CARE HOME ADULTS 18-65
Outreach, 162 Bury Old Road 162 Bury Old Road Crumpsall Manchester M7 4QY Lead Inspector
Steve O`Connor Unannounced Inspection 4th October 2005 11:00 Outreach, 162 Bury Old Road DS0000021621.V256335.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 Outreach, 162 Bury Old Road DS0000021621.V256335.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. Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Outreach, 162 Bury Old Road Address 162 Bury Old Road Crumpsall Manchester M7 4QY 0161 740 0471 0161 740 5678 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) Outreach Community & Residential Services Maretta Bernadette Anne Patten Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th September 2004 Brief Description of the Service: The Outreach home at 162 Bury Old Road is a residential care home providing 24-hour accommodation and support to 7 service users with a learning disability. One bedroom is available for respite care. The home is situated in the North of Manchester close to local shops, amenities and public transport links. It is a Victorian terrace building situated on a busy residential street and is of the same size and character as surrounding houses. There is a small car park to the rear adjacent to a well-maintained garden. Accommodation is provided over three floors and a basement area. Six single bedrooms with wash-hand basins are situated on the first and second floors. There is also a self-contained flat on the first floor. Communal space consists of two lounge areas, a dining room and kitchen. Outreach, 162 Bury Old Road DS0000021621.V256335.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 on the 4th October 2005. Time was spent talking with people, the manager, some of the staff on duty and observing how staff worked with people. In addition people’s files and other documents were inspected. A tour of the premises was also made. The previous inspection in September 2004 identified a number of areas of work that the home needed to improve upon. The majority of these have been addressed and now meet the required standards. The CSCI had not received any concerns or complaints about the home since the last inspection. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. What the service does well:
The home supports learning disabled people, some of whom may express themselves in ways that challenge the home with their behaviour. Without a safe and supported environment the people living at the home would find it very difficult, if not impossible to live on there own in the community. The importance of being able to provide a stable, safe and relaxed environment and its affect on people’s behaviour and how they cope with problems was shown through the experience of a person who had been living at the home for around a year. They described a previous care home they had lived in, as having a very negative affect on their mood and this affected how they behaved and became more and more stressed. The move to the home came at a time of crisis for the person and the staff team had to provide them with a lot of support and encouragement. The affect on the person of the move has been very positive with them saying, “ I get much more support here, the staff have the time to talk to you and you can talk to them about anything.” The home has a clear commitment to try to provide people with new opportunities to achieve their goals, learn new skills and take part in valued social, leisure and community based activities. One person had never been on holiday abroad before or been on an aeroplane. The home supported this person to introduce them to the airport, to make the choice of where they wanted to go and provided one to one staff support during the whole holiday. The home had supported and encouraged people to develop their interests and hobbies, such as art, and made use of both mainstream adult education and
Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 6 specialist services. People had been supported to make use of their local community and beyond through using local specialist day care services, visiting local attractions, day trips and a range of social and leisure activities. People were actively encouraged to maintain their independent living skills and take part in maintaining the standard of cleanliness in the home and a range of domestic activities. Maintaining people’s general and emotional health and wellbeing is an important area of support. The home helps people to keep healthy by making sure that they have access to G.P services, chiropodists, dentists and other general health services. In addition the home has worked very closely with specialist such as Psychologists to help people cope with their emotions and behaviour. Through the home’s work and alongside other specialist services a person’s prescribed medication had been reduced from over 15 different medicines to just five with very few incidents of behaviour that could challenge the staff. Another area that the home does well is in encouraging and supporting people to maintain their independent living skills and to make decisions and choices about their day-to-day lives. People are supported and encouraged to take responsibility for domestic chores around the house such as cleaning, laundry and shopping. People are encouraged to shop for and prepare their own meals and one person has their own food budget which they decide what to spend on and what they want to cook. People are consulted and issues that affect the home and routines are discussed. This included a meeting that discussed whether the kitchen should be locked because of a number of potentially dangerous incidents. Instead it was agreed to keep unlocked and small changes made to the kitchen equipment to keep it safe. This showed that the home listened to what people wanted. What has improved since the last inspection?
