Inspection on 09/08/05 for Palmyra

This inspection was carried out on 9th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Palmyra 20/04/07

Palmyra 10/01/06

Palmyra 10/03/05

Palmyra 25/08/04

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

CARE HOME ADULTS 18-65 Palmyra 38 Great Georges Road Waterloo, Liverpool Merseyside L22 1RD Lead Inspector Lorraine Farrar Unannounced 9 August 2005 th 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 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 Stationary 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. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Palmyra Address 38 Great Georges Road Waterloo Liverpool L22 1RD 0151 949 0529 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Making Space North West Mrs Valerie Brown Care Home 14 Category(ies) of MD Mental Disorder (14) registration, with number of places Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 14 MD Date of last inspection 10/3/05 Brief Description of the Service: Palmyra is registered to provide support and accommodation for 14 adults who require support in managing mental health. it is situated in a residential area of Waterloo and is well placed for providing access to local community facilities, leisure facilities, shops and transport. The building is a large detached Victorian house and due to its location amongst similar properties it is not immediately distinguishable as a care home. All private accommodation in the home is in single bedrooms with washbasins, bathroom facilities are shared. A number of shared areas are available, these include smoking and non-smoking areas, a quieter lounge, dining room and private garden. Wakeful staff are available twenty four hours a day, in addition to care staff, the home also employs cooks and cleaning staff, although residents are encouraged and supported to take part in these tasks where possible. The building is owned by Riverside Housing, a local housing association who are responsible for maintaining the premesis. The home is operated by Making Spaces, an organisation and registered charity who provide support for adults with mental health support needs. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four hours and included discussion with five residents, the manager and two staff, reading files and records and a partial tour of the building. What the service does well: What has improved since the last inspection? Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 6 Since the previous inspection the home have ensured that they carry out fire risk assessments and that all staff receive regular training and drills in this area. A system has been put into place to ensure that residents care plans are reviewed and monitored regularly. The home now plan residents meetings prior to a staff meeting so that issues, which were raised, can be discussed. Residents are supported to be independent, wherever possible taking responsibility for household tasks, their leisure time and holding keys to the home and their room. 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. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 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 standard(s) 2,4 The home obtains a good range of information and assessments about prospective residents and uses this to make a decision as to whether they can offer the person a service. They also carry out their own assessment although this is not always completed. Any prospective residents are offered the opportunity to visit the home and to stay for a short period, where the person chooses not to do so the home alters their trial period to accommodate this. EVIDENCE: Staff in the home were able to explain that prior to a new resident being offered a place they obtain full assessments and information about the person, this includes an application form, two written references and assessments from other professionals such as the NHS, Community Psychiatric Nurse (CPN) etc. At least two staff visit and meet the person and carry out their own assessment. A resident’s file examined contained all of these records and the manager explained that three staff met with the person and their current support workers and carried out their own assessment. The manager was also able to give examples of times when they have not offered a place to a person, as they did not feel able to meet their needs. The home had obtained a very good range of assessments for this person however their own assessment form recorded only limited information, the home should make sure that they record all the information they obtain on this form so that it can then be used as part of the care planning process. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 9 The home have written information, which is given to any new residents, this states that before deciding to move in the person is welcome to visit the home. The manager explained that before moving in they offer the person the opportunity to visit and to stay for a meal, overnight or the weekend as they choose. She was also able to give a good example of the support the home offers if the person refuses to visit explaining that they then offer a longer trial period and obtain contact numbers in case of a crisis. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 6,7, There are individual care plans in place for all residents. In some areas the support the person requires in well documented, however in other areas the plan does not fully reflect the support the person requires or the in-depth knowledge the staff team have of the individual. Plans are reviewed regularly and the home are aware of the need to alter their system of care planning to make them more reflective of the individual. The home and organisation encourages residents to make decisions and provides support to them with this process, they are active in looking at ways to involve residents more in the running of the home. EVIDENCE: The home has individual care plans in place for all residents, three of these were read during this inspection. The manager explained that the home intend to change their care plan format to one based on person Centred Planning (PCP) and have obtained information on this style of planning. Staff spoken with had an in-depth knowledge of the people they support and are able to explain the support the person needs with their physical and mental health and how this differs between individuals. Care plans did not fully reflect all of this information or the in-depth support that staff provide, the