Inspection on 06/12/05 for Nottingham Neurodisability Services Aspley

This inspection was carried out on 6th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nottingham Neurodisability... 07/07/08

Nottingham Neurodisability... 19/12/07

Nottingham Neurodisability... 28/08/07

Nottingham Neurodisability... 29/08/06

Nottingham Neurodisability... 23/05/05

Nottingham Neurodisability... 13/07/04

Nottingham Neurodisability... 10/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Aspley Neuro Disability Unit Robins Wood Road Aspley Nottingham NG8 3LD Lead Inspector Steve Keeling Unannounced Inspection 6th December 2005 10:00 Aspley Neuro Disability Unit DS0000059536.V271706.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 Aspley Neuro Disability Unit DS0000059536.V271706.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. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Aspley Neuro Disability Unit Address Robins Wood Road Aspley Nottingham NG8 3LD 0115 942 5153 0115 942 5154 aspley@fshc.co.uk 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) Four Seasons Homes (Ilkeston) Ltd Mr. Akinwumi Olusegun Akinpelu Care Home 32 Category(ies) of Physical disability (32) registration, with number of places Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: Aspley Neurodisability Unit is a purpose built unit situated in the inner city area of Nottingham in Aspley. The home is within access to local shops, library, health centre, churches and a pub. The communal lounges of which there are two and a designated dining area are situated on the first floor. Resident’s rooms are both on the ground floor and the first floor. All personal rooms are of single occupancy and fitted with an en-suite facility. A passenger lift facilitates access to the first floor. Four Seasons Healthcare Limited was registered in February 2004 with the Commission for Social Care Inspection as the registered providers. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a 4-hour period and involved one inspector. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the home setting and that their safety and well being is being maintained. On this occasion two service users notes were case tracked and two service users were spoken with. At the time of the inspection a total of 25 service users were accommodated at the home. The manager within the unit was very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. What the service does well: It was evident that the newly appointed manager of the unit has an excellent knowledge of both the physical and psychological needs of individuals with physical disabilities and is providing clear direction for all grades of staff in an attempt to provide a service which will address the service users holistic needs. Staff members interact with service users in a caring and sensitive manner. Residents living at the home provided positive comments on the care provided at the home. Service users stated that they feel safe within the homes environment and felt their privacy was respected and their dignity was upheld. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Aspley Neuro Disability Unit DS0000059536.V271706.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 Aspley Neuro Disability Unit DS0000059536.V271706.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): 2 The aspirations of the service users are not assessed or documented appropriately and as such it could not be established if these needs are being addressed effectively at the home. EVIDENCE: The individual care plans examined did not evidence sufficient information appertaining the rehabilitation of the service users so as to achieve optimum independence. No documentary evidence was available to identify the service users long-term goals and aspirations. The newly appointed manager of the home confirmed that this element within the assessment process requires further development and it was established that she would be addressing it in the near future in an attempt to establish clear goals for the service users within the home. The Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection. Aspley Neuro Disability Unit DS0000059536.V271706.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): 6. 7. Individual care plans do not reflect the changing needs of the service user as such the care planning process is ineffective in meeting the holistic needs of the service users. Service users are encouraged to make decisions appertaining to the own life and are assisted appropriately. EVIDENCE: The care plans examined on the day of the inspection were clear, concise and informative although it was established that care plans were not evident to address all the service users needs identified within the pre-admittance assessment documentation. The manager of the home demonstrated a thorough knowledge of the principles of care in relation to individuals with physical disabilities. In relation to the dissemination of information within the service users care plans the manager stated that some further work is required to ensure that staff at the home are fully informed of the identified needs within the care plans and how to address them effectively. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 10 Currently only one hand over is performed per day and it is the intention that this process will be performed twice daily to aid the communication process. The manager also intents to instigate a “Key Worker” system within the home to ensure information is disseminated appropriately throughout the nursing and care staff team. Care plans that were evident within the service users documentation did not have times scales for re-evaluations and it was stated by the manager that currently, evaluations were being performed in a random manner. It is good practice to have review dates specified on the care plans to ensure the changing needs of the service users are constantly under review. The home maintains daily progress documentation for all service users within service users individual care plans, in which elements of care identified should be evaluated effectively. It was evident that currently the evaluation process was not effective, as not all elements within the care plans had been evaluated within the daily progress documentation. The newly appointed manager of the home confirmed that the aforementioned elements within the care planning and assessment process requires further development and it was established that she would be addressing it in the near future in an attempt to establish clear goals for the service users and appropriate direction for all staff within the home. The Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection. Through discussion with service users it was evident that service users receive appropriate assistance from care staff to make decisions about their lives. The inspector witnessed care staff interacting with the service users in a very pleasant and respectful manner and it was evident that the service users were very comfortable and contented within the home environment. Aspley Neuro Disability Unit DS0000059536.V271706.