CARE HOME ADULTS 18-65
Natalie House 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG Lead Inspector
Gerard Hammond Unannounced Inspection 17th November 2005 10:30 Natalie House DS0000016731.V268273.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 Natalie House DS0000016731.V268273.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. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Natalie House Address 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG 0121 457 9592 0121 457 9592 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) Alphonsus Homes Ms Novelet Stewart Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 23rd June 2005 Brief Description of the Service: Natalie House is registered to provide accommodation, personal care and support for five adults with learning and physical disabilities. It is situated in a quiet residential area on the edge of the Lickey Hills in Rednal, Birmingham. The house is close to public bus routes and the shopping centre at Rubery is also nearby. The property is a purpose built bungalow and first opened in 1991. It is specifically designed to meet the needs of people with learning disabilities, who may also be physically disabled. Each single bedroom has en-suite facilities, including level entry shower, w.c. and wash handbasin. There is a large bathroom with spa bath and w.c., and a separate w.c. In addition there is a lounge giving access to the garden, a dining room, kitchen, separate laundry and office. The garden is enclosed and private, and includes both lawn and patio areas. There is limited off-road parking at the front of the house. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was the second visit of the current inspection year. This report should be read in conjunction with the one written following the inspection completed on 02 June 2005. Direct observation and sampling of records (including personal files, care plans, safety records and previous inspection reports) were used for the purposes of compiling this report. The Registered Manager was interviewed formally. The Inspector met all of the residents. Unfortunately, the communication support needs and level of learning disability of all of the people living in this house make it difficult to seek their views directly. A tour of the building was also completed. What the service does well: What has improved since the last inspection?
Efforts have been made to meet some of the requirements made at the time of the last inspection. Residents’ contracts have been amended and updated. Some work has been done to start the development of care plans and risk assessments. A new assessment format has been devised, and care plan formats are being updated, so that they can be produced on a computer and amended / updated more easily. A new digital camera has been purchased, so that pictorial aides can be developed to support communication initiatives. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 6 Some thought has been given to analysing the activity opportunities currently enjoyed by people living in the house, and to thinking about the purposes of activities undertaken. Adult Protection Procedures and the Workplace Fire Risk Assessment have both been amended and updated, as required. The Organisation continues to develop its Quality Assurance and Monitoring System. What they could do better:
Care plans and risk assessments continue to be in need of development. Work already done towards this now needs to be built on. As identified at the time of the last inspection, changes need to be made so that it is possible to measure improvements and progress. This will involve setting some clear goals and reviewing these properly, at least every six months. Care plans should also include all the information essential to providing support appropriately to each individual, and be supported by detailed communication guidelines. In the same way, work done towards developing residents’ activity opportunities now needs to be taken further. Recording of activities needs to be more detailed, and should include activities undertaken at home as well as out in the community. The complaints procedure is still in need of minor amendment, to clarify matters appropriately. Some aspects of medication administration are in need of attention, though practice is generally satisfactory. Medication Administration Records must be completed appropriately. It is also recommended that photocopies of prescriptions should be retained, to assist in the identification of any prescribing errors. Of some concern is the ongoing matter relating to bathing facilities currently available in the Home. A thorough assessment is required to inform further discussion of this issue, and this should now be dealt with, without further delay. Staff numbers should also be reviewed. In particular, there are two areas of major concern: support for residents at mealtimes, and the availability of activity opportunities, especially at evenings and weekends. Visits to the Home and reports required under Regulation 26 (Care Homes Regulations 2001) should take place at least once every month, with reports being available for inspection.
Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 7 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. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 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 Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 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): 5 Residents have individual written contracts, as required. EVIDENCE: There have been no new admissions since the last inspection. Standards 2 and 4 were assessed at the time of the last inspection, and met in full. At that time, a requirement was made with regard to residents’ contracts. These have now been amended and updated, and include details of costs and contributions as required. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 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&9 Individual care plans and risk assessments require further development to include residents’ goals, and reflect how their care needs should be met, in greater detail. EVIDENCE: Standard 7 was also assessed at the last inspection, and was met in full. Requirements were left concerning the development of care plans and risk assessments, and limited progress has been made in this regard. New care plan templates are being developed, so that these can be written and amended on a computer. This should be seen as a positive development, and should make a positive contribution to care management practice, when systems are up and running. To support this, a new assessment format has also been devised, and this is now partially implemented. It is recommended that care plans and risk assessments are numbered and indexed appropriately, in order to facilitate clear cross-referencing, as previously indicated. It is important that progress is made to develop plans, as required at the last inspection. Work needs to be
Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 11 done on setting goals, improving the detail about how support should be given, and developing individual’s communication guidelines. Comprehensive risk assessments should produce control measures, which can then be used to inform individual care plans. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 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, 13, 15, & 17 As previously reported, residents are able to take part in appropriate activities and to be a part of their local community, but more work to develop opportunities is yet to be done. People living in the house are supported to keep in touch with their families and loved ones. Residents enjoy a balanced and nutritious diet. EVIDENCE: Standards 12 and 13 were assessed at the last inspection, and requirements made to evaluate residents’ opportunities for activities, as an integral part of care plan reviews. Some attempts have been made to address issues raised, and work done on this now needs to be taken further. A new community activity assessment chart has been devised and put into place. This only identifies activities undertaken away from the house. There is evidence that some thought has been given to the purposes of activities, and this needs to be encouraged and developed further. Activity recording needs to be in more detail, and should also include activities undertaken at home, where
Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 13 appropriate. There are also issues about scheduling staff support for residents’ activities, and the Manager is seeking to resolve these. Personal records, and conversations with the Manager, indicate that residents are supported to maintain contact with families and friends, in accordance with the wishes of all involved. Visits are facilitated both at the house and away from home, and some people also maintain contact by telephone. Food stocks were examined: supplies were plentiful, and fresh produce including fruit, salad and vegetables freely available. Residents were observed taking lunch, and seen to be offered choices appropriately. Staff supported people sensitively to have their meals in a sensitive manner, but there are issues about the number of staff required to do this properly (see Standard 33 also). Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 Residents are given personal support with respect and sensitivity. Improving their communication opportunities could enhance this further. General practice in the storage, handling and administration of medication is satisfactory, but one or two issues require attention. EVIDENCE: Standard 19 was also assessed at the last inspection. A requirement was made in respect of seeking advice about the bowel care management of one of the residents. The Manager reported that the GP had been contacted, advice given, and action taken. The relevant care plan should now be updated to reflect this. A requirement was made that ways of extending residents’ communication opportunities should be actively explored, so as to improve levels of engagement and enhance consultation. The Manager advised that a digital camera has now been purchased for the Home to facilitate the development of pictorial aides to support individual’s communication. There is also an outstanding requirement in relation to the Home’s medication policy (see Standard 40). This needs to be developed to give clear guidance on procedures when administering medication, and also the action to be taken in the event of an administration error. The Manager advised that this issue has
Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 15 been discussed at the Organisation’s management team meeting, and recognised as a deficit. However, it should be acknowledged that this issue is covered specifically in the test conducted after staff have completed medication training, and clear evidence of this was seen. The policy requires amendment to reflect practice appropriately. Medication records were examined. Previous inspection reports have indicated that the management of medication within the Home has been generally satisfactory. Medication is stored appropriately, and records include information on medication prescribed, and protocols for PRN (“as required”) medication are in place. While the Medication Administration Record (MAR) was generally complete, it was noted that there were unexplained gaps on the day of the inspection visit. The Manager indicated that the medication had been given in all instances, but had not been signed for, as required. It is recommended that a recent photograph of each resident be filed with his or her MAR, and also that photocopies of prescriptions are retained, to assist in the identification of any prescribing errors. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were assessed at the last inspection. A minor adjustment to the complaints procedure remains outstanding. The adult protection procedure has been amended as required. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Issues relating to the suitability of current bathroom facilities and the provision of specialist equipment for some of the residents remain outstanding. EVIDENCE: Standards 24 and 30 were assessed at the last inspection, and met in full. Residents at Natalie House continue to enjoy the benefit of living in a house that is comfortable, safe and homely, and kept clean and tidy with a good standard of hygiene maintained throughout. Refer to the last inspection report (02 June 2005) for details of the issues relating to the provision of bathing facilities within the Home. This matter remains outstanding. The Manager must complete the report required at the time of the last inspection, and submit this to CSCI without further delay. This should clearly address the support needs of the residents, and also the health and safety issues relating to staff. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 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, 33 & 35 Staffing levels need to be reviewed to ensure that the care team can operate effectively. A current training and development plan is required in order to assess members of staff’s qualifications, training needs and competencies appropriately. EVIDENCE: Standards 34 and 36 were assessed at the last inspection and met in full. Standard 35 was also assessed, and partially met. An up to date training and development plan should be provided to show the current training needs of the members of the staff team. This should include all the information indicated in the requirements section of this report. The Manager advised verbally that three members of the current staff team are qualified to NVQ level 3, and four to NVQ level 2. Four staff are said to have undergone training on the Learning Disability Awards Framework (LDAF), and one has completed the course. As indicated earlier in this report, the Inspector observed residents taking lunch. There is an outstanding requirement that staffing levels should be reviewed, particularly in respect of support needed at mealtimes, to undertake personal care routines, and activity opportunities.
Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Residents are able to benefit from living in a home that is generally well run. Information gained from quality assurance and monitoring systems should now be made available to interested parties, showing how residents’ views and wishes have underpinned this process. General practice promotes the health, safety and welfare of people living in the house. EVIDENCE: The Manager reported that she anticipates completing NVQ level 4 and the Registered Manager’s Award by April 2006. As previously reported, the Manager and staff appear to enjoy a genuine rapport and a good working relationship. The overall style of management is seen to be open and inclusive. Evidence of developments in systems for quality assurance and monitoring of the service were seen, including in-house audit checks, pre-audit
Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 20 questionnaires and audit checklists. The Organisation follows a practice of allowing other Home Managers to go and audit homes other than the one in which they work. The results of this activity should be collated and made available to interested parties. In particular, systems should indicate clearly what has been done to take into account the wishes and views of people using the service, as much as this can be achieved. It was noted that reports required under Regulation 26 (Care Homes Regulations 2001) were not available for the months of March, May, August, September and October 2005. This is explained in part by the fact that the previous Service Manager has left the Organisation. A previous requirement that the workplace fire risk assessment should be updated has now been met. The local Fire Officer has inspected the premises recently, and the Manager must ensure that the requirements of his report dated 31 October 2005 are complied with, as indicated. It was noted that fire evacuation drills are being held regularly, and that the fire alarm and emergency lighting systems have been checked as required, and a record maintained as appropriate. Portable appliance testing of electrical equipment has also been completed. Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X 1 X X X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 3 2 2 X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Natalie House Score 2 X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 3 X DS0000016731.V268273.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 (1-2) Requirement Care plans should be developed so that they contain all information essential to provide individual support. Care plans should also include goals with measurable outcomes, and be reviewed at least every six months. Reviews should be recorded in writing, and indicate who takes part and how decisions are reached. Outstanding since 02/06/05 Risk assessments should be cross-referenced with the care plan(s) to which they relate, and reviewed in conjunction with them (as at 2. above) Outstanding since 02/06/05 Residents opportunities for activities must be properly evaluated as an integral part of their care plan reviews. This must include accurate recording of activities offered, declined and undertaken, both at home and in the community. It must also include information concerning the purpose of activities undertaken and demonstrate how choices have been made.
DS0000016731.V268273.R01.S.doc Timescale for action 28/02/06 2 YA9 13 (4a-c) 28/02/06 3 YA12 16 (2m-n) 28/02/06 Natalie House Version 5.0 Page 23 Outstanding since 02/06/05 4 YA18 15 (1-2) Ways of enhancing residents communication opportunities must be actively explored so as to improve levels of engagement and enhance consultation. Outstanding since 02/06/05 Guidance obtained from the GP in respect of residents whose bowel care requires monitoring, and advice given must be included in individual care plans. The complaints procedure should be amended to indicate that complaints should be registered within 3 days, or as soon afterwards as is practicable. The appeal period should also be extended. Outstanding since 02/06/05 The bathing support needs of each person in the Home should be reviewed, and a report submitted to CSCI in accordance with guidance given in the main body of this report (see Standard 27) Outstanding since 02/06/05 A review of staffing levels must be completed to include support required at mealtimes and to undertake personal care routines, as well as the provision of appropriate activity opportunities in the evenings and at the weekend. Outstanding since 31/05/05 A current training and development plan for staff must be submitted to CSCI. This should include details of training already completed by each staff member and indicate when refreshers or additional courses are required, when these are scheduled, and who is to deliver the training.
DS0000016731.V268273.R01.S.doc 28/02/06 5 YA19 12 (1-3) 31/12/05 6 YA22 22 28/02/05 7 YA27YA29 23 (2n) 31/01/06 8 YA33 18 (1a) 31/01/06 9 YA35 18 (1c) 31/01/06 Natalie House Version 5.0 Page 24 10 YA39 24 (1-3) 11 YA40 13 (2) 12 YA41 26 The Organisation should develop and implement systems to monitor and evaluate the quality of the service offered in the Home, taking special account of the communication needs of the residents. Make the report of the findings of monitoring activity available to interested parties. The medication policy should be developed to give clear guidance on procedures when administering medication, and the action to be taken in the event of an administration error. Outstanding since 31/06/05. Reports of visits required under Regulation 26 must be available for inspection. Outstanding since 30/04/05 28/02/06 31/01/06 31/01/06 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 3 Refer to Standard YA6 YA9 YA20 Good Practice Recommendations Residents communication guidelines should be placed in a prominent position on their care plans. Risk assessments should be indexed appropriately Retain photocopies of all prescriptions, and file a current photograph of each person with his or her Medication Administration Record (MAR) Natalie House DS0000016731.V268273.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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