planned Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 11 new format will provide a good system for recording this information. The home must make sure that their care plans are detailed enough for a member of staff who is unfamiliar with the person to follow. A resident confirmed that they do discuss their care plan with their keyworker however not all plans had been signed by the resident to show that they had discussed and agreed the contents, the home must offer all residents the opportunity to talk about and sign their care plan, if they choose not to do so this information must be recorded. Care plans contain information about how the person manages their finances and some good information regarding their healthcare needs. The manager carries out a regular audit of care plans to make sure they are reviewed and kept up to date. The home holds regular residents meetings, the manager explained that Making Space have introduced a scheme called “Involve”, this scheme looks at the ways in which residents can become more involved in the home, staff and residents will receive training including how to interview new staff. Residents spoken with confirmed that they hold regular residents meetings and knew who their representative was. The manager explained that the residents meetings are held just before staff meetings so that any issues, which are raised, can be discussed, records read in the home confirmed this. The home should consider setting action plans following these meetings to make sure any issues raised by residents are dealt with. Information about relevant advocacy services is available in the home and staff were observed to advocate firmly but professionally for a resident when needed. Residents are offered the choice of managing their own finances wherever possible, and records are kept of their decision. Good practice was noted in that care plans contain money management assessments signed by the resident. Records of correspondence regarding the persons benefits are retain and show that the home offers support to residents in dealing with this. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 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 standard(s) 12,13,1416 The home offers appropriate support to residents in accessing local community facilities and in finding out about leisure and educational opportunities. Staff have a good awareness of residents rights and respect their choices. EVIDENCE: Most of the people living at Palmyra are able to go out and about independently as they chose, and were seen to do so during the inspection, residents spoken with had a good knowledge of the local community and explained that they are members of a local church, use local shops and pubs etc. A resident spoken with explained that if possible all residents are independent with household tasks such as washing and ironing although staff will help if needed. The home have contacted an organisation called Mainstream who have arranged to visit residents, this organisation provides support to people in accessing leisure and educational activities. A summer fete was recently held by the home, residents said that they enjoyed this and it gave them the opportunity to meet with some of their neighbours. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 13 A resident spoken with said that staff do go out with them if needed and explained that some day trips and a holiday are planned. Activities in the home are the same as in any household and include TV, Video, music and household tasks. A resident explained that they have a key to both their bedroom and the front door, throughout this and other visits to the home residents were seen to make use of these as they chose. Staff were seen to knock on bedroom doors and obtain permission before entering. Residents make use of all of the shared areas as they choose and staff were seen to respect peoples privacy if they chose to spend time alone. During the inspection all staff were seen to talk with residents, include them in conversations and speak with them in a friendly and respectful manner. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 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 standard(s) 19, 21 The home provides a high level of support to residents in meeting their healthcare needs and works well with other healthcare professionals to provide a consistent service. EVIDENCE: The home have provided an excellent level of support to one resident who has been ill recently, this has included providing a member of staff to attend daily appointments, they make sure that this is a member of staff the person is comfortable with and utilise bank staff familiar with the home to support other residents. They make sure that if a resident is in hospital they receive regular visits and that the required support is in place when the person returns home. There are information leaflets in the home to advise the person and staff about their condition and treatments and well kept records of advice received from healthcare professionals. The resident explained that “staff are very kind” and confirmed that the home had provided support in attending appointments etc. Through reading records in the home it was evident that the team work well with healthcare professionals and act upon their advice where it is in the persons best interests, staff were also observed to have the knowledge and ability to challenge and seek a second opinion if they believed this was in the residents best interests. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 15 Care plans are updated monthly with information about the person’s healthcare needs and any changes, the home support residents to make regular healthcare appointments such as dentist, optician as well as appointments relating to maintaining their mental health. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 22 The home has a good system in place for helping people to make a complaint and for dealing with any complaints that arise. EVIDENCE: The home has a system in place for recording any complaints although none have been received since the last inspection. This is clear and provides information about how to make a complaint, who will look into it and the time it will take, information about how to contact the Commission for Social Care Inspection (CSCI) is also provided. The manager advised that all residents have been given a copy of this and residents asked confirmed that they knew who to talk to if they had a complaint. