CARE HOME ADULTS 18-65
Pia - Manor Court Road, 132/4 132 Manor Court Road Nuneaton Warwickshire CV11 5HQ Lead Inspector
Sheila Briddick Unannounced Inspection 18th November 2005 08:15 Pia - Manor Court Road, 132/4 DS0000004227.V264908.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 Pia - Manor Court Road, 132/4 DS0000004227.V264908.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. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Pia - Manor Court Road, 132/4 Address 132 Manor Court Road Nuneaton Warwickshire CV11 5HQ 02476 383986 02476 640146 jmorrissey@people-in-action.co.uk 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) People in Action Mrs Julie Ann Morrissey Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th June 2005 Brief Description of the Service: 132/134 Manor Court Road is a registered care home for eight people with learning disabilities and has been separated into two separately staffed homes that occupy the top and ground floors of two semi-detached houses. Effectively these are two group living homes. 24 hour care and People in Action offer personal support. 132 Manor Court Road is situated on the ground floor of the house and can accommodate four people with physical and learning disabilities. Each service user has their own bedroom with shared facilities of a kitchen, bathroom with W. C., separate WC and large lounge/dining room. There is a separate laundry area. 134 Manor Court Road can accommodate four people with learning disabilities and is situated on the first-floor level of the house. Each service user has their own bedroom with shared facilities of a kitchen/dining area, laundry, and bathroom with WC and lounge. There is a shared garden to the rear of the house. The property is situated close to Nuneaton town centre. Rail and public transport links are nearby. There is limited off-road parking. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 18th November 2005 between the hours of 8.15 a.m. and 11.00 a.m. During this time the inspector had the opportunity to meet with the residents, observe the interactions between the residents, staff and their environment, taught at home and examine documents relating to the residents and the management of the home. Residents were at home during the inspection and their views and those of the staff supporting them are included in this inspection report. A second visit was made on 28th November 2005 to meet with the manager and look at staffing records and discuss good practice issues. What the service does well: What has improved since the last inspection?
Risk assessment in the home is improving with strategies now implemented to ensure that people living and working in the home are safe, especially at night time. Care practice in administration of medicine in the home is slowly improving through the implementation of monitoring systems and refresher training. A recent decoration programme has taken place in the home. One service user expressed positive comments about the decorating of their room and said they liked their new carpet. Care plans are beginning to be reviewed to reflect changing needs. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 6 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. Pia - Manor Court Road, 132/4 DS0000004227.V264908.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 Pia - Manor Court Road, 132/4 DS0000004227.V264908.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): 1 Information about the services and facilities in this home is not current and requires reviewing so that perspective service users have up-to-date information they need when making a decision about coming to live in the home. EVIDENCE: The service user guide and complaints policy and procedure was examined and found to have out of date information regarding management of the home and contact with the Commission for Social Care Inspection. Reference is made in the service user guide to consultation that takes place through annual surveys and house meetings with service users. There was no documented evidence in the home of this taking place. Pia - Manor Court Road, 132/4 DS0000004227.V264908.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 and 9. The people living in this home are being involved in the day-to-day decisions of activity in the home. There is very little documented evidence however in the home of how the individual and collective choices of service users are being made. The management in the home is effective and enabling people to take risks as part of an independent lifestyle. EVIDENCE: Four care plans were seen on this occasion and each was in the process of being reviewed by the key worker. Preliminary notes are being made on care plan documents regarding any changes necessary. It is intended that a meeting will take place with service users prior to the review being completed to seek their views. The timescale for care plan reviews to be completed is extended. There is documented evidence of the home working closely with specialist services as part of meeting individual and specific needs; this includes psychologists, psychiatrists, learning disability nurses, occupational therapists and speech therapists.
Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 10 As part of monitoring systems to ensure plans are maintained up-to-date additional team leader support has been increased to enable this to be done effectively and more regularly. This is to commence 01/12/05. Good practice was observed during the visit of staff involving service users in all activities that were happening that day. There was a lack of a documented evidence however in the home of consultation on a more formal basis, both individually and collectively, with service users about life in the home and service development. Risks to service users have been identified and staff spoken with were aware of the need for these to be reviewed to ensure ongoing safety. This included a review of the recently introduced monitoring system to ensure night-time safety in the home. Pia - Manor Court Road, 132/4 DS0000004227.V264908.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): 16 Care practice in this home is promoting individual choices and respecting service users rights and responsibilities within their daily lives. EVIDENCE: Care plans seen during this visit clearly identify the preferences and individual likes and dislikes of the service user. Staff practice in the home confirmed their understanding of individual service user needs. Staff were talking and interacting with people living in the home in a manner that was respectful and appropriate to the individuals communication needs. Service users were seen to be able to be alone or join others in the home if they wished. Service users can have a key to their room if they wish and staff were seen to be respectful of service user’s privacy by knocking on bedroom doors before entering. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 12 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, and 20. Personal support in this home is offered in such a way as to promote and protect service user’s privacy, dignity and independence. The people living in this home are supported to access good quality health care with evidence of multi-disciplinary working taking place. The home has made some progress with regard to arrangements for administration of medication. Service users are less at risk however, there continues to be some discrepancies on medicine management records. EVIDENCE: The individual personal care and health care needs of service users is clearly identified on their care plan. Diary records evidence the support service users have in accessing health services for appointments. Staff spoken with had a good understanding of the personal choices regarding care needs of service users. Good care practice was observed of staff supporting moving and handling needs and during and after epileptic seizures. The health-care needs of service users are being monitored well with good records being maintained. This includes epilepsy seizure recording and completing behaviour monitoring records as requested by psychology services. There is significant evidence of multi-disciplinary working in planning treatment and care for specific health care needs. This includes specialist consultants,
Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 13 psychologists, learning disability nurses and family members. Documentary evidence is being maintained of decisions being made on behalf of service users when they are not able to regarding health care. There is documented evidence of service users being offered annual health checks, which includes attention to vision and hearing. A good practice recommendation was made regarding support being accessed from dietician services to compliment healthcare support being given to people with osteoporosis. Strategies had been put in place to raise standards in the administration of medication in the home; this has included monitoring systems for staff competency and refresher training where necessary. Good care practice was observed during this visit of medicine being administered to service users. The staff member administering medication had a good understanding of the importance of up-to-date records being maintained and of the medication needs of the service users. There were some discrepancies however on medication records of the quantities of medicine to be given as required, (PRN) being held in the home. Service user’s preferred way of taking their medicine is clearly identified and documented. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Staff’s knowledge and understanding of adult protection issues is good. Systems for recording possessions purchased made by service users could be more robust so that service users are at less risk of possible abuse. EVIDENCE: Staff spoken with demonstrated a good knowledge of adult protection issues. Protection of Vulnerable Adults, (POVA), training is available to all staff. There is significant evidence of care plan programmes to meet specific and individual needs being discussed and agreed with specialist services and this includes psychologists and psychiatrists. Incidents of self harm or harm to others and action taken are recorded, with copies forwarded to the Commission for Social Care Inspection, however in one instance when harm to others well being had taken place this was not discussed with the Vulnerable Adults Social Services Team for consideration of whether an investigation was necessary. In general records of service users personal monies are being maintained well however an inventory of individual purchases made by service users is not being maintained. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 Service users bedrooms offers sufficient privacy and enables them to pursue their chosen interests and activities. EVIDENCE: Service users spoken with were happy to show the inspector their bedrooms. They said they liked their bedroom and were pleased with recent decoration that had taken place and new carpets that had been fitted. Bedrooms reflect the individual needs and choices, interests and hobbies of service users. Aids or adaptations service users need to promote their independence and support mobility has been fitted where necessary and this includes overhead hoist systems. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 16 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): 33 and35 A staff team who are accessible and approachable, good listeners and communicators are supporting the people living in this home and competent to carry out the tasks required of them. EVIDENCE: There was sufficient staff on duty at the time of the inspection to meet service user’s assessed needs and chosen activities. Staff communicated with service users appropriately and at a level and pace to service user’s understanding. The people living in this home benefit from a mixed gender staff team and male and female workers were supporting people at the time of the visit. Staff spoken with confirmed that regular team meetings are taking place. Documented evidence shows that meetings are regular and address all issues of the service provision. If service users are at home they are able to attend team meetings. People in Action has an established training and development programme and a designated person with the responsibility for implementing this. Staff spoken with were complimentary about the level of training opportunity offered and that this is appropriate to the skills and knowledge they need to support the people living in this home. Recent training has included Dementia Awareness, Equality and Diversity, Learning Disability Award Framework and NVQ. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 17 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): 39 Quality assurance and monitoring systems in place based on seeking the views of service users are not being used effectively to measure success in achieving the aims, objectives and statement of purpose of the home. EVIDENCE: The statement of purpose for the home states that an annual survey of views of service users will occur and the outcome published and sent to Social Services and the Commission for Social Care Inspection. People in Action has developed a questionnaire entitled What I think about my home to be used with service users as part this annual survey. The document is in written and symbol format. Service users however have not been supported to complete the questionnaire to enable them to say whether the service is meeting their aims and objectives. Good practice recommendations were discussed regarding appropriate support to service users when completing questionnaire documents. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 18 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 2 X X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 2 X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Pia - Manor Court Road, 132/4 Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X X X DS0000004227.V264908.R01.S.doc Version 5.0 Page 19 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 YA1 Regulation 6 Requirement The statement of purpose, service user guide and contracts must be reviewed and updated to reflect the current situation in the home. All care plans must be reviewed with the service user at least every six months and updated to reflect changing needs, with agreed changes recorded and actioned. (Old timescale of 01/12/05 extended) Care plan review records must evidence the views of the service user, when able, and the next review meeting date. (Old timescale of 01/12/05 extended) A monitoring system must be developed to ensure care plans are being maintained up to date for staff to have sufficient and up-to-date information necessary to meet the changing needs of service users. (Old timescale of 01/09/05 not met) Timescale for action 30/01/06 2. YA6 15 30/01/06 3. YA6 15 30/01/06 4. YA6 24 30/01/06 Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 20 5. YA7 12 6. YA20 13 7. YA23 12 8. YA23 13 9. YA39 24 Consultation meetings, (house meetings), must be reestablished and held monthly with a record of the meeting maintained. (Old timescale of 30/08/05 not met) A documented record must be maintained of the balance of as required medication carried over onto the new Medicine Administration Record, (MAR) chart. A record must be maintained in the home for each service user of items purchased with their personal monies with an agreed value level of items to be recorded agreed. It is recommended that this be of a value of £20. All incidents where service users have been placed at harm from others must be reported to Social Services for their consideration as to whether the incident is to be investigated through the Vulnerable Adults policy and procedure. The registered manager must ensure that systems identified in the service user guide as being in place for consultation with service users are implemented and that the results of annuals