Inspection on 09/03/06 for Outreach Community & Residential Services

This inspection was carried out on 9th March 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Outreach Community & Residential... 10/02/09

Outreach Community & Residential... 09/09/08

Outreach Community & Residential... 16/10/07

Outreach Community & Residential... 08/08/06

Outreach Community & Residential... 17/08/05

Outreach Community & Residential... 16/12/04

Outreach Community & Residential... 19/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Outreach Community & Residential Services 86 Meade Hill Road Prestwich Manchester M25 0DJ Lead Inspector Stuart Horrocks Unannounced Inspection 9th March 2006 09:30 Outreach Community & Residential Services DS0000008445.V279570.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 Outreach Community & Residential Services DS0000008445.V279570.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. Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Outreach Community & Residential Services Address 86 Meade Hill Road Prestwich Manchester M25 0DJ 0161 740 3256 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 Lesley Ann Smith Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 5 service users, to include: Up to 5 service users in the category of LD (Learning Disabilities under 65 years of age). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 17th August 2005 Date of last inspection Brief Description of the Service: 86 Meade Hill Road is one of a number of care homes managed by Outreach Care Services. Outreach is a charitable organisation offering 24-hour care, mainly to Jewish people with a learning disability or mental health problem. 86 Meade Hill Road is a six bedroomed detached house owned by Greater Manchester Jewish Housing Association. The home provides care and accommodation for five service users with profound learning disabilities. The remaining bedroom is used as an office/sleep-in room. The house is located close to local shops, pubs and Post Office. Buses to and from Prestwich and Manchester pass nearby and a metrolink station is within walking distance. A ramped path is provided to the front door and the house is accessed by one step both at the front and back entrances. A drive provides parking space and on street parking is available outside the house. A safe enclosed lawned and patio area is provided to the rear of the property. Outreach Community & Residential Services DS0000008445.V279570.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 was started at 9.30am.It took place on one day and it lasted for about 5 ½ hours. Much of this time was spent in talking to the manager and four staff members and in looking at paperwork. Some time was also spent in looking around the home. None of the residents have the ability to communicate verbally therefore the inspector was not able to talk to the residents to get their views about what it is like to live at the home. However the inspector noted that the residents seemed to be happy and content. What the service does well: What has improved since the last inspection? What they could do better: The paperwork that describes how residents needs have been assessed before they are first admitted to the home must in future be kept at the home so that the suitability of the arrangements can be checked at inspections. The written documentation that describes how residents are to be cared for needs to be made clearer therefore providing easy access to this information for the staff. Consideration must be given to providing the staff with specialist training so making sure that they can meet all of the residents needs. Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 6 Staffing levels must be reviewed therefore ensuring that the needs, including the health and safety needs of the residents and the staff can be met. The requirements made in a recent Fire Authority inspection report must be dealt with. The homes quality checking system needs to be extended so that the residents, their families and others have the opportunity to take part in this process. 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 Community & Residential Services DS0000008445.V279570.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 Outreach Community & Residential Services DS0000008445.V279570.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): 2. The outcome for this Standard could not be assessed, as no initial referral or assessment information was available at the home. EVIDENCE: The inspector was told that all initial referral and assessment information is kept at the Outreach central office. The inspector was also informed that when residents are first referred to the organisation that their needs are assessed by staff in the central office with a decision then being made by these staff about which of the Outreach houses that the resident will be placed to live at with a trial period of residence then following. Further assessment is then done, the suitability of the placement is then assessed and a care programme is put together. Should a resident need to be moved between houses then this is done over a gradual introductory period of between six to eight weeks. All of the residents presently living at Meade Hill Road have been accommodated there for between one to ten years and they have lived within the scheme between fourteen to eight years therefore their initial assessment information is available for inspection. Following discussion with the manager it decided that for future placements the initial referral and assessment information would be available at the home for inspection so that the suitability of the arrangements can then be checked. A requirement is therefore made to this effect. Outreach Community & Residential Services DS0000008445.V279570.