The home was required at the previous inspection to improve in a number of areas where it was not meeting the standards needed. They have made sure people’s care plans were up-to-date and completed, they had looked at the risks and hazards people may face and identified where support was needed. The medication administration system had been improved to make it safer and more accurate, a policy for how staff may physically intervene to make people safe, all personal information was recorded correctly and all staff had undergone First Aid and Basic Food Hygiene training. An area that the home has improved on since the last inspection is in the recording of the support, activities and information about what is important for the people who live at the home. The assessment of people’s needs, the recording of individual care plans, using an ‘Individual Person Planning’ system, care plan reviews, monthly and daily recording have all become more detailed and descriptive so that a clear picture of people’s experiences can be shown
Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 7 What they could do better:
Recently a person was supported by a member of staff to go on a short-break holiday abroad. Unfortunately the staff member was taken ill and the manager had to go and bring them both back home. What this incident highlighted was that the home was supporting people to take up lots of different opportunities for a range of new activities. New activities can raise new risks to a person and the home use their knowledge and experience of the person to try to ensure that they are safe and yet can still take up these new activities. What the home needs to do is to make sure that it has a clear and detailed Risk Assessment and Management Policy and procedures and undertake a risk assessment for new activities to record how the home are going to try to minimize the risks people face, by as much as is possible, whilst still allowing them to try new and exciting activities. The home should have a staff team of three part-time and three full-time support workers. There are currently two vacancies and regular bank staff is covering at least 3 to 4 shifts each week. There are plans for two permanent staff to be employed but the home must make sure that it has a full staff team that can meet the support needs of the people living at the home and not have to rely on bank or agency staff. The home’s recruitment procedures are essential to make sure that only staff who are suitable come to work with vulnerable people. The staff files were seen and it was found that some references did not have a company stamp or telephone number to allow references to be checked. The home must ensure that all references from previous employers contain a relevant company stamp and telephone number. The home employ staff that require work permits that allow them to legally work in the United Kingdom. The relevant staff file did not contain a copy of the person’s current work permit and from other documentation seen it was found that the staff’s work permit has expired. The manager had only just found this out because most of the staff documentation and information was kept at the main office of the organisation that manages the home. The home must ensure that staff have the required documentation to work legally in the United Kingdom and that all relevant documentation is maintained securely within the home. The home does support people whose behaviour can be at times be challenging and may need staff to physically intervene to safeguard the person, other people, themselves or the environment. The home had developed a policy for physical intervention but it was very brief and contained very little specific detail. It is recommended that the home’s policy and procedures for managing physical intervention be based on the British Institute of Learning Disability (BILD) guidance. Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 8 The home was working closely with people to get to know them and what they want from life. It was clear that staff were knowledgeable about the people they supported and they were beginning to record more details about the activities, events and ways that people want to spend their time. It is recommended that the home continue this work with all the people living at the home. On the whole the home has a nice relaxed and homely atmosphere with domestic style furniture, fixtures and fittings. It was noticed that the carpet in the basement lounge was stained and needed replacing and in one of the bathrooms the sealant and tiling around the bath was in need of repair. Also the dining room and a lounge are in the basement and use florescent strip lighting. It is recommended that the home consider whether the use of florescent lighting creates the environment it wants to achieve. 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. Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 9 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 Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 10 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 People’s goals and needs had been assessed prior to coming to live at the home. EVIDENCE: The purchasing local authority had provided the home with pre-admission assessment documentation. The home undertakes its own initial assessment within 7 days of the person’s admission. For an emergency admission information from the purchasing authority is provided within a short time of the person’s arrival. Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 11 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 and 9 People’s goals and support needs had been identified and changes reflected in the support provided. Whilst people are supported to take risks the home’s policies, procedures and systems need to be reviewed. EVIDENCE: The purchasing authority had provided a care plan that contains vague, nonspecific goals. From the assessment material the home develops an Individual Person Plan (IPP) that sets out more details of a persons needs and goals and the support required to meet them. The IPP care plan was reviewed on an ongoing basis based on the complexity of the needs of the person. At a minimum the plan is reviewed every six months. The IPP’s had been fully completed, dated and signed by the person. The home had a clear risk assessment process that identified hazards and risks in people’s lives and guidance in how to support people to minimize the hazards they face. However, a recent incident during a supported holiday highlighted the need for the home to review its Risk Assessment and Management Policy and procedures and to ensure that it undertakes written risk assessments in relation to new activities people participate in.
Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 16 and 17 People are encouraged and supported to take up opportunities to participate in a range of meaningful home and community based activities within a relaxed routine and have access to a health diet. EVIDENCE: The home supported and encouraged people to take up opportunities and participate in social, leisure, skills development, educational home and community based activities. People were encouraged to maintain their independence skills and to make choices and decisions about their day-to-day lives. It was clear that the home was working alongside people to find new and valued activities and were starting to record a ‘menu’ of activities that one person enjoyed. It was recommended that the home continue this work with all the people living at the home. The routines of the home were relaxed and informal and based on the needs of the people living at the home.
Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 13 People were encouraged were they can to take part in the menu planning, shopping, preparing and cooking of meals. One person had their own food budget and shopped for and cooked all their own meals. The food stores were sufficiently varied to provide a choice of nutritious meals. Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The home supported people to maintain their personal and healthcare and the medication administration system supported people’s wellbeing and protection. EVIDENCE: People were encouraged and supported to maintain their independence with their personal care needs. The home supported people to access the relevant general and specialist healthcare services and worked in partnership with services to maintain people’s health and wellbeing. The home was completing individual health profiles for each person. The medication administration system has been updated with the use of a new NOMAD system. All recording was accurate and medication prescribed ‘as required’ (PRN) had clear guidance for administering and recording. All staff had received up-to-date training in the administration of medication. Outreach, 162 Bury Old Road DS0000021621.V256335.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): 23 The home generally had the policies, procedures and systems in place to protect people from abuse. EVIDENCE: The organisation’s Adult Protection Policy was based on the Manchester MultiAgency Adult Protection Policy and Procedure. The organisation had also developed an Aggression Towards Staff Policy and procedure. The organisation had developed a Physical Intervention Policy but the policy was brief with little detail. It is recommended that the home’s policy and procedures for managing physical intervention be based on the British Institute of Learning Disability (BILD) guidance. The Management of Service Users Finances Policy and procedure was seen and found to contain clear guidance on the process, recording and auditing of service users’ personal monies. Evidence was seen that the service had developed behavioural strategies for each person to provide guidance to staff on working with behaviour that may challenge them. Outreach, 162 Bury Old Road DS0000021621.V256335.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): 24 On the whole people live in a homely, comfortable and safe environment apart from the areas identified below. EVIDENCE: The premises were generally clean, well maintained and provided a comfortable and safe environment for people to live. The carpet in the basement lounge was stained and needed replacing and in one of the bathrooms the sealant and tiling around the bath was in need of repair. The dining room and lounge in the basement use florescent strip lighting. It is recommended that the home consider whether the use of florescent lighting creates the environment the home wants to achieve. Outreach, 162 Bury Old Road DS0000021621.V256335.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): 32 and 34 The use of agency staff means that the home cannot fully show that it provides a competent and qualified team. The home’s policies, procedures and systems for recruitment of staff had not been followed and so did not fully protect people. EVIDENCE: The staff team consisted of the manager with three full-time and three parttime support worker posts. At the time of inspection two posts were vacant and were being filled with agency staff up to 3 to 4 times a week. The manager informed the inspector that two permanent staff had been appointed and were just waiting for CRB clearance. The home must ensure that it has a stable and full work team based on the support needs of people living at the home. Staff had undertaken Basic Food Hygiene and First Aid training. The staff files were seen and it was found that some staff references did not have the required referring company stamp or a contactable telephone number. This requirement was highlighted at the previous inspection and was reiterated. In addition, the file for a member of staff who requires a work permit to work legally in the United Kingdom did not contain a copy of the permit, documentation seen showed that the permit ran out in September 2005 and
Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 18 the manager was only aware of this because she had to go to the organisations office to get the staff files. Outreach, 162 Bury Old Road DS0000021621.V256335.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): EVIDENCE: These standard were not assessed during this inspection. Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 20 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 3 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Outreach, 162 Bury Old Road Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000021621.V256335.R01.S.doc Version 5.0 Page 21 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 YA9 Regulation 13 Requirement The home must have a clear and detailed Risk Assessment and Management Policy and procedures and undertake risk assessments for new activities to record how the home are going to try to minimize the risks people face, by as much as is possible, whilst still allowing them to try new and exciting activities. The carpet in the basement lounge was stained and needed replacing and in one of the bathrooms the sealant and tiling around the bath was in need of repair. The home must ensure that it has a stable and full staff team based on the support needs of people living at the home. All staff references from previous employers must have the required company stamp or action taken to verify the authenticity of the reference.(Previous timescale of 12.11.04 was not met)
DS0000021621.V256335.R01.S.doc Timescale for action 01/01/06 2 YA24 23 01/02/06 3 YA32 18 01/12/05 4 YA34 19 01/11/05 Outreach, 162 Bury Old Road Version 5.0 Page 22 5 YA34 19 The home must ensure that staff has the required documentation to work legally in the United Kingdom and that all relevant documentation is maintained securely within the home. 01/11/05 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 YA13 Good Practice Recommendations It is recommended that the home continue to work with all the people living at the home to develop and record a menu of meaningful and valued activities that they enjoy and wish to try. It is recommended that the home’s policy and procedures for managing physical intervention be based on the British Institute of Learning Disability (BILD) guidance. It is recommended that the home consider whether the use of florescent lighting creates the environment the home wants to achieve. 2 YA23 3 YA24 Outreach, 162 Bury Old Road DS0000021621.V256335.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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