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 17 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 standard(s) 24,25,2730 Palmyra provides sufficient shared and private space for residents, staff and visitors. The home is regularly decorated and maintained with a view to making the environment as homely as possible whilst taking into account the safety of residents and staff. Bathrooms and the laundry area are generally clean and well maintained although one of the toilets required re-sealing in order to prevent a spread if infection. EVIDENCE: The home provides enough shared space for residents, this includes a smoking lounge, dining room, small upstairs lounge and large enclosed garden. From the outside the home fits in well with local properties and is not identifiable as a care home, it is well located in Waterloo with easy access to local shops, transport and leisure facilities including pubs, churches and the seafront. The lounge area has been made to look as homely as possible with new settee covers, pictures etc, this is balanced with the need to make the home as safe as possible, therefore the floor is tiled as the majority of people living there smoke. The hall area has recently been decorated with one resident commenting, “it looks very nice”. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 18 The home has a lift to the two top floors although some bedrooms, the laundry and smoking room are only accessible via steps, this is suitable for the people currently living there but may become less so as they age. The garden is accessed via a patio door in the lounge and has a ramp fitted leading to the grassed area. There are several seating areas, a safe pond and flags have recently been laid with plans in place to provide a barbeque area, this provides a pleasant place for residents’ to sit and either socialise or spend some quiet time. All bedrooms in the home are single and provided enough space for residents and their belongings, good practice was noted in that the home had provided safe storage in the cellar area for one resident who has a lot of possessions. None of the bedrooms are en-suite although all are fitted with washbasins. The home has three bath / shower rooms and several separate toilets, these are lockable for privacy although they can be overridden in the event of an emergency. Some of the sealant around the top floor bathroom toilet had come away and appeared grubby, this must be replaced. The laundry area is in the cellar and provides industrial washing and drying machines and ironing facilities. A resident spoken with explained that staff do some washing and ironing but if possible all residents do their own on a rota basis and that this works out well. The home was clean and well maintained with gloves, bags and cleaning materials available to deal with any possible outbreak of infection. Most of the people living at Palmyra smoke, therefore the large downstairs lounge is a designated smoking area, smoke free areas are available in the dining room and small upstairs lounge. In addition to communal rooms and bathrooms a separate sleeping in room and shower room are provided for staff. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34,36 Staff receive regular formal supervision during which their training needs are identified and the work they perform is discussed. The organisation carry out appropriate checks prior to employing a new member of staff, however these are not all held on file in the home as required by regulations. Staff are provided with copies of their terms and conditions for working in the home. EVIDENCE: Three staff files were read during this inspection, they contained copies of staff supervision, Criminal records Bureau checks (CRB) their contract, terms and conditions and training records. Some files contained two written references others did not. The manager explained that these are dealt with by the organisations head office and she does not always see them prior to appointment although they are usually held on file in the home. The home must make sure all staff files contain references for examination during inspection, the organisation should include the manager in examination of references for potential staff in order for her to be fully involved in the decision making process. Files contained evidence that staff have regular formal supervision with senior staff in which they can discuss their work, training needs etc, a member of staff spoken with confirmed that this takes place regularly. Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home carries out the necessary checks and training to ensure the building is safe for residents and staff are training in health and safety issues. EVIDENCE: Up to date records and certificates are available in the home for the testing of electrics, gas, water, small appliances and water / fridge / food temperatures. The home have provided training for staff in fire, food and health and safety and carry out regular fire drills and checks. Opportunity Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 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 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 2 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x x x 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Palmyra Score x 4 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 22 no 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 6 Regulation 15(1) Requirement Timescale for action 5/12/05 2. 6 15(2)(a) 3. 4. 27 34 23(2)(b) 17(2) The home must ensure information in care plans is sufficient for unfamiliar staff to support the resident The home must offer residents 7/11/05 the opportunity to read and sign care plan, if they do not wish to do so this should be recorded. The home must replace the 10/10/05 sealant around the toilet in the top floor bathroom The home must ensure copies of 10/10/05 two written references for staff are held on file 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 6 7 34 Good Practice Recommendations The home should record all information they regarding a prospective resident on internal assessment form The home should draw up action plans following residents meetings The home manager should have sight of references for potential staff. F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 23 Palmyra Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo L22 0LG 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 Palmyra F53 F03 S5388 Palmyra V239143 080805 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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