CARE HOME ADULTS 18-65
Nine Elms Lane 87-89 Nine Elms Lane Park Village Wolverhampton West Midlands WV Lead Inspector
Joy Hoelzel Unannounced Inspection 26th January 2006 12:00 Nine Elms Lane DS0000017190.V275902.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 Nine Elms Lane DS0000017190.V275902.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. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Nine Elms Lane Address 87-89 Nine Elms Lane Park Village Wolverhampton West Midlands WV 01902 833730 01902 833731 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) N/K Lonsdale (Midlands) Limited Miss Kay Michelle Andrews Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Learning Disability who may also have physical disability Learning disability with Guardianship or supervision orders under the Mental Health Act 1983 27th September 2005 Date of last inspection Brief Description of the Service: 87-89 Nine Elms Lane is a care home providing accommodation, personal and nursing care for seven adults with learning disabilities. It is privately owned by Lonsdale (Midlands) Limited. The home is located in a residential area of Wolverhampton overlooking parklands. Local shops and amenities are a short walk away. The property is a two storey building providing single private accommodation, communal lounge and dining areas. The home has a passenger lift for access to the first floor. There is adequate parking to the front of the building with enclosed gardens to the rear. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over three hours on Thursday 26th January 2006 and is the second of the two statutory inspections for 2005/06. Three care staff, the manager and a registered nurse were on the premises at the time of the inspection. Seven people are currently residing at the home. Four clients were out at various day centres and three people and were at the home engaged in various activities. One care plan was inspected in depth, together with supporting documents, discussions were held with residents and staff, and a tour of the building was conducted. What the service does well: What has improved since the last inspection?
An existing bathroom on the first floor is having an easy access shower installed; this will give clients an additional option of their preferred method of bathing. A revised system with new documentation has been implemented for the safe receipt of medication into the home. Repairs have been made to some soft furnishings and household linen has been purchased. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 6 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. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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 Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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): 1 Prospective clients and other interested parties are unable to make an informed choice about the home, as the information is unavailable. EVIDENCE: The statement of purpose for the home is still unavailable. The registered manager explained that the document has been drafted but has not been printed and was not accessible on the computer at the home. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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): 6 Staff are sensitive to the individual needs of each client and meet these in a professional manner, however the care plans do not accurately reflect this. EVIDENCE: The care plans are being reviewed at monthly intervals by the staff and whenever possible the client or representative. The registered managers explanation of the current problems with one client and the care plan generated for sleeping did not accurately correspond. The arrangements being made for this service user during the night are not acceptable. Alternative arrangements were discussed with the registered manager and recommendations were made for obtaining further advice and specialist equipment. The care plan for maintaining continence did not include in sufficient detail the instructions and interventions that staff need to take. The registered manager explained that staff were aware and had knowledge of this persons needs and attended to them at regular intervals during the day and night. The registered manager stated that an occupational therapist had been contacted for advice of specialised equipment for use in the bathroom. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 10 Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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): 17 Further improvements are required to ensure that each person is provided with a well balanced diet. EVIDENCE: Some minor improvements have been made to ensuring a well balanced diet is offered to clients. The registered manager stated that the dietician, day centres and other care homes have been contacted for advice on menu planning. New documentation has been devised for the weekly menu but has not been completed. Cartons of fruit juice were in the fridge but there was no evidence of any fresh fruit and the only fresh vegetables in the storeroom were potatoes and onions. The registered manager explained that two days, Monday and Friday, are allocated for food shopping, subsequently stocks were low. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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): 16,18,20 The home provides a good quality and unique lifestyle for the people in residence EVIDENCE: Staff demonstrated a good knowledge of each client and the amount of personal care they individually require. One client is currently having problems and difficulties during the night, the registered manager explained the support the staff were giving this person. Care files evidence that additional support is obtained from other healthcare specialists when required e.g. District nurses, continence advisors, etc. The three clients at the home were unable to comment about their particular needs but appeared well groomed and cared for. The procedures for the receipt of medication into the home have been revised together with additional documentation for any tablets that are refused or not required. The Medication Administration Record charts appeared to be completed satisfactorily. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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): 22,23 The home has a satisfactory complaints procedure in place, which can be produced in an appropriate format for the people currently living at the home EVIDENCE: The registered manager stated that no changes had been made to the complaints or adult protection procedures. The complaint procedure is readily available and can be produced in pictorial form if required. The adult protection procedures, including the whistle blowing procedures are available for staff reference when needed. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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): 24 The standard of the environment is good providing service users with a safe well-maintained environment to live in. EVIDENCE: Some improvements have been made to the environment with alternative flooring being replaced in problem areas, repairs have been made to the soft furnishings and new household linen has been purchased. The client’s bedrooms are homely, personalised and well maintained. Following an assessment into the individual needs of the clients, the registered manager has arranged for a new shower facility, with easy access, to be installed. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 15 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): 33,36 The lack of regular supervision and support given to staff has the potential to disadvantage service users in receipt of the individual care that has been identified. EVIDENCE: Staffing during the 24 hour period remain at the agreed levels with first level nurse cover and support workers. Staff were observed to be sensitive to the individual clients needs and together they were engaging in various activities, e.g. watching television, looking at catalogues and playing games. Alternative methods of communication with the clients when verbalising is difficult. Some records were seen for staff supervision but it was evident that not all staff are receiving formal supervision with their line managers every two months. The registered manager stated that no staff members have yet to receive an annual appraisal to review their performance and was unsure of when this would happen. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 16 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 Health, safety and welfare of service users and staff are promoted fully by safe working systems in place. EVIDENCE: The registered manager stated that she would be leaving the home in February as she has secured new employment. She discussed the future management plans and advised that recruitment for a suitable replacement has begun. The last quality assurance audit report is dated April 2001. The registered manager was unsure if any monitoring systems in the form of questionnaires had been undertaken since that date. An individual within the organisation carries out monthly visits; the report is forwarded to the manager and Commission for Social Care Inspection. Safety checks are maintained each month for the fire alarm system, hot water temperatures, and nurse call system. The patient hoist is serviced each six months and all portable electrical equipment is safety tested each year. Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 17 Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 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 Standard No Score 1 1 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 x 3 X 2 X X 3 X Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 19 Yes 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 YA1 Regulation 5 Requirement The Registered Provider needs to ensure that there is a service users guide; this must be available to all service users and their advocates. Previous timescale of 30/11/04 and 30/11/05 not met. This is now a priority requirement. Timescale for action 28/02/06 2 3 YA6 YA17 12(1)(a) 16(2)(i) 4 YA36 18(2) The information recorded in the 28/02/06 care plan must accurately reflect the care that is being offered. The registered person must 28/02/06 ensure that meals are provided are wholesome, nutritious and varied. Previous timescale 31/10/05 not met. The Manager must ensure that 28/02/06 there are procedures in place to ensure that all staff members have supervision at least 6 times a year and an appraisal annually. Previous timescale of 30/11/04 and 30/12/05not met This is now a priority requirement.
DS0000017190.V275902.R01.S.doc Version 5.1 Page 20 Nine Elms Lane 5 YA39 24(1) The registered person must ensure that quality assurance and monitoring systems are developed and maintained. 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nine Elms Lane DS0000017190.V275902.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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