CARE HOME ADULTS 18-65
Parkbourn (Autism Initiatives) 1-4 Parkbourn Maghull Liverpool Merseyside L31 1LH Lead Inspector
Debbie Corcoran Unannounced Inspection 26th October 2005 1:00 Parkbourn (Autism Initiatives) DS0000005310.V267276.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 Parkbourn (Autism Initiatives) DS0000005310.V267276.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. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 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) Autism Initiatives Mrs Lisa Hankin Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 8 LD Date of last inspection 11.03.2005 Brief Description of the Service: Parkbourne is a registered 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.V267276.R01.S.doc Version 5.0 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 5 hour period. The inspector met all of the service users during the inspection and had the opportunity to talk with a relative of one of the service users. The inspector also met with the registered manager and interviewed two members of care staff. 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. A tour of the home was carried out. This did not include the service user’s bedrooms on this occasion. What the service does well:
The findings of the inspection were 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 / guidance for staff on how to meet the needs of the service users. The service users are supported to remain healthy and all health related checks are up to date and well documented. Staff also refer for more specialised support as appropriate to the needs of the service users. Staff recruitment and selection procedures are thorough and aim to protect the service users. There are a number of well established members of staff who know the service users well and have formed long standing relationships with them and staff generally appear to have a good understanding of the needs of the service users. Staff training opportunities are good and each member of staff has a training and development plan. Staff have regular meetings both as a team and on an individual basis with their manager. The home is well presented, well maintained and presented as clean and hygienic. All health and safety checks were up to date including fire checks, water temperature checks, safety certificates and staff are provided with training in health and safety topics. The standard of food and meals appears to be good and staff have clear information on the service user’s needs and preferences of food. All records kept at the home are in good order, up to date and maintained securely as appropriate. The home is well managed by a long standing manager and staff have clear roles and responsibilities. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 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.V267276.R01.S.doc Version 5.0 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.V267276.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 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, 8, 9, 10 Each service user has a plan of care which clearly reflects their needs and includes goals for their personal development. The plans are reviewed and updated regularly. 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. Personal and confidential information is handled appropriately. EVIDENCE: Each of the service users has an individual plan of care which includes a good level of information on how to meet their needs. The plans include information on the service user’s health related 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. The plans examined were found to be up to date. The plans are reviewed every six months and the reviews include the service user, their relatives or representatives, care staff, social workers and any other relevant people. Care staff including new staff are familiar with the service user’s care plans and other relevant information.
Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 10 A relative of one of the service users gave very good feedback on the quality of care provided at the home and was very positive about all aspects of her sons support. Each of the service users has an assessment of any risks concerned with their care and support. The risk assessments are comprehensive and are reviewed and updated regularly. 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. Members of care staff have given examples of how service users are supported in day to day household tasks for example mealtimes, shopping and housework. Service user’s care plans include some information on the household tasks service users are supported with and the nature of support required with these. There are some restrictions on access within the home, these are based upon risk assessments and are recorded as such. The home has a policy and procedure on confidentiality. Records were evidenced to be maintained securely and staff are aware of their responsibilities in maintaining confidentiality and have signed a confidentiality agreement. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,14, 17 Service users are supported to use and develop their daily living skills and communication skills. Staff support service users to use local facilities and pursue their leisure interests. The level of opportunities for this does not seem to be equitable for all service users. Staff are aware of the service users’ likes and dislikes in food and of any special dietary needs which the service users have and the service users are offered a healthy and well balanced diet. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 12 EVIDENCE: Each of the service users has a plan of care which includes information on how to meet the individuals social, emotional, communication and independent living skills. Service user’s care plans / action plans identify targets for them to develop in these areas. The plans are monitored monthly and reviewed every six months. The service users are supported in a variety of leisure activities. These include bowling, going to the cinema, walking, shopping, eating out, visiting pubs, swimming and discos. An activities board, with pictures, is used to communicate what activities are due to take place. The inspector examined service user’s daily records and the activities records in order to assess the frequency of leisure opportunities. If the records have been kept up to date then they indicate that there is quite a difference in the level of opportunities between service users. It was recommended that the manager reviews this in order to ensure equality of opportunity for all of the service users. The service users have the opportunity of an annual holiday. There was a good quantity and variety of food available on the day of inspection, including fresh fruit and vegetables. Service users are involved in shopping for food and in some food preparation. The main meal of day on the day of inspection was home cooked and made with fresh ingredients. Where service users require support with a special diet or with eating this is recorded in their plan of care. Food storage was checked and found to be appropriate with the exception of some food not being date labelled after opening. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 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 support. Service users are well supported to remain healthy. Medication is handled safely and in accordance with policies and procedures. However, medication administration records are not being accurately completed at all times. EVIDENCE: When a service user requires support with their personal care information on their strengths, needs, routines and preferences has been recorded. Times for going to bed, getting up and bathing etc have been reported to be flexible and determined by the individual but with some restrictions particularly in relation to day care arrangements. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 14 There was a good level of evidence to indicate that the service users are being well supported to remain healthy. Service user records indicate that staff are supporting service users in visiting their G.P and attending hospital or specialist health related appointments. A record of the outcome of such appointments is maintained. Service users are also supported with regular health checks for example eye sight tests, well person clinics etc. Review information includes information on when the most recent health checks have taken place. The home has a medication policy and procedure. Medication was observed to be appropriately stored and records were maintained appropriately. The only exception to this being that prescription creams were not always being recorded as administered. A pharmacist periodically checks the home’s medication administration practices. The majority of staff have received medication training. 