CARE HOME ADULTS 18-65
9 New Hutte Lane 9 New Hutte Lane Halewood, Liverpool Merseyside L26 9UD Lead Inspector
Joanne Revie Unannounced 18 August 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 9 New Hutte Lane Address 9 New Hutte Lane Halewood Liverpool Merseyside L26 9UD 0151 291 9139 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brothers Of Charity Ms D Fitzsimmons Care Home 3 Category(ies) of LD - Learning Disability registration, with number of places 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 3 LD Date of last inspection 24th January 2005 Brief Description of the Service: 9 New Hutte Lane is a three-bedded detached bungalow, which is situated in the Halewood area of Liverpool. Alternative Housing owns the property and the service is provided by the Brothers of Charity. The service provides personal care and support to three services users who have severe learning disabilities. All three service users moved to the home following the closure of a long-term institution some time ago. The home has a garden, which is adapted for Service Users who have physical disabilities, and a purpose adapted mini bus is available for outings and appointments. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. On the day of this unannounced visit one service user was at home, the other two were attending the local day centre. Two staff were on duty. Discussions were not held with the service user who was at home due to communication difficulties. Discussions were held with the staff on duty. It was not possible to make contact with any relatives or representatives of the service users who live at the home. What the service does well:
Each service user has a comprehensive care plan. This contains details of all their needs, likes, dislikes and capabilities. This is important, as none of the service users are able to verbally communicate therefore staff rely on this document to understand the service users needs. Staff who know the service users well have input into these plans. An example of input from other health care specialists was also viewed. This showed that the service explores all avenues when providing care to its service users. Staff explained that they are able to understand the service users wishes through observing their body language. This was also documented in the plans of care. Service users are encouraged to live as independent a lifestyle as possible. Risk assessments are carried out which clearly identify the support required by each service user when undertaking activities. Staff have a very good understanding of each of the service users within their care. It was evidenced that they clearly understand principles of good care and try to reflect this when caring for the service users. This is important as due to communication difficulties it would be very easy for the staff to impose their will on the service users rather than the service users being encouraged to make their own choices. Service Users always have staff support when attending hospital appointments. Medications are managed safely within the home by staff who have been trained to do so. Some service users require medication that is” give when required”. Staff have clear guidelines on when this should be administered which reduces the risk of service users taking medication that they don’t need. Staff have received training on how to protect service users from abuse. During the visit they proved to be very knowledgeable on this subject. This is important, as the service users who live in the home are very vulnerable. The service has produced a comprehensive policy on abuse awareness/prevention, which is clear and easy to understand. All staff receive a summarised version of this within the staff handbook once employment begins. The Home is a comfortable place to live. It has undergone extensive refurbishment and redecoration in recent years. The home provides staff to a ratio of two staff for three service users. This increases at times according to the daily activities of each service user.
9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 6 At night the service provides one waking member of staff and one sleeping member of staff to provide extra support should the need arise. Service users have access to a spacious shared lounge with combined dining room, which overlooks the garden. The garden is secluded and has been fitted with handrails so that service users who have a physical disability can enjoy it. Service users are supported to attend local day centres, receive one to one support when visiting the community and are encouraged to visit places of local interest. Each service user has an essential lifestyle plan. This document details who is important in their lives and the support that they require to maintain a fulfilling relationship with this person. Visitors are encouraged to visit the home when they choose. What has improved since the last inspection? What they could do better:
Over the last few months there has been a migration of some of the staff team to other homes within the service. This has occurred slowly and service users have adapted to the changes. This has also included a change in manager. Unfortunately this has resulted in the service users not being given the opportunity to go on holiday as has happened in previous years. Staff stated that they believed that the service was aiming to provide a planned holiday later in the year but they were unsure of when or where this was occurring. This must be addressed to ensure service users experience a full quality lifestyle.
9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 7 Although the service users bedrooms appeared clean and comfortable some required works which were identified as follows: One front bedroom has a stain on the ceiling near the chimney breast, the other front bedroom requires attention to the wall paper behind the service users arm chair. The back bedroom has had a change of heating to reduce the risk of injury occurring to the service user. This has left an unsightly patch, which requires redecoration. These matters must be addressed. Alternative Housing are responsible for carrying out Health and Safety checks at the home. Although the organisation takes a serious approach to Health and safety some areas were found to be lacking. A safety certificate stating that the electrical supply to the property was safe could not be found and there was no evidence that the Water supply had been cleansed. The manager is undertaking quarterly Health and Safety Audits on the property but this has not been completed since March 05 and is now overdue. A fire risk assessment was viewed but this had been completed in September 03. Fire risk assessments must be reviewed annually and updated as necessary. These matters must be addressed to ensure that the service users are living and Staff are working in a safe environment. 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. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 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 standard(s) EVIDENCE: All three service users have lived at the home for a number of years. No other standards were assessed from this section on this occasion. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 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 standard(s) 6,7,9 Service Users are encouraged to lead independent lifestyles with staff support once all risks have been identified. Service users are empowered to make decisions and choices within their capacity. Staff have clear detailed instructions on the care and support that each service user requires. Service users are supported to remain healthy. EVIDENCE: Discussions were held with two staff members. Care plans and essential lifestyle plans were viewed for three service users. Each service user has a comprehensive plan, which clearly reflects their needs. The plans are individual to the service users and are regularly reviewed and updated. Relevant health care professionals and key staff are involved in this process. Staff understand service users needs and likes and dislikes through monitoring and observing body language. Service users are encouraged to take risks associated with normal aspects of daily living whenever possible. Risk assessments are carried out which are specific to the service user and are individual. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 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 standard(s) 12,13,14,15,16 Service Users are supported to undertake quality activities inside and outside the home (according to their needs likes and dislikes), which also promote personal development. Service Users have not been given the opportunity to go on holiday this year. Visitors are encouraged to visit when they choose and service users are supported to interact during these visits. EVIDENCE: Care plans for each service were viewed as well as the daily reports and the service users learning log. A discussion was held with two staff members. It was evidenced that each service user is offered a quality lifestyle according to their capabilities and individual likes/ dislikes. Two service users regularly attend a local day centre but undertake activities at the home also such as attending bar b ques and visiting places of interest. One service user does not interact as well as the others and this has limited the choices available. Staff have responded to this by ensuring that health needs and medication are reviewed in the hope that improvements will be identified which can lead to a more fulfilling lifestyle. A holiday as been planned for later in the year but staff could not confirm when or where this was taking place. Learning logs have been developed and implemented since the last inspection.
