CARE HOME ADULTS 18-65
Parkbourn (Autism Initiatives) 1-4 Parkbourn Maghull Liverpool Merseyside L31 1LH Lead Inspector
Debbie Corcoran Unannounced Inspection 24th February 2006 10:30 Parkbourn (Autism Initiatives) DS0000005310.V286482.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 Parkbourn (Autism Initiatives) DS0000005310.V286482.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. Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Parkbourn (Autism Initiatives) Address 1-4 Parkbourn Maghull Liverpool Merseyside L31 1LH 0151 527 1009 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) www.peterhouseschool.org Autism Initiatives Mrs Lisa Hankin Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 8 LD Date of last inspection 26th October 2005 Brief Description of the Service: Parkbourn is registered as a care home for eight people who have a learning disability. The service is provided by Autism Initiatives, which is an organisation which specialises in providing services to people who have autism. The property is owned by Riverside Housing Association. The home is located in a residential area in Maghull. The home was originally four domestic sized properties. These have been converted to create one building. The building is divided for practical purposes into two separate living areas. Each living area has a lounge, kitchen and dinning area and two bathrooms. Five members of staff are on duty throughout the day when all of the service users are at the home and there is also one waking and one sleep in staff available throughout the night. Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out unannounced. It took place over a 3 hour period. A full tour of the home was carried out. Records were examined and these included a sample of the service user’s records and care plans, staff records, staff rotas, menus, medication administration records, health and safety checks and other relevant records. What the service does well:
As at the last inspection the findings of this inspection were mainly positive and indicate that the manager is aiming to ensure that the home meets all of the national minimum standards. The quality of care planning is good and each of the service users has a detailed care plan which is regularly reviewed and updated. The care plans include a good level of information and guidance for staff on how to meet the needs of the service users and on the service user’s preferences, likes, dislikes and routines. The service users are supported to make decisions as to their daily routines, for example when to get up and go to bed, their activities and what and when they eat. Some information in the home has been produced using pictures. The manager is collecting a range of pictures which will be used for service users to more easily communicate their choices and wishes to staff. The service users are supported to remain healthy and records show they are regularly supported to visit their GP, nurse, optician and dentist. Staff also refer for more specialised support when this is needed. There are a number of members of staff who have worked at the home for some years and who know the service users well and have formed long standing relationships with them. Staff generally appear to have a good understanding of the needs of the service users. Staff are provided with good training and many of the staff are qualified to a National Vocational Qualification (N.V.Q) in care. The home was generally well presented, although there are some areas for improvement. The home was presented as clean and hygienic and all health and safety checks were up to date. The home is well managed by a manager who has worked for Autism Initiatives for many years and has been managing this home for the past five years. Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Parkbourn (Autism Initiatives) DS0000005310.V286482.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 Parkbourn (Autism Initiatives) DS0000005310.V286482.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 Autism Initiatives has a process to ensure that service user’s needs are assessed before they move in to the home in order to ensure the person’s needs can be met at the home. EVIDENCE: There have been no new service users admitted to the home for a number of years and certainly since the introduction of the national minimum standards. It has therefore not been possible to practically assess that the home is meeting some of the above standards. The manager was able to provide a copy of the assessment format which would be used for new service users. All service users are having a reassessment of their needs carried out as a new way of assessment and care planning is being introduced at the home. The manager is aware of the need to attain assessment information from referring agencies and other relevant sources prior to offering a service to a new service user. Parkbourn (Autism Initiatives) DS0000005310.V286482.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 service user has a care plan which reflects their needs and includes goals for their personal development. Service users are supported to make choices. When a service user is involved in an activity which involves taking risks then the level of risk is assessed and plans are put in place to manage the risk. EVIDENCE: Each of the service users has a care plan which includes a good level of information on how to meet the person’s needs. The plans include information on the service user’s health needs, communication needs, detailed guidelines for support with personal care, detailed guidelines for support with behaviours and routines. Clear and achievable goals for development have been set and these are monitored and reviewed. Each section of the plan is evaluated on a monthly basis. Two care plans were examined on this occasion. The plans are usually reviewed every six months and the reviews include the service user, their relatives or representatives, care staff, social workers and relevant people. It was noted that there has been a delay in the review of the care plans on this occasion. The manager reported that this is because the home are in the process of introducing a new way of care planning the inspector was shown an example of what the new care plans will be like. The new plans will
Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 10 have more emphasis on identify particular goals for the service user to aim for eg. choosing an evening activity or learning a new personal care skill and pictures will be used to assist the service users in meeting these goals. For example one of the service users may be shown a whole range of pictures of different activities and will be encouraged to choose which one they would like to be supported with. Staff will then keep a daily record which details how they have supported the service users with all aspects of their care plan. The service users are supported to make decisions as to their daily routines, for example when to get up and go to bed, their activities and what and when they eat. Service user’s care plans include a good level of information on the service user’s preferences, likes, dislikes and routines. Some information in the home has been developed in an easily accessible format. Examples of this are that the fire procedure is available in picture format and kitchen cupboards have pictures on the front to indicate what is inside them. The manager showed the inspector a range of pictures which are being collected in order to provide service users with more opportunities to make choices through the use of pictures. When a service user is thought to be at risk in any given activity then a risk assessment is carried out and guidelines on how to reduce and manage the risk are in place. Each of the service users has an assessment of any risks concerned with their care and support. In assessing this standard risk assessments in relation to the care and support of one of the service users was examined. The risk assessments are comprehensive and are reviewed and updated regularly. Parkbourn (Autism Initiatives) DS0000005310.V286482.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): 12, 13, 15, 16 Service users are supported to take part in appropriate activities both within the home and in the local community. Service users are supported to maintain relationships. Service users are encouraged to use and develop their skills, make choices and their rights are respected. EVIDENCE: The service users are supported to be involved in a whole range of activities both within the home and in the local community. A record of all activities is kept and this showed that the community activities which service users are involved in include bowling, going to the cinema, walking, shopping, eating out, visiting pubs and swimming. An activities board, with pictures, is used to communicate what activities are due to take place. A collection of pictures is being developed to enable service users to more readily choose which activities they would like to be supported in. Indoor activities include one to one activities with staff which might involve a game or group activities for example a disco. All service users attend a resource centre throughout the week and this provides further opportunities for the service users to be involved in a range of appropriate activities.
Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 12 Service users are encouraged to develop and maintain relationships through attending a number of resource centres, social groups and in using community facilities. Service users and staff maintain regular contact with members of the service user’s family. Each of the service users has a care plan which includes information on how to meet the individuals social, emotional, communication needs and encourage and support them in developing their independent living skills. These indicate that service user rights and responsibilities are being respected. Parkbourn (Autism Initiatives) DS0000005310.V286482.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 Each service user has a care plan which clearly details the support they require with personal care. Service users are well supported to remain healthy. Medication administration records are not being completed accurately at all times and this may leave service user and staff at risk from administration errors. EVIDENCE: When a service user requires support with their personal care then information on their strengths, needs, routines and preferences with this are well recorded in their care plan. Times for going to bed, getting up and bathing etc have been reported to be flexible and determined by the service user but with some restrictions particularly in relation to day care arrangements. Service users are being well supported to remain healthy. Service user records show that staff are supporting service users in visiting their G.P and attending hospital or specialist health related appointments. Staff maintain a record of the outcome of all appointments. Service users are also well supported with regular health checks for example eye sight tests, well person clinics etc. Each service user has a review of their care and support every six months and this is used as an opportunity to identify what support the service users has had to remain healthy and to identify future needs to remain healthy.
Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 14 The home has a medication policy and procedure. Medication was observed to be appropriately stored, however, medication administration records were not being maintained appropriately. There were a number of gaps in the administration records and staff were frequently not signing for having administered prescribed creams. The majority of staff have received medication training and only staff who have received this training are responsible for the administration of medication. Service user’s records indicate that the service users medication is being reviewed regularly. Service user’s records also include information on their medication and the possible side effects of these. The manager has recently introduced a new system for recording medication in to the home, medication administered, medication leaving the home and for checking the balance of medications on a regular basis. Parkbourn (Autism Initiatives) DS0000005310.V286482.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 The home has an appropriate complaints procedure. Policies, procedures and practices are in place which aim to protect service users against abuse or neglect. EVIDENCE: The home has a complaints procedure which is time scaled appropriately. The procedure includes details of the Commission for Social Care Inspection. A leaflet explaining the complaints procedure is also available and this includes pictures to aid understanding. There have been no complaints made to the home since the previous inspection. The home has an adult protection and prevention of abuse policy and procedure and a whistle blowing policy. The inspector recommends that staff are provided with training in the protection of vulnerable adults. Two staff have had adult protection training and the manager intends for this to be expanded to include all staff. When appropriate service user’s plans include detailed guidelines for supporting the person with their emotional needs and with behavioural issues. A small number of staff have recently undertaken “positive intervention” training which is training on how to support people with behaviours which may be challenging. The home has a policy and procedure on the management of service users money, valuables and financial affairs. The manager has addressed an issue of service users paying money to staff for travel purposes since the last inspection as this could have left service users and staff in a vulnerable position. These expenses now come out of a petty cash fund. Parkbourn (Autism Initiatives) DS0000005310.V286482.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): 24, 27,30 The service users live in a home which is generally well presented, homely, spacious, safe and comfortable. However, there are some areas of redecoration or repair which need to be addressed. The home is presented as clean and hygienic and staff have relevant training in maintaining hygiene. EVIDENCE: The home is located in a residential area in Maghull. The house was originally four houses and it provides a good amount of living space. The home is divided into two separate ‘units’ each of which has a domestic sized kitchen / diner and sitting room. The home has a third lounge area which can be used as a private room for visitors and there is also a music/‘chill out’ room. Communal areas easily meet the standard for space. On the whole the home is well presented and well maintained and furnishings and fittings are of an appropriate standard. However, there are some areas which require attention. These are; one of the landing areas is in need of redecoration following work having been carried out, the carpet and carpet grip in one of the lounges needs to be repaired or replaced, some areas of the hall are in need of redecoration, one of the lounges is in need of redecoration and the bathrooms need some attention to be presented as homely and domestic.
Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 17 The home was presented as clean and hygienic. Policies and procedures are in place in relation to health and safety and infection control and staff are provided with training in food hygiene and health and safety. Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 18 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, 33, 35 Staff are provided with a good level of training and many have achieved a relevant qualification. There are numerous staff vacancies at the home and recruitment needs to be improved to ensure that service users are supported by a stable and qualified staff team. EVIDENCE: The home is running on a reduced staff team due to there being a number of vacant posts. There are currently three fulltime and three part time vacant posts. The manager is using bank and agency staff to fill these hours as there continues to be difficulty in recruitment. The manager reported that she feels the recruitment has improved and reported that recruitment drives have been scheduled for the forthcoming year. Although the use of agency staff is high staff rotas confirmed that the same agency staff are being used to ensure consistency of support for the service users. However, the manager should make all possible efforts to ensure a full staff team. At the time of inspection there were eight members of staff on the team. Of these four had attained a National Vocational Qualification (N.V.Q) and three staff were undertaking the award. Staff training records were not fully examined on this occasion. However, it was noted that staff have been provided with some training in core health and safety skills and in topics relating specifically to the needs of the service users for example, an introduction to autism.
Parkbourn (Autism Initiatives) DS0000005310.V286482.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): These standards were not assessed on this occasion. EVIDENCE: Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 3 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 2 25 x 26 x 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 4 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 x x x x x x x x Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard YA20 YA33 Regulation 13 (2) 18 (1) (a) (b) Requirement All medication records must be maintained accurately. The registered manager must ensure that there is an effective staff recruitment process and implement planning to improve staff retention. Timescale for action 24/03/06 24/04/06 3. YA24 23 (2) (d) 4. YA24 23 (2) (b) The registered person must 24/05/06 ensure redecoration of one of the landing areas, the hall and one of the lounge areas. The registered person must 24/04/06 ensure that the carpet and grip are repaired or replaced in one of the lounge areas. Parkbourn (Autism Initiatives) DS0000005310.V286482.R01.S.doc Version 5.1 Page 22 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 YA23 Good Practice Recommendations Staff should be provided with training in the protection of vulnerable adults. Parkbourn (Autism Initiatives) DS0000005310.V286482.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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