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): 12. 17. The home provides wide and varied social activities, which will be further, enhanced once the newly appointed social activities coordinator is in post. The service users are given the opportunity to participate in a varied and nutritionally balanced diet. EVIDENCE: An activities coordinator is currently in the process of being appointed at the home and will be on post once all the appropriate police checks and references have been attained. The activities coordinator within the home will be responsible for the continued provision of varied and stimulating social activities such as music appreciation sessions, games, painting and pottery within a specifically designated area at the home. An activities record is maintained for all service users to demonstrate all the activities that the service users have participated in. It was evident that throughout the festive period service users will be afforded the opportunity to enjoy a Christmas party, guest singers and a carol service Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 12 together with a pantomime have been arranged. Friends of the church also attend the home on a bi-weekly basis. Service users are also encouraged to interact within the broader community and are often accompanied to the local public house and the local town centre to shop or browse. Transport should be available in the near future to allow social interactions beyond the immediate environment of the home. Currently a mini bus driver is not in employment and as such the facility is not available. The inspector was informed that the position has been advertised and will be filled as soon as a suitable candidate has been found. A newly appointed chef at the home is in the process of revamping the daily menus and it is the intention of the chef to consult with the service users at their bi-monthly residents meeting to ascertain preferences in relation to the type of food they would wish to be available at the home. It was established that the residents wished the main meal of the day to be served in the evening; this request was accommodated at the home thus further satisfying the wishes of the service users and respecting their wishes. It was evidenced that service users always have a choice of meals and that daily menus are displayed for service users perusal on a menu board within the dining room area. On the day of the inspection it was evident that the food in the home is wholesome, nutritionally appropriate and varied. It is also the intention of the chef to provide snacks of fresh fruit with mid morning tea to further promote variety in relation to the diet afforded to the service users within the home. The home has also benefited from a complete refurbishment of the kitchen area, which was exceptionally clean and fit for purpose. All service users spoken with specifically highlighted a significant improvement in the quality of the food at the home and had a great deal of admiration in relation to the chef’s abilities. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. 19. Service users stated that staff are supportive and that service users preferences are accommodated at the home. Documentary evidence to support individual preferences was not evident to adequately support that emotional and physical needs are being met at the home. EVIDENCE: Service uses spoken with all stated that that staff at the home were particularly accommodating in relation to the provision of a supportive environment conducive to maintaining optimum independence and comfort. In an attempt to ascertain the opinion of the service users a “residents committee” and “social committee” is in operation. The intention is to provide an appropriate forum for open discussions in relation to all aspect of care provided to the service users within the home. The committees include service users, relatives and staff. The manager of the unit clearly values these meeting as they aid the identification of needs and desires of the service users. As stated previously, the manager of the home is aware that the service users care plans do not always address personal preferences in relation to personal Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 14 care but does intent to formulate care plans to specifically these issues in the near future. The Commission for Social Care Inspection issued a requirement to address the identified shortfall and will be monitoring the manager’s progress at the next inspection. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22-23 were not inspected on this occasion. EVIDENCE: Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The ongoing refurbishment will provide service users with appropriate bathing facilities to accommodate their individual needs. EVIDENCE: At a previous inspection shortfalls were identified in relation to the availability and type of bathing facilities at the home. It was evident that a shower room that was previously out of use will be repaired and it was determined that the work on the bathroom area would be commencing on 7th December 2005. It is the intention of the manager to have another bathroom area modernised so as to easily accommodate service users with complex mobility needs. The manager stated that the newly adapted bathing area should be made available once the finances have been agreed and it is anticipated that the work will commence next year. All bathrooms inspected together with en-suite facilities within the service users rooms were decorated appropriately, clean and odour free. Service users stated that the staff always respected their privacy and dignity. It was established that staff always knocked on the bedroom doors of service users before entering thus promoting the principles of privacy and dignity. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 17 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): 34. 35. The recruitment practices employed at Aspley Neuro-disability unit is appropriate and meets the standards identified within the Care Standards Act (2000). The quantity and skills mix of staff employed at the home is sufficient to meet the needs of the service users. EVIDENCE: The manager at the home has now addressed shortfalls in the homes recruitment practices identified at a previous inspection. Staff files examined evidenced appropriate documentation to ensure the vulnerable service users are protected. The staff files examined contained Criminal Records Bureau checks (CRB) and two satisfactory references, it was established that no numbers of staff are employed at the home until the aforementioned checks have been undertaken and are satisfactory. Staff employed at the home is sufficient to meet the needs of the service users and an appropriate skill mix was evidenced. It was evidenced that the manager and her deputy manager have initiated a 24 hour an call rota to ensure that a senior member of staff is available should any emergencies develop of the home. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 18 On the morning of the inspection six carers, and three qualified nurses were on duty. Throughout the afternoon period, four carers and two qualified member of staff were on duty and two carers and one qualified nurse covered the night period. Aspley Neuro Disability Unit DS0000059536.V271706.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): 39. 42. The manager of the home ensures that the service users have the opportunity to participate in the development of the home through effective consultation processes. The manager at the home ensures that the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: Through discussions with service users it was evident that they felt confident in the managers ability to manage the home effectively and felt assured that any concerns would be addressed effectively and efficiently. The manager ensures that the home is run in the best interests of the service users, to aid this process, and as stated earlier, service users are encouraged to attend monthly residents meetings within the home so that issues relating to the care provided to service users can be openly discussed thus identifying and addressing any concerns that the service users might have. Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 20 The monthly meetings also provide a forum to discuss plans for the development of the home, an example being the revised menu, which is currently being formulated. The manager of the home operates an open door policy and encourages service users to discuss any concerns with her or her deputy manager and it was evident that service users were very comfortable with the manager’s open and approachable persona. It was evidenced that the home is maintained to a satisfactory standard throughout and it was determined that appropriate precautions are taken in relation to the control of Legionella contamination and the testing of fire equipment and fire alarms. It was also evidenced that appropriate maintenance is performed by external contactors, on all equipment designed of aid mobility such as wheelchairs, hoists and baths. The emergency lighting system is maintained by an external contactor to ensure it is operating effectively thus promoting the safety and welfare of the service users. External contractors, on a monthly basis, also perform pest control procedures, once again to ensure the safety of the service users. The maintenance technician, who is employed for forty hours per week, performs hot water outlet checks on a monthly basis so as to minimise the risk of scolds. It was evident that the maintenance technician maintains excellent records appertaining to the all the aforementioned issues, the documentation was clear, concise and very well maintained. Aspley Neuro Disability Unit DS0000059536.V271706.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 2 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 x 17 Standard No 31 32 33 34 35 36 Score X X X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Aspley Neuro Disability Unit Score 2 2 X X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000059536.V271706.R01.S.doc Version 5.0 Page 22 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 YA2 Regulation 12 Requirement The Registered Person must identify within the care plans what specialist support services are being offered to support any service user receiving rehabilitation Outstanding requirement from 30/09/05 The Registered Person must ensure assessments are complete to ensure holistic needs are addressed Outstanding requirement from 30/09/05 The Registered Person must ensure that care plans set out how the current and anticipated specialist requirements will be met, for example rehabilitation and therapeutic programmes Outstanding requirement from 30/09/05 The Registered Person must ensure care plans are updated to reflect residents changing needs Outstanding requirement from 30/09/05 The Registered Person must ensure risk assessments inform staff how to meet residents DS0000059536.V271706.R01.S.doc Timescale for action 31/05/06 2. YA2 14 31/05/06 3. YA6 15 31/05/06 4. YA6 15 31/05/06 5. YA7 13 31/05/06 Aspley Neuro Disability Unit Version 5.0 Page 23 needs Outstanding requirement from 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. Refer to Standard Good Practice Recommendations Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Aspley Neuro Disability Unit DS0000059536.V271706.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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