CARE HOME ADULTS 18-65
Old Racecourse Road, 6a 6a Old Racecourse Road Maghull Liverpool Merseyside L31 8AN Lead Inspector
Debbie Corcoran Unannounced Inspection 19th January 2006 11:45 Old Racecourse Road, 6a DS0000005426.V283498.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 Old Racecourse Road, 6a DS0000005426.V283498.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. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Old Racecourse Road, 6a Address 6a Old Racecourse Road Maghull Liverpool Merseyside L31 8AN 0151 531 6154 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) Expect Limited Mrs Eleanor Dowling Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 3 LD Date of last inspection 17.10.2005 Brief Description of the Service: 6A Old Racecourse Road is registered as a care home for three people with a learning disability. The service provider for the home is Expect Ltd. This organisation is in the voluntary sector and is a registered charity. The registered Landlord for the property is Liverpool Housing Trust. The property is a five bed roomed dormer bungalow. The home is located in a residential area in Maghull. It is in keeping with other properties in the area and is indistinguishable as a residential care home. The home is located approximately one mile from local shops and is a fifteen minute walk from the nearest train station. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a period of 3 hours. During the visit all three of the service users were present and one of the service users was spoken with about the quality of the service provided. The manager and a member of care staff were on duty and the inspector both spoke with both. A tour of the home was carried out. Service user plans, health and safety records, medication administration records, staff records, menus and other relevant records were examined. What the service does well: What has improved since the last inspection?
Since the last inspection there has been some improvement in the service users diet. Issues regarding how food is stored have been addressed and all staff have been provided with food hygiene training. Service users now have their own bank accounts and their personal monies are no longer managed centrally. This also means that service users now have ready access to their own money. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 6 The most recently produced information for service users has been written in plain language and includes the use of pictures. 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. Old Racecourse Road, 6a DS0000005426.V283498.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 Old Racecourse Road, 6a DS0000005426.V283498.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): These standards were not assessed on this occasion. EVIDENCE: Old Racecourse Road, 6a DS0000005426.V283498.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, 7, 9 Each of the service users has a plan of care which includes a good level of information on their needs and the plans are reviewed and updated regularly. Service users are encouraged to make choices and their choices and preferences are well recorded. When service users are involved in an activity which involves taking risks the risk is assessed and plans are put in place to manage the risk. EVIDENCE: Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 10 Each of the service users has a care plan. These are of a good standard and include information on the person’s daily routines, likes and dislikes, skills and needs, targets for their personal development, a health action plan, weekly activity plan, finance action plan and some very good detailed information on the service user’s needs in relation to their health and diet and specific health conditions. The plans are monitored monthly and reviewed every six months. Reviews can take different forms but the manager should ensure that some of the reviews are a holistic review of a person’s support and not just an update of their care plans. As at the previous inspection the manager reported that new care plans are going to be introduced which are referred to as ‘person centred plans’. The manager has been provided with training in this type of care planning and it is intended that service users will have the opportunity of a new plan in the near future. Service user’s are reported to be supported to make choices regularly. The service user’s choices, preferences and routines are well recorded in their care plans and staff are clearly encouraged to be aware of this information. One of the service users reported that she makes her own decision about her day to day routines. Expect Ltd has started to introduce some information in plain language and including the use of pictures When a service user is thought to be at risk then a risk assessment is carried out and plans are put in place to manage the risk. The risk assessments are comprehensive and have been reviewed and updated since the previous inspection. The home has a risk assessment policy. Old Racecourse Road, 6a DS0000005426.V283498.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): 11, 12, 15, 16, 17 Staff encourage service users to partake in activities, develop their skills and exercise choice and responsibilities. Service users are supported to maintain relationships. Service users are offered a varied diet and are encouraged to choose meals daily. EVIDENCE: Service user’s care plans have a section which includes goals for their personal development. The goals are realistic and achievable and reflect the needs of the service users. However, these plans are out of date and need to be reviewed and updated. Daily records were examined to assess the level of activities services users are supported with. There appears to have been some improvement in this area since the previous inspection. Service users are supported in both indoor and outdoor activities and these are appropriate to their age and interests. Service users are supported in maintaining relationships as appropriate.Service users rights and responsibilities are recognised and staff appear to encourage
Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 12 service users to make their own decisions and to make decisions regarding the running of the home. The home does have menus but these are used as a guide only. Service users have the option to choose what to eat on a daily basis and this is then recorded. There has been some improvement in one of the service users diet since the previous inspection. One of the service users said that the food was nice and that they chose what they wanted to eat. There was an appropriate amount and variety of food available at the time of the inspection. Food was stored appropriately and all staff have undertaken food hygiene training. Service user’s records include a good amount of information on the person’s dietary needs and guidelines for supporting the service users with eating are in place when required. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 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, 20 The service user’s strengths and needs with personal support are well documented and the service users are supported by a small staff team who know their personal care needs and preferences well. The service users are well supported to remain healthy. Medication is handled safely and in accordance with policies and procedures. EVIDENCE: Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 14 Service user’s care plans include guidelines for supporting the service user with personal care tasks and with moving and handling tasks. The plans include a good level of information on the individual’s likes and dislikes and preferred routines. There was a good level of evidence to indicate that the service users are supported to remain healthy. Service user’s records include a good level of information on the health related needs of the service user and records also evidenced regular G.P, occupational therapy, community nurse involvement and hospital appointments. Each service user has a health action plan and these include a record of target and actual dates for all health checks. There is evidence that the service users are well supported with maintaining their health but the health action plans are not being kept up to date to reflect the service user’s most recent appointments for regular health checks. It should be noted that these are however taking place. The home maintains a record of all medication received, administered and stock checked. Medication storage and administration records were examined and found to be appropriate. All of the staff team have undertaken a medication awareness course. The home has a medication policy. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 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): 22, 23 Policies, procedures and practices are in place which aim to prevent an abusive, neglectful or issue self harm from occurring. Systems are in place for dealing with complaints and for dealing with allegations of abuse and staff have received training in the protection of vulnerable adults. EVIDENCE: The home has a complaints procedure which is time scaled appropriately and includes details of the Commission. A comments, complaints and suggestions notice is also available in the home along with a complaints leaflet. There have been no complaints made to the home since the previous inspection. Any complaints made are recorded and forwarded to the head office of the organisation. The complaints procedure should also be produced in a more service user friendly format although it has been reported that this has been explained to service users. The home has a protection of service users policy and an abuse policy and a copy of Sefton Borough Council’s adult protection procedures. Staff have been provided with protection of vulnerable adults training. The home has a policy and procedure for the management of service user’s money and financial affairs. Each of the service users now has their own bank account and the service users’ personal monies are no longer held centrally and therefore service users have ready access to their own money. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 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): These standards were not assessed on this occasion. EVIDENCE: One requirement given at the previous inspection regarding the environment has not been met and has therefore been given following this inspection. This requirement was for one of the service user’s bedrooms and the kitchen to be redecorated. The timescale given for this had not passed at this inspection. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 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): 31, 32, 35, 36 Staff have clear roles and responsibilities. Staff training opportunities are good and in line with the needs of the service users. Staff have the opportunity to meet one to one with their manager and to meet as a team on a regular basis. EVIDENCE: Staff have job descriptions which are clearly defined and include supporting service users to achieve aims. There was evidence in service users files that staff have appropriately referred for specialist support and advice to meet individuals needs. One of the service users gave good feedback on members of the staff team and staff were observed to interact with the service users with warmth and familiarity. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 18 Each member of staff has a training file. Staff training records indicate that most staff have undertaken core skills training, for example food hygiene, fire safety, first aid, moving and handling. Staff have also been provided with training in issues such as diabetes, medication, the role of a support worker, adult protection. The inspector examined the training records for two members of staff employed within the past year and these indicate that the staff concerned have had excellent training opportunities. Only one member of care staff currently has an N.V.Q in care. Three members of staff are scheduled to undertake an N.V.Q in care in the near future. Training is identified in staff supervision and appraisals and each member of staff has an individual training and development plan. The training and development budget and programme is managed centrally. Staff are receiving regular and recorded supervision and staff team meetings are taking place regularly. Staff also undergo an annual appraisal. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 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, 41, 42 Practices that promote the health and safety of service users and staff are in place. Service user’s rights are safeguarded by the safe keeping and security of records and records are up to date and maintained appropriately. Quality assurance processes are in place, however, these need to be developed further. EVIDENCE: The manager has applied to the Commission to be registered manager of the home. This application is currently being processed. The home has a number of policies, procedures and practices in place which aim to ensure the health and safety of service users and staff and these include procedures on issues such as infection control, fire safety and moving and handling. Records of fire and other health and safety checks were examined and found to be up to date. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 20 The records kept at the home are in good order, up to date and maintained securely. A record of all accidents, injuries, incidents and complaints is maintained. All records were available for inspection. The registered person ensures that the home is visited on an unannounced basis at least once per month and provides a report on the findings of the visit to the Commission in line with Regulation 26 of the Care Home Regulations 2001. These visits form part of the quality assurance process. The quality assurance process should be developed to include seeking the views of service users and their representatives as appropriate in order to form an opinion on the standard of care provided. The manager did provided some evidence that one of the service users has been included in a survey on the quality of the service which was carried out as one piece of work across all of the residential services. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 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 Standard No Score 1 x 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 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 3 32 3 33 x 34 x 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 x 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 2 x 3 3 x Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 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 YA24 Regulation 23 (2) (d) Requirement The kitchen and one of the service user’s bedrooms must be redecorated. Timescale for action 20/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA6 YA39 Good Practice Recommendations Consideration should be given to develop the process for reviewing service users care and support. Action plans relating to service users should be reviewed and updated. Quality assurance processes should be developed further. Old Racecourse Road, 6a DS0000005426.V283498.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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