9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 12 These documents include all activities undertaken throughout the day such as making beds etc. Each log gives details of the activity undertaken, what the aim is, and who provided support. This supports the service users with personal development. It was evidenced that staff clearly understand principles of good care and try to reflect this when caring for the service users. Each service user has an essential lifestyle plan. This details who is important in their lives and the support that they require to maintain fulfilling relationships. Viewing the visitor’s book showed that visitors come to the home at a variety of times. Staff confirmed this to be true. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 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 standard(s) 18,19,20 Service users receive the personal care and health care that they require. Medications are managed safely within the home. EVIDENCE: Health Action Plans and medication administration records and policies were viewed. A discussion was held with staff on duty. The Health Action plans were found to be detailed and specific to each service user and contain details of a variety of input from other health care specialists as well as usual annual checks. Medication Administration records were viewed which were found to be clear and fully completed. Guidance is available on when to give medications that are “ give as required”. Staff confirmed that they have had training on this subject and have access to a comprehensive policy. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Service users are protected from Abuse by staff that have been trained on this topic. EVIDENCE: Discussions were held with staff. A copy of the abuse awareness policy and staff handbook was also viewed. The service has a comprehensive policy in place, which is easy to understand. Staff confirmed and proved knowledgeable on what constitutes abuse and how to report concerns in line with Local Adult Protection Guidelines. They confirmed that they had received this knowledge through training that was provided by the service and that they had each received a copy of the staff handbook, which also contains guidelines on abuse awareness. 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,30 All communal areas of the home are clean, comfortably furnished and decorated to a good standard. The bedrooms require a variety of works to ensure that they meet the same standard. The risk of cross infection occurring is reduced within the home. EVIDENCE: The environment including bedrooms was viewed. Over the last few years the service has undergone extensive refurbishment, which promotes a homely atmosphere. Some concerns were evidenced in the service users bedrooms as follows: One front bedroom was found to have a stain on the ceiling near the chimneybreast, which requires attention. The other front bedroom had torn wallpaper behind the service users armchair. The back bedroom has had the type of heating changed following an identified risk for the service user. This has left an unsightly patch on the wall, which requires redecoration. All parts of the home were found to be clean and tidy. Staff confirmed that they undertake cleaning duties and have had training on the prevention of cross infection. The service has facilities to dispose of clinical waste and is fitted with a washing machine, which is able to clean soiled washing appropriately.
9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards were assessed from this section on this occasion. However viewing off duty showed that the service is appropriately staffed. EVIDENCE: 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not all the required certificates were available to prove that the home is safe place to live. EVIDENCE: The Health and Safety file and relevant certificates for the service were viewed. Alternative Housing owns the house. They have attempted to implement a file, which gives a clear overview of necessary checks, which are undertaken to meet legislation. The fire alarm has been regularly serviced and tested and staff confirmed that they had received training plus updates on this subject. All equipment related to fire fighting is also regularly tested. A gas safety certificate was viewed which was current. Portable appliances have been tested for safety. However a safety certificate stating that the electrical supply to the property could not be found. On viewing the file there was no evidence that the Water supply had been cleansed. The manager is undertaking quarterly Health and Safety Audits but this has not been completed since March 05 and is now overdue. A fire risk assessment was viewed for September 03.
9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 18 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 x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 2 x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 2 3 3 x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
9 New Hutte Lane Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x 1 F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 19 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 YA14 Regulation 16.(2)(m)(n) 23.-(2)(b) 13.-(3)(4) Requirement The service must follow through its intentions to plan a holiday for those service users who wish/are able to participate. The service must ensure that the works identified in each of the bedrooms are carried out. The service must produce evidence to CSCI showing that the service has a safe water and electricity supply. The fire risk assessment for the home must be reviewed and if necessary updated. Timescale for action 31/10/05 2. 3. YA25 YA43 31/10/05 30/09/05 4. YA43 23.-(4)( c) 30/09/05 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. Refer to Standard YA43 Good Practice Recommendations The manager should continue to carry out the quarterly Health and Safety Audits 9 New Hutte Lane F53 F03 S21495 New Hutte Lane V228223 200805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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