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Inspection on 25/10/05 for Phoenix House

Also see our care home review for Phoenix House for more information

This inspection was carried out on 25th October 2005.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides a permanent, secure, safe home for up to eleven adults. The home has a friendly atmosphere. The house is adequately maintained. The service users are supported by a staff group that know their individual needs. Many of the staff have worked at the home for some years. The service users have the opportunity to attend regular activities out of the home, either as a group or individually. The service users all spoke positively about living at the home, the activities, the support from staff and holidays.

What has improved since the last inspection?

The fire doors have been improved. Staff have attended infection control training. Also some staff have commenced health and safety training. The service users had been on their annual holiday. A new service user had settled into the home. The managers had commenced management training.

What the care home could do better:

All service users must have up to date care plans and risk assessments. Senior staff need training in risk assessing. The medication records must be accurate. Further training for staff in safe working practices needs to be planned. Arrange for the service users, with support, to manage their own monies. Some of the fire doors require attention. A wash hand basin must be fitted in the laundry. The management arrangements, in the home, need to be discussed with CSCI. A quality assurance programme needs to be introduced. A legionella risk assessment must be carried out and the water temperatures tested and recorded weekly.

CARE HOME ADULTS 18-65 Phoenix House 122 Bromyard Road St Johns Worcester Worcestershire WR2 5DJ Lead Inspector P Wells Unannounced Inspection 3.30 25 October 2005 th Phoenix House DS0000018670.V261724.R02.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 Phoenix House DS0000018670.V261724.R02.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. Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Phoenix House Address 122 Bromyard Road St Johns Worcester Worcestershire WR2 5DJ 01905 426190 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) Mr Nigel Hooper Nicola Toni Nicholls Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2005 Brief Description of the Service: The home is a large detached house on the west side of Worcester. Locally there are shops, a pub and a bus route into Worcester city. There are five single bedrooms and three double bedrooms with suitable communal rooms. The service users have mild to moderate learning disabilities, whom require support and some need assistance with their personal care. Mr Nigel Hooper is the registered provider. The home has two, joint registered managers, Mrs S Jones and Mrs N Nicholls. The main purpose of the home is to provide a permanent, homely environment encouraging service users to be involved in household tasks. Mr Hooper also operates a second care home next door and supported living accommodation for two persons on the same site. Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection that commenced during the late afternoon of Wednesday, 25th October 2005. For this inspection, time was spent preparing - reading the previous report and pre inspection questionnaire. This was the inspector’s first inspection of the home. Four hours were spent at the home. The focus of this visit was to get to know the service, meet with the service users and staff on duty. Also time was spent with one of the managers of this home, (and the manager of the sister home joined us), to follow up on the previous requriements and recommendations. The inspector met with the service users, viewed the home with them, observed the evening routine and read documentation. The inspector appreciated the co-operation and time of the service users, staff and managers. What the service does well: The service provides a permanent, secure, safe home for up to eleven adults. The home has a friendly atmosphere. The house is adequately maintained. The service users are supported by a staff group that know their individual needs. Many of the staff have worked at the home for some years. The service users have the opportunity to attend regular activities out of the home, either as a group or individually. The service users all spoke positively about living at the home, the activities, the support from staff and holidays. Phoenix House DS0000018670.V261724.R02.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. Phoenix House DS0000018670.V261724.R02.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 Phoenix House DS0000018670.V261724.R02.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): 2,3,4 The service obtained information from Social Services prior to the admission of a prospective service user. Introductory visits to the home for the service users, their families and representatives take place. The home should undertake it’s own assessment to ensure that the needs of a prospective user can be met. EVIDENCE: Since the last inspection one service user had moved in. This admission was discussed with the manager and assessment viewed. It was apparent that a detailed assessment had been obtained from the social worker. The home relied on this rather than carrying out and recording it’s own assessment which would have ensured that the service could meet the new service user’s needs and he would be compatible with the other service users. Fortunately some of the service users and prospective service attended the same day centre so knew each other. Introductory visits had been arranged which assisted the service user in settling in. Phoenix House DS0000018670.V261724.R02.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): 6,9 Each service user needs to have an up to date plan and risk assessment, which indicates clearly how the individual’s needs are met and any risky situations managed to encourage an independent lifestyle. EVIDENCE: Service user files with life plans were in place for nine of the service users. However no plan had been established for the tenth person who moved into the home five months ago. The manager advised a life plan was being drafted. The inspector was shown the plan for a service user who had been admitted last year and a review had taken place. The plans viewed gave useful information about each service user. There was a separate record indicating reviews had taken place but often the plans had not been updated to reflect the changes in an individual’s situation. Risk assessments had been completed for the majority of service users but gave a description of the situation or the room rather than identifying any risks and indicating how these were to be managed to safeguard the individual. For example the only