CARE HOME ADULTS 18-65
Fch - Nairn Close/Orkney Close 2 Nairn Close Nuneaton Warwickshire CV10 7LG Lead Inspector
Sheila Briddick Unannounced Inspection 12th September 2005 08:15 Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 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 Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 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. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fch - Nairn Close/Orkney Close Address 2 Nairn Close Nuneaton Warwickshire CV10 7LG 02476 353399 02476 344357 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) FCH - Housing and Care Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th April 2005 Brief Description of the Service: 2 Nairn Close and 9 Orkney Close are part of FCH Friendship Housing and Care. The home provides two separate living environments each for three people with a learning disability. The houses are in close proximity to each other and function as two separate units although staff work across both houses. Each house provides service users with single bedroom accommodation, a bathroom and toilet facility, lounge, kitchen and dining room. A downstairs bedroom facility is available at each house, which at 9 Orkney Close includes an ensuite shower and toilet facility. There is also a conservatory at 9 Orkney Close. There is limited but sufficient parking to the front of each house with enclosed gardens and patio areas to the rear. The properties are in an established residential area of the town of Nuneaton, close to local shops and on a bus route to the town centre. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 12th September 2005 between the hours of 8.15am and 1.30pm. A second visit was made on 14th September to meet with service users. During both visits the inspector had the opportunity to talk with staff as well as the people living in the home, observe the interactions between service users and staff and their environment. A tour of both properties took place and documents relating to service users and the management of the home were examined. Since the last inspection visit on the 6th April 2005 a Vulnerable Adults investigation took place following an allegation of abuse in the home. FCH Housing and Care completed a thorough and proper investigation into the allegation, working closely with the Commission for Social care Inspection and North Warwickshire Social Services. The allegation was substantiated and the owners have taken appropriate steps to safeguard Service Users, including referring to POVA. What the service does well: What has improved since the last inspection?
The living environments at both houses are now providing people with a warm, welcoming and safe place in which to live. Old and unused equipment has been removed and new furniture, carpeting and curtains fitted. Service users were very pleased with all the changes in the home and had been involved with all the planning for choosing and buying furniture. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 6 A service user was particularly pleased with being able to change their bedroom when a vacancy occurred. Infection control and cleaning procedures at Nairn Close can now be more easily managed due to the open plan stairway being enclosed. Medication records are maintained up to date and each service user has now been provided with a safe place to keep their personal possessions. One service user spoken with was very pleased with being able to keep their paperwork ‘safe in my box, which I can open when I want to.’ Service users views are being sought during the care plan review meeting and recorded. The manager is now more involved in recruitment and selection of staff and the staff team are being asked to contribute their views regarding FCH Housing & Care’s Business Plan. 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. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 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 Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 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): Standard 2. The home ensures that they have sufficient information about service users before they come to live in the home so that needs can be appropriately and safely met. Reviewing these needs with care mangers would ensure that the home is continuing to meet changing needs or choices. EVIDENCE: Three care plans were seen at this inspection and each held a care management assessment that had been completed prior to the service user coming to the home. The home had also completed it’s own assessment with each service user. The choice made by one service user to move from one house to another and the reasons for doing so had not been recorded on their care plan or reviewed with their care manager. The service user expressed positive comments about the move as did the other people living in the home and the move was recorded in their personal diary as being positive and of being the service user’s choice. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 and 9. Service users views are sought with a variety of evidence to indicate their views are acted upon. Risk management is good and ensures that service users living in the home are safe from harm. EVIDENCE: House meetings are happening regularly and records show that service users are consulted with on all issues regarding their lifestyle in the home and the local community. A service user said that staff came to the meetings and safety in the home was also discussed at the meetings. Staff spoken with demonstrated an understanding of the importance of promoting service user rights through ‘asking for opinions, suggesting options regarding activities, holidays and choice of food’. Key worker meetings record the summary of action to be taken to meet discussed needs and the participation of the service user, who are signing the record when able. Effective communication was observed between service users and staff during the visits to the home. Staff said that pictures are used with service users to enable better communication in decision making. The individual communication needs of service users is clearly identified on their care plan.
Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 10 The home is continuing to develop communication skills that will meet needs and this should include development of personal ‘communication passports’. Risk management in this home is good. Risk for each individual is identified and recorded on the care plan. This includes risks in activities in the home and when out, regarding financial management and use of equipment. A service user spoken with said that they felt safe in the home, well cared for and that staff treated them well. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16. The people living in this home have appropriate support to live ordinary and meaningful lives and to participate in and contribute to the community in which they live. EVIDENCE: Throughout the inspection staff were observed to respect service users choice and personal space by asking service users for their opinion, keeping service users informed and asking permission to go in bedrooms and when accessing personal records such as diaries. Each service user now has a personal lockable box in which they can keep their personal records, monies or valuables. Service users spoken with said that this was a good thing. Service users were seen to be able to move freely around their home and were comfortable about doing this. The individual preferences of service users regarding household activities is recorded on their care plan and this includes the support necessary when doing so. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 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 the following standard(s): Standards 18 and 19. Care plan programmes in place are clear and up to date and ensure that personal support and healthcare is consistent, reliable and responsive to changing needs. EVIDENCE: Service users spoken with said that staff treated them well and they felt well cared for. Comments made regarding healthcare included, ‘ we go to the doctors – and go on the bus’, ‘we go to the dentist’ and ‘I go to Keep Fit classes’. Service users knew who their GP was and were the surgery is located. Care plan records were up to date and showed that healthcare needs are being reviewed as needs change. Health Action Planning is taking place with the support of the Learning Disability Nurse Team. Other professionals involved in the healthcare of service users includes, Dieticians, Psychologists, Opticians and Dentists. Personal diaries show that service users are being encouraged to live a healthy lifestyle through diet, and exercise. Three service users are members of a local Keep Fit Group. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 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 the following standard(s): Standard 23 Robust procedures in place to protect people from harm, including ‘whistle blowing’, are responded to immediately in the event of suspicion of, or evidence of abuse to ensure people can live in a safe environment. EVIDENCE: FCH Housing & Care carried out a thorough and proper investigation into an allegation of abuse made through the ‘Whistle Blowing ‘policy in April 2005. The investigation was completed through the Vulnerable Adults procedure involving Social Services and the Commission for Social Care Inspection and included referring to POVA. A record of the investigation and Hearing that followed has been forwarded to the Commission and has been maintained on file. Service users spoken with said that they felt safe at the home and that staff were ‘nice’ to them. The staff spoken with demonstrated an understanding of their role and responsibility within the Vulnerable Adults procedure and protection of people in care had been included in their Learning Disability Award Framework, (LDAF), training. The team have not accessed more formal training in POVA policy and procedure although the ‘Acting Manager’ is considering this. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 14 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): Standard 24 Recent investment has significantly improved the appearance of this home creating a comfortable and welcoming environment for those living there and visiting. Continuing investment is necessary to ensure health and safety can be maintained. EVIDENCE: The standard of the environment at Nairn Close has significantly improved since the last inspection visit. New furniture in the dining areas and lounge and wardrobes for service user bedrooms has been purchased. New carpeting in shared areas has been laid and decorating has taken place. The most significant improvement has been through the enclosing of the ‘open plan’ staircase, closing this has now improved the appearance of the hallway and promotes effective cleaning. The home was odour free, bright and cheerful. The people living there were very happy about the changes that have been made to their environment. Diaries and house meeting records show that service users had been involved in choosing furniture and colours for the decorating that took place. The garden area had been cleared of rubble and plans to make the garden a welcoming place to sit are to be discussed with service users Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 15 Orkney Close was equally as warm and welcoming and the people living there were happy with their environment. Staff said that since decoration had taken place in the conservatory area one service user now prefers to spend time there for relaxation. The carpet in the dining room and on the staircase however at Orkney Close whilst clean is showing signs of wear and tear, which includes ‘fraying’ of areas at doorways and on the stair riser. This has the potential to cause trips and falls. There are areas on kitchen worktops that cannot be cleaned effectively as there are chipped and scratched. The standard of cleanliness in both houses was good and staff spoken with felt keeping the environment a pleasant and clean place for people to live was something they did well. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 36 The people in this home benefit from a well supported and supervised staff team. EVIDENCE: There are effective arrangements in place for staff to be briefed by managers and be involved in the development of the service. This includes established procedures for regular supervision, appraisal of training needs, monthly team meetings and induction for all new staff. Three staff files and team meeting minutes were seen and all records were up to date and in good order. Staff spoken with confirmed they were having regular supervision with the Acting Manager and that this included appraisal of training needs. A team meeting was taking place at the time of this inspection visit, this was well attended and a Senior Manager of FCH Housing & Care was present. The ‘Acting Manager’ has recently reviewed the Induction policy and procedure for new starters and also intends to work through the procedure with all staff to refresh knowledge of policy and practice in the home. This is good practice and will ensure that aims and objectives for the service provision are being consistently met. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 17 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): Standard 39 The home is making significant progress in developing systems for reviewing all aspects of it’s performance through a programme of self-review and consultation, which includes seeking the views of service users and their relatives. EVIDENCE: Feedback from service users is being sought through regular house meetings with them and as part of the key worker review meetings. A record of action taken as a result of feedback is recorded. Continuing development of care planning in the home is now ensuring the views of service users are recorded on care plans and reviews demonstrate achievements and successes in meeting outcomes for service users. Questionnaires have recently been sent out to relatives seeking their views on the service and one has been returned. This was seen and confirmed that the relative was extremely satisfied with the care their family member was receiving. Feedback has not been sought from professionals involved with the service provision but this is being considered. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 18 Staff spoken with discussed the newly introduce document from FCH Housing & Care seeking feedback from employees on the Business Plan for Care and Support Services, being able to contribute to this is welcomed by the staff. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 19 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 X 3 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Fch - Nairn Close/Orkney Close Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000004360.V249904.R01.S.doc Version 5.0 Page 20 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 YA24 Regulation 23.2(b) Requirement All areas of ‘fraying’ carpet in the dining room and on the staircase at Orkney Close must be repaired. The kitchen worktops that are damaged at Orkney Close must be replaced with new. Timescale for action 12/10/05 2 YA24 23.2(b) 30/10/05 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 2 Refer to Standard YA2 YA7 Good Practice Recommendations It is recommended that a care management reassessment is requested for the service user who has moved into alternative accommodation at Nairn Close. It is recommended that Communication Passports are developed for service users with communication needs with the support and guidance of speech and language therapists. It is recommended that the staff team access refresher training in the Protection of Vulnerable Adults, which includes the Local Authority POVA policy and procedure. It is recommended that the dining room carpet at Orkney
DS0000004360.V249904.R01.S.doc Version 5.0 Page 21 3 4 YA23 YA24 Fch - Nairn Close/Orkney Close 5 YA39 Close be replaced. It is recommended that the views of other professionals involved in the care provision of the people living in the home is sought as part of monitoring that the service is meeting it’s aims and objectives. Fch - Nairn Close/Orkney Close DS0000004360.V249904.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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