in place for personnel to show how each service user was to be supported by activities provided in the home to assist them to develop or maintain their independent living skills. The homely appearance of the home was spoilt by the increase in the plethora f office equipment and documentation in a communal and public area of the building. There was also a risk that information discussed in this office area
Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 7 and over the telephone might compromise service users’ rights to confidentiality. 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.V281278.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standard was not reviewed at this inspection having been assessed as met at the previous inspection. EVIDENCE: Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 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): 6,10 The records assessed at this inspection showed that a comprehensive assessment of need and corresponding care plan was in place for each service user but that there were no formal arrangements in place to ensure that service users were properly supported with their personal development programmes during the day. The gradual development of a staff office in a public area of the building meant that there was a risk that some aspects of care that must remain confidential would be compromised. EVIDENCE: The case file assessed contained a thorough assessment of need and corresponding care plan. Significant events that could affect the service user’s well being had been monitored on a regular basis. The file contained evidence that health care professionals had contributed to assessments and programmes to manage challenging behaviours. Indeed records indicated that these had been well managed and were much fewer than had been the case when the service user had been admitted to the home. However the service user did not attend day care services on two days mid week and therefore her personal development plan was handled exclusively by the home on these
Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 11 days. These arrangements in house were flexible for all service users. A onepage document for all those who lived in the home showed their contribution to cleaning their rooms, assisting in the kitchen (according to ability), laying tables and similar. Other than this, there was little evidence to show how service users were to be occupied during the day. It was explained to the inspector that was this was done on ad hoc basis according to individual preferences. The inspector felt that there should be a more organised approach to this. Given the lack of experience of some personnel there must be guidance in place to ensure that each service user is given the opportunity to maintain/develop their personal living skills and achieve a fulfilling lifestyle within the home. The room that was originally used, as a combined staff office/sleeping in room was no longer used for this dual purpose and was used only as a sleeping in room and for one to one meetings. The area outside the kitchen that was a thoroughfare through to the lounge/diner which had previously been used partially as an office area and partially for service users’ activities had been significantly taken over by the plethora of a staff office. Incoming and outgoing telephone calls were seen to take place in this area. Given than calls would inevitably involve information about service users the inspector felt that there was a risk that confidentiality would be compromised. One member of staff disputed this whilst another agreed that it had taken place. It was explained to the inspector that handover meetings sometimes took place in the laundry room. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 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): 12 There was insufficient evidence to show that every service user had been given the opportunity to take part in fulfilling activities in the home. EVIDENCE: In addition to the arrangements about the lifestyle detailed previously in the section for standard 6, the arrangements for the day-to-day routines for two service users who did not attend day care services were not sufficient as there was no individual plan in place for either to detail proposed daily activities. Mulberry House DS0000039287.V281278.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, 20 Satisfactory arrangements were in place to ensure that medications were given safely and to support a service user to self medicate. One service user found house rules to be restrictive. EVIDENCE: One service user stated that she had to go to her room at 20.00 hours. In a telephone conversation with the manager after this inspection it was explained to the inspector that there was no such house rule but that the majority of service users chose to go to bed around that time and that as the day staff handed on to night staff at 20.30 hours the service users may have developed the idea that it was time to go to their rooms. The manager was advised that the service user’s perception was that this was a house rule and that she must be reassured about her personal choice of times to go to her room. Medicines were stored in an appropriate locked metal wall cupboard. Records assessed showed that medications had been given as prescribed. Two members of staff had signed to witness all administrations of medication. Comprehensive guidelines were in place to show when and why medications for occasional use were to be given and whether there were side effects to take into account.
Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 14 One service user had been supported to manage her medication. Medication was given to her on a weekly basis for storage in a safe in her bedroom. Staff observed the service user to take her medication and had signed the records accordingly. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The protection of service users from harm had been compromised because not all of the necessary checks on the calibre of staff had been carried out before employment commenced EVIDENCE: The personnel file for a recent employee was assessed. Whilst it showed that recruitment practice had improved and had included a check from the Criminal Records Bureau, there had been reference to the POVA First register. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 16 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): 27,28 Restrictions had been placed on the use of an ensuite facility without explanation. The development of office facilities had meant that service users had not been provided with an environment that was as homely as it could have been. EVIDENCE: The on/off pull cord to a service users’ ensuite shower facility had been cut off at a height that could not be reached by either the service user or the inspector. The service user stated that the actual shower had been out of order for some considerable time. A member of staff explained that the time during which the shower had been out of order was in fact much less and that arrangements were in place to repair the fault. It was explained that that the pull cord had been shortened because the service user had been in the habit of pulling it continuously. It was difficult to see how the cord could be activated as it was cut off just short of the ceiling. A system must be sought to disable the shower for short periods only, so that it can be used when required. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 17 The area outside the kitchen that led to the lounge/diner was in use as an office. Situated in this area were two computer tables with screens, a telephone/fax machine, a shredder, a printer, two staff notice boards, filing cabinets and a metal medication cupboard. Other integral cupboards housed documents, personnel files and service users’ case notes. Procedural manuals and other such files were housed on a windowsill. It was explained that one service user also used one of the computers from time to time. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 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): 32,34,35 Whilst the staff were evidently well meaning, the conduct of some members of the team had not upheld service users’ rights to dignity and respect. Failure to provide sufficient induction for a member of staff had meant that insufficient care had been taken to maintain a service user’s self esteem. EVIDENCE: A relaxed and friendly atmosphere was noted as the inspection commenced. The staff on duty demonstrated an interest in the service users’ welfare. However the conduct of individual members of staff was not entirely in keeping with good practice guidelines for effective working with people with learning difficulties: One member of staff had a calming influence on those who tended to become agitated quickly. Another conversely was quite authoritative in her manner towards service users. Another passed observations about a service user’s conduct that was of minor consequence. Whilst the observation was true, it had been uttered in the presence of others in the lounge. There was a risk that such action, whilst evidently well meant, might provoke an adverse response from the service user. Indeed the service user became agitated and used abusive language after this dialogue. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 19 The service user was told in the presence of other service users and members of staff that the inspector was present and watching the service user’s behaviour. Up until this point the inspector had been engaged with another service user but indeed noted the situation once it had been advertised. The inspector felt that it was not helpful to either the service user’s self esteem or the inspection process for it to be implied that the inspector was able to censor such behaviour. The personnel file for one recent employee was assessed. The worker was able to describe aspects of his induction in relation to the health and safety requirements of his role and showed an interest in service users’ welfare. There was lack of organisation about other aspects of the induction process. The worker explained that he read procedures when he got the chance but this was not always possible when the daily care of service users was required. The format for recording his induction process was blank. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 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): 40 Satisfactory arrangements were in place to protect service users from injury. EVIDENCE: Records indicated that systems and equipment was subject to regular assessment to ensure the safety of those who lived and worked at the home. Discussions with staff and records indicated that guidance had been given to staff about safety matters in the home. It was not possible to assess the outstanding standard 39 as the inspection was closed abruptly when it was belatedly explained to the inspector that all of the staff would be leaving the building to accompany service users to a recreational activity. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 21 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 x 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 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 2 28 2 29 x 30 x STAFFING Standard No Score 31 x 32 2 33 x 34 1 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x x 2 LIFESTYLES Standard No Score 11 x 12 2 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 3 x x x x 3 x x x Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 22 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 12(1)(a) 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 specialists (Not assessed in full at this inspection) Care planning arrangements must include details of personal development plans to show how the arrangements for daily activities in the home have been designed to support service users to maintain/develop independent living skills and to achieve a fulfilling lifestyle when at home. The registered person must ensure the confidentiality of information shared about service users. This must include conversations and telephone contact that takes place in the public staff area. Times for bed/going to bedrooms in the evening must
DS0000039287.V281278.R01.S.doc Timescale for action 31/08/05 2 YA6 12(1)(a) 15 31/03/06 3 YA10 12(1)(a) 28/02/06 4 YA18 12(2), 15 28/02/06 Mulberry House Version 5.1 Page 23 5 YA27 6 YA28 7 YA32 8 YA34 9 YA35 not be imposed on service users. They must suit service users’ preferences and where a time is to be imposed the reason, for health or in order to get up for a pre-arranged appointment is explained to the service user and detailed on care records. 12(1)(a) Any arrangements to disable 23(2)(c ) service users’ shower must be qualified on care planning records and ensure that it can be used when required. 12(1)(a) The use of communal space for 23(3)(a) office purposes must not intrude on service users’ comfort and detract from the homely appearance of the home. 12(1)(a) Personnel must receive training 18(1)(c)(i) in communication skills and in dealing with anticipated behaviours, so that interventions take account of service users’ rights to respect, dignity and self- esteem. 12(1)(a) Recruitment procedures must 19(1)(b) include reference to the POVA First register and a CRB check. (Previous timescale of 30/07/05 had not been met in full. 18(i)(c)(i) Staff must receive a satisfactory 17(2) induction within six weeks of their appointment that includes the principles of care. Records must be maintained of induction processes. 28/02/06 31/03/06 31/07/06 28/02/06 28/02/04 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 Page 24 1 YA28 It is recommended that consideration be given to moving the laundry to an outside facility and using that room as an office. Mulberry House DS0000039287.V281278.R01.S.doc Version 5.1 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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