risk in one service user’s bedroom was the rug but this had not been mentioned, in another service user’s risk general risk assessment Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 10 there was no mention that the person suffered with epilepsy. It was said that there was a separate, up to date risk assessment and protocol for the epilepsy but this could not be found and the manager recalled that it had been sent to the day centre. There were no details in the plan about the type of epilepsy and how to manage a seizure. It was said that the advice given by inspectors on risk assessing differed, although this was not apparent to the new inspector. The senior staff would benefit from training in risk assessing and how this relates to service user’s care plans. Staff were also keeping separate logs of daily activities, weighing and events. The language used on some occasions relating to individual situations needed to be checked so that staff were not judgemental or disrespectful about service users. Health matters were referred to in the plans and have been commented upon on pages 14 & 15. Nevertheless, it was apparent through observations and discussions with the manager and staff that the service users’ individual needs, abilities and choices were well known and met. This was also confirmed by individual service users. Phoenix House DS0000018670.V261724.R02.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): 12,13,15,16 The individual lifestyles of the service users were respected and independence encouraged for some service users. A variety of activities took place out of the home on a regular basis. EVIDENCE: It was evident from speaking with service users, staff, the manager, reading service user files that these standards were met. Individual lifestyles and personal development of the service users was respected and promoted by the manager and staff. For example the service users spoke enthusiastically about their day placements and regular leisure activities. They also enjoyed their days at home when they assisted with domestic tasks. On the evening of the visit, two service users were out, one with relatives and another in town. Eight of the service users were having a night in watching television, pursuing their own interests and chatting. On these evenings staff explained (and it was observed) Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 12 that the service users took baths/showers early evening, then retired to their rooms or bed. Service users spoke of the summer holiday at Butlins. Also three service users had been on holiday abroad. Some of the service users would like a computer and video or digital camera in the home to use. Service users indicated that they keep in contact with friends and families who can visit them. The home has a vehicle for taking service users out and to day placements. Also some of the service users walked to local places and used buses. The home had a set routine yet respected the individual lifestyles. There were bedroom door locks but it was unclear whether the service users were encouraged to use these locks and some did not have keys. One lock needed repairing. The main meal was prepared by staff and served soon after the service user returned from day placements (5.15 pm). On the evening of the visit it consisted of home made shepherds pie and mixed vegetable. A meal was kept for a service user who was out. Drinks and biscuits were served about 7.00pm prior to the service users starting their bedtime routine, which seemed early. Phoenix House DS0000018670.V261724.R02.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 The service users receive appropriate support with their individual personal and healthcare needs. Aspects of the medication system need reviewing with the pharmacist. EVIDENCE: The personal and health care needs of service users were monitored and documented for most of the service users in their plans. A service user plan for one individual had not yet been compiled. The majority of service users were able to mange their own personal care with prompts from staff. It was evident that service users were supported with any health problems that arose and medical advice sought. A record of health care appointments was kept for the majority of service users. Service users were weighed from time to time and a record kept of this but the purpose was unclear and not referred to in service users’ plans. A review should take place to confirm which service users (for health reasons) need to be weighed on a regular basis and how this will be recorded in their plans and monitored. Senior staff were about to attend a training session on introducing health care action plans with the service users. This proposal is welcomed. Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 14 The medication system was not fully inspected on this occasion and will be viewed by the pharmacist inspector soon. However the following was observed: A monitored dosage system was in use. The service users’ medication was kept in a locked cupboard in a lounge, with monies and other record. The medical administration charts printed by the pharmacist were being completed by staff when medicines were administered to a service user. However the record was not accurate because the dates did not tally with when staff were signing. This was of concern and the manager was requested to discuss and address this issue with the pharmacist immediately. The managers had arranged medication training themselves in-house for staff which was commendable. However all staff who administer medication need to be trained by a qualified person such as a pharmacist or attend a recognized course. The community pharmacist could be asked to run in-house sessions. It was pleasing to hear that three staff were undertaking a distance learning course on the administration of medications. There should be a list with sample signatures for the staff who are designated to administer medicines to service users (previous recommendation). Phoenix House DS0000018670.V261724.R02.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): EVIDENCE: These standards were not fully assessed on this occasion except for following up on previous requirements and recommendations: • The staff had not yet received training on abuse awareness. • The provider was still handling the service users monies and service users had to access their monies through the home’s petty cash. • The records kept of the service users monies did not have two signatures. Phoenix House DS0000018670.V261724.R02.