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. Parkbourn (Autism Initiatives) DS0000005310.V267276.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): 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. However the lack of a policy and procedure on service user’s payment of travel expenses to staff leaves service users and staff in a potentially vulnerable position. 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. When appropriate service user’s plans include detailed guidelines for supporting the person with their emotional needs and with behavioural issues. The home has a policy and procedure on the management of service users money, valuables and financial affairs. However, there are occasions when service users pay money to staff for travel purposes but there is no policy and procedure on this. This must be addressed at it leaves both service users and staff in a potentially vulnerable position. Parkbourn (Autism Initiatives) DS0000005310.V267276.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, 28, 30 The service users live in a home which is well presented, homely, spacious, safe and comfortable. 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. The home is generally well presented and well maintained and furnishings and fittings are of an appropriate standard. Health and safety practices are adopted and all health and safety checks were up to date. 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.V267276.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): 31, 34, 36 Staff have clear roles and responsibilities. Staff recruitment and selection procedures are good and aimed at the ensuring the protection of service users. However, there are numerous staff vacancies at the home and recruitment needs to be improved. Staff have the opportunity to meet one to one with their manager and to meet as a team on a regular basis. EVIDENCE: The home has a good staffing structure and staff roles and responsibilities are clear. Some members of the staff team have worked at the home for a number of years and have therefore had the opportunity to form long standing relationships with the service users. Discussions with members of the staff team indicated they have a good level of understanding of the needs of the people they support and records evidenced that the staff team have referred for specialist for service user as appropriate. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 18 Staff files were examined in order to assess staff recruitment and selection practices. The files evidenced that the organisation have attained Criminal Records Bureau disclosures and references prior to employing new staff. Autism Initiatives are reported to include service users in the recruitment and selection of staff across the organisation. However, there was no evidence of this including the service users in this particular home. The staffing compliment is down as there are currently between 30 – 40 hours per week of vacant staff hours. The manager is using casual staff and agency staff to fill these hours but she reported that there is consistency in the staff used. There has been difficulty with staff recruitment for some time and this needs to be addressed. The manager should look to ensure a more efficient recruitment and selection process and implement planning to improve retention of staff. Staff records show that staff are receiving regular and recorded supervision and all staff undergo an annual appraisal. Staff who provide supervision have been provided with training in supervision skills. Records showed that staff also have the opportunity to meet as a team on regular basis and these meetings are recorded. Parkbourn (Autism Initiatives) DS0000005310.V267276.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): 37, 38, 39, 40, 41, 42 The home is well managed by an experienced and long standing manager. The registered provider is failing to ensure that monthly quality assurance visits are being carried out at the home and the commission is not being provided with regular reports on the home. Policies and procedures and practices are in place which aim to safeguard and protect the well being of service users and staff. Records are well maintained, up to date and stored appropriately. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 20 EVIDENCE: The manager has worked for Autism Initiatives for a significant number of years and has been managing this particular home for the past five years. The manager is supporting the aims and objectives of the home and directing staff appropriately. Feedback on the manager from staff and from a relative was good. The manager reported that she is involved in a ‘communication forum’ group which has been established to look at developing how services are provided to service users. With regard to quality assurance the registered person should ensure that the home is visited on an unannounced basis at least once per month and provide a report on the findings of the visit to the Commission in line with Regulation 26 of the Care Home Regulations 2001. The home maintains a large number of policies, procedures and guidelines. All policies and procedures have been signed by members of the staff team and the registered manager. Copies of all policies and procedures are easily available to staff, relevant procedures such as the complaints procedure and the fire procedure have been produced in an accesible format for service users. All records in the home were evidenced to be maintained securely and were in good order and up to date. The service users can access their records if they so wish. The home has a number of policies and procedures and practices which aim to ensure the health and safety of service users and staff and these include policies on health and safety, infection control, fire safety and moving and handling and staff are provided with training in many of these areas. Fire safety and health and safety precautions are taken and records of these are maintained. These were all up to date and in good order. The home has named health and safety, fire safety and food hygiene officers. Risks assessments are in place in relation to the care of the service users and in relation to safe working practices for staff. All risk assessments are regularly reviewed and updated. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 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 x x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 x 3 4 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 3 x 3 LIFESTYLES Standard No Score 11 3 12 x 13 x 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 x x 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Parkbourn (Autism Initiatives) Score 3 4 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 4 3 x DS0000005310.V267276.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA39 Regulation 26 (5) Requirement The registered person shall ensure that monthly unannounced visits are carried out to the home and supply the commission with a report following each visit. There must be a clear policy and procedure on service users money being paid to the organisation / staff for travel purposes The registered manager must ensure that food is stored appropriately at all times. All medication must be recorded as given or otherwise on medication administration records. The registered manager must ensure that there is an effective staff recruitment process and implement planning to improve staff retention. Timescale for action 21/12/05 2 YA23 13 (6) 26/02/06 3 4 YA17 YA20 13 (3) 13 (2) 27/10/05 27/10/05 5 YA33 18 (1) (a) (b) 26/01/06 Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 23 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 YA23 YA14 Good Practice Recommendations Staff should be provided with training in the protection of vulnerable adults. The registered manager should review the leisure opportunities for all service users. Parkbourn (Autism Initiatives) DS0000005310.V267276.R01.S.doc Version 5.0 Page 24 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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