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 and 7. Written care information is in place but this needs to be made clearer so making sure that the staff are able to meet the residents assessed needs. The residents appeared to be well cared for and the staff assisted them in making decisions about their lives. The above key Standard 9 was not examined at this inspection. It should however be noted that this standard was met at the time of the previous inspection (August 2005). EVIDENCE: The care files of several residents were looked at. These files contained detailed and comprehensive information about how the resident’s social, physical and health care needs are dealt with. This information includes which goals are to be achieved, safety risk assessments and to some extent what the residents support needs are. The information in these documents was up to date and regularly reviewed at the required interval. However these files contain such a large volume of information that this makes access to the details somewhat difficult where it is not easy to readily see what Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 10 the resident’s care need are. Accessing this would probably be taxing for a new worker for example, where a considerable amount of reading would need to be done before a picture of the resident’s care needs could be established. The manager and the inspector discussed these issues where it was thought that the development of an archive file for some information and a slimmed down “working” file for day to day information would bring benefits in terms of ready access to the information about the residents’ needs. It was also felt that the development of care plan summary for each resident with the level of support identified would be useful and that this should be included in the “working” file. A recommendation is therefore made to this effect. The manager should bear in mind that the development of the above-described system of documentation may serve to demonstrate a link between current staffing levels and the needs of the residents that would then require taking in to account. The residents presently living at the home have very limited ability to make decisions and choices about their lives. They do to some extent make some choices about the clothes that they wear, about the food they eat and at what time they go to and get up from bed. Each resident has written decision making assessment that confirm that they are largely unable to make anything other than simple choices with the bulk of decisions being made by the staff, parents and care managers. The staff are however well aware of the residents personal preferences regarding their daily lives and they encourage, assist and support the residents in making appropriate choices and decisions about their daily activities. Outreach Community & Residential Services DS0000008445.V279570.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): 16. The residents’ rights and equal access to ordinary life activities are promoted and respected by the staff. The above key Standards 12, 13, 15 and 17 were not examined at this inspection. It should however be noted that these standards were met at the time of the previous inspection. EVIDENCE: From speaking with the staff, looking at paperwork and from observations made during the inspection, it was clear that the staff promote the residents rights and that the residents are encouraged to be as independent as possible, subject to any restrictions which are recorded in the residents’ care files. The residents are not able enough to have door keys or to open their mail without help, but they do have virtually unrestricted access to most parts of the home and garden and some residents do help with setting and clearing the table at mealtimes, with washing up and some straightforward cleaning tasks. Staff do call the residents by the name they (the resident) prefer and the staff have a comfortable and natural manner with the residents. Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 12 Outreach Community & Residential Services DS0000008445.V279570.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 Residents have their support needs met in the way that they prefer and require. The above key Standards 19 and 20 were not examined at this inspection. It should however be noted that these standards were met at the time of the preceding inspection. EVIDENCE: The five residents are fully dependent upon the staff for all personal care tasks. The routines of the home are flexible this includes mealtimes and the times for getting up and going to bed. Some residents are able to decide about which clothing to wear whilst others require assistance. The staff makes sure that the residents personal hygiene, clothing, hair care and general appearance is appropriate and enhances their dignity. Each resident has a designated key worker and written information is available regarding each resident’s likes, dislikes and preferred routines. The residents presently require no specialist equipment, aids or support. Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above key Standards 22 and 23 were not examined at this inspection. It should however be noted that these standards were met at the time of the previous inspection. EVIDENCE: Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Meade Hill Road provides a clean, comfortable and homely environment for the people living there. EVIDENCE: Meade Hill Road care home is a large detached house. It is comfortable, bright, cheerful, clean and welcoming, with a good standard of decoration and furnishings. The home is situated on a main road and it is not distinguishable as a care home therefore promoting ordinary life principles. The building is generally well maintained both to the exterior and the interior. The home was completely redecorated with new carpets fitted in April 2005 and the central heating boiler has recently been replaced. The property is close to shops, a park and pubs and there is easy access to public transport. Ramps are provided to both the front and rear doors and there is a pleasant and well-maintained garden at the back of the building. Although the premises comply with the requirements of the local environmental health department the remedial action required (one item) in a Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 16 Fire Authority inspection report of the 9th March 2006 is still under consideration. Please see Standard 33 (Staffing) for further comments made regarding this required action. The home was clean and tidy on the day of this inspection with a good standard of hygiene and cleanliness achieved. No malodours were detected. Laundry equipment is sited in a small room adjacent to the home’s kitchen with hand washing facilities being available in the kitchen. Care must be taken in ensuring that cross-infection does not occur. The home has control of infection policy and procedural guidance. Outreach Community & Residential Services DS0000008445.V279570.