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 The premises are suitable for their purpose. The location of the house is convenient to local services and facilities. The house is homely, clean and appropriately furnished. There is adequate communal space for the number of service users. Some of the fire doors need attention and two aspects relating to hygiene should be improved. EVIDENCE: This care home is situated on a main road on the west side of Worcester. There are shops nearby as well as a pub and bus route. The large, two storey, detached house is suitable for the number of service users. On the ground floor there were two lounges, dining room, kitchen and laundry. Also bathing and toilet facilities and two bedrooms, one single and one double. On the second floor there were four single and two double bedrooms, an office, bathing and toilet facilities. The house was homely, safe and maintained. The home has it’s own front and rear gardens. Some of the service users showed the inspector around the home and their bedrooms, which were suitably furnished and personalized. Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 17 At night the member of staff slept on a folding guest be in the lounge, rather than in the office, as previously. This arrangement will be discussed with the provider. Since the last inspection the fire doors have been fitted with intumescent strips and fire brushes (previous requirement). Some of the doors were now not closing properly and needed adjusting. The door lock on a bedroom door needed repairing. A hand washbasin had not been fitted in the laundry, as previously required. It was noted that the kitchen did not have a dishwasher, which would be more hygienic, also staff and service users felt it would be beneficial. Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 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): EVIDENCE: These standards were not fully assessed on this occasion but the following was noted: There were sufficient staff on duty to look after the service users whom they knew well. The staff were aware of the home’s routines, their roles and responsibilities. The staff training programme needed to be developed to include refresher training for all staff in safe working practices. Phoenix House DS0000018670.V261724.R02.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, 39,42 The home has established management arrangements which need reviewing. A quality assurance system should be introduced and aspects of health and aspects of safe working practices developed. EVIDENCE: The home has two, joint registered managers who have worked at the home for some years. One of these managers advised that she commenced on the manager’s course in January 2005 and has passed one unit. The other manager has not been at work for a few months and this matter is to be followed up with the provider. A quality assurance programme has yet to be introduced by the provider (previous requirement). The standard on Safe Working Practices is wide ranging and a sample were considered with the following noted: The home had a variety of risk assessments for the premises, which were suitable but needed to be kept up to date and developed. For example the risk Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 20 assessment for one lounge did not refer to the trailing wires, overloaded extension adaptor and fire door needing attention. Training for senior staff in risk assessing and risk management has already been commented upon in this report on page 11. Staff had received up to date training in some safe working practices – infection control, first aid and three staff were undertaking a distance learning courses on medication, moving and handling. Staff still need courses on abuse awareness, medication, food hygiene, health and safety led by qualified/professional and trainers. The staff had received an annual fire training session on 03/05/05 The portable appliances had been tested in September 2005. A certificate of electrical safety for the mains wiring could not be located. The water temperatures were not being tested and recorded, as previously required. It was unclear whether a legionella risk assessment had been carried out, as previously required. Phoenix House DS0000018670.V261724.R02.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 3 3 3 X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 1 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Phoenix House Score 3 2 X X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 2 X DS0000018670.V261724.R02.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 2 Standard YA6 YA9 Regulation 15 13,15 Requirement Each service user must have an up to date plan indicating their personal and health care needs. All risk assessments carried out in respect of service users’ activities must contain comprehensive information about how risks are managed by the home. (timescale of 31/03/05 partially met) All staff must receive up dated medication training from a qualified person or accredited trainer. (timescale of 31/05/05 partially met) The medication administration forms must indicate accurately the date staff sign for administering any medication to a service user. The practice of the provider acting as appointee for service users and managing their monies must be reviewed. The service users need to be supported in managing their own finances. The fire doors must be adjusted to close properly and one door lock repaired. Hand washing facilites must be DS0000018670.V261724.R02.S.doc Timescale for action 31/01/06 31/01/06 3 YA20 13 31/01/06 4 YA20 13 02/11/05 5 YA23 20 31/01/06 6 7 YA23 YA30 23,13 13,23 02/11/05 31/01/06 Page 23 Phoenix House Version 5.0 8 YA39 24 9 10 YA42 YA42 13 13 11 YA42 13,18 provided in the laundry room, (timescale of 31/08/05 not met) A quality asurance sysytem must be introduced in accordance with the requirements of regulation 24 and Standard 39/. (timescale of 31/05/05 not met) A legionella risk assessement must be available in the home for inspection A certificate of elctrical safety undertaken by industry acredited engineer must be avialable in the for inspection. All staff must receive training in safe working practices - abuse awareness, medication, food hygiene, health and safety. 28/02/06 31/01/06 31/01/06 31/01/06 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 4 5 6 7 Refer to Standard YA2 YA9 YA16 YA19 YA20 YA23 YA30 Good Practice Recommendations The home should carry out and record it’s own assessment for a prospective service user. Senior staff would benefit from training in risk assessing and care planning Service users should be given keys to their bedrooms and the front door unless it is assessed and recorded that there is a risk. The arrangements for weighing service users should be reviewed. Staff, who are designated to give out medication, should provide a sample signature on record. Two signatures should be sought for financial transactions of service users money. Consideration should be given to installing a dishwasher. Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Phoenix House DS0000018670.V261724.R02.S.doc Version 5.0 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. 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