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): 32 and 33. Good progress has been made with regard to NVQ training but further training is needed to equip the staff with the knowledge and skills needed to make sure that they can meet the needs of the residents. Staffing levels must be reviewed therefore making sure that the needs, including the health and safety needs of the residents and the staff can be met The above key Standards 34 and 35 were not examined at this inspection. It should however be noted that these standards were met at the time of the earlier inspection. EVIDENCE: Staff training has been provided with regard to the NVQ courses. Three staff have achieved an NVQ at Level 2 and the inspector was told that two other staff are intended to start this training later in 2006.The manager has already achieved the Level 4/Registered Managers Award. The inspector was also told the two staff are due to do communication training for residents who are unable to communicate. Staff training is also provided in the required health and safety subjects such as fire safety, first aid and food hygiene. Following discussion with the manager it was identified that consideration should be given to providing the staff with further specialist training in the care of residents with learning disability needs. Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 18 The staff are allocated as follows: 8am to 10am two support workers. 10am to 6pm three support workers. 6pm to 9pm two support workers. 9pm to approximately 10:30 pm one support worker who then “sleeps in” overnight. The home manager is also routinely available Monday to Friday 9am to 5pm but often works other shifts also. Discussion with the manager and the staff showed that one resident usually needs a 2 to 1 staff provision to meet their needs, another resident needs 1 to 1 whilst the other residents usually require 2 or 3 staff to support all three. In general the manager and the staff felt that this level of staffing provision was sufficient to meet the needs of the residents until 9pm but that after this time that this level of staffing was insufficient. Their comments were based on their knowledge of the residents’ needs where they felt that a single member of staff was insufficient to deal with the risks that may develop and in particular the fact that overnight the single sleep-in worker was vulnerable. As mentioned previously the GMC Fire and Rescue Service stated in their report of the 9th March 2006 that “Action to provide an extra member of staff at night requires prioritising for early completion”. This requirement is with regard to there being sufficient staff available overnight to assist with the evacuation of the residents from the home in the event of a fire. Discussion with the staff revealed that they have considerable concerns about overnight fire safety where only one member of staff is on duty in a sleep-in provision. Taking the manager’s, the staff’s and the Fire Authority’s concerns into consideration, and also a previous incident; the inspector requires that the registered person must review overnight staffing provision and that consideration must be given to providing two staff from 9pm onwards and that one of these staff must be on waking duty during the night. A requirement is therefore made to this effect. Outreach Community & Residential Services DS0000008445.V279570.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 and 39. The manager is able and experienced and she manages the home well, therefore ensuring that the residents receive a good standard of care. The home has recently used a quality assurance system to measure it’s success in meeting the aims and objectives, but this needs to be extended to include the residents and their relatives so that their views can also be taken in account. The above key Standard 42 was not examined at this inspection. It should however be noted that this standard was met at the time of the prior inspection (August 2005). EVIDENCE: The home manager has been previously approved and registered with the CSCI and she has been running the home for approximately the last four years. The registered manager has successfully completed the Registered Managers Award and she therefore has qualifications in both care and management. Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 20 The staff said that the manager runs the home in an open and inclusive way and that she is approachable, fair-minded and easy to get along with. The inspector was shown a comprehensive and detailed quality assurance assessment process document that was completed for Meade Hill Road in November 2005. This assessment covers a wide range of topics including the operation of the service, the care of the residents and staff issues. A report was seen to have been produced including an action plan to deal with any issues identified by the process. Unfortunately due to their disabilities the residents were not able to be involved in this quality assurance assessment and neither were their relatives and families consulted. In discussion with the manager it was agreed that in future the home will consult with relatives and other interested parties (e.g. GP’s, social workers) and that consideration will be given to finding ways of involving the residents in the quality assurance process. Outreach Community & Residential Services DS0000008445.V279570.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 1 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 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X 3 X 2 X X X X X Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No. 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 14 Timescale for action The registered person must 12/05/06 ensure that residents initial referral and assessment information be available at the home for inspection so that the suitability of the arrangements can then be checked. The registered person must 19/05/06 ensure that the home complies with the requirements made in the Fire Authority inspection report of the 9th March 2006. The registered person must 30/06/06 ensure that where required the staff are provided with training in the care of residents with learning disability needs. The registered person must 19/05/06 review overnight staffing provision and consideration must be given to providing two staff from 9pm onwards and that one of these staff must be on waking duty during the night. The registered person must 30/06/06 ensure that the homes quality assurance process includes the views of the residents, their relatives and other interested parties (GP’s, social workers etc). DS0000008445.V279570.R01.S.doc Version 5.1 Page 23 Requirement 2 YA24 23 3 YA32 18 4 YA33 18 5 YA39 24 Outreach Community & Residential Services 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 Refer to Standard YA6 YA6 Good Practice Recommendations The registered person should consider developing archive and working care files for the reasons as described in the body of this report. The registered person should consider developing resident care plan summaries for the purposes as explained in the body of this report. Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Outreach Community & Residential Services DS0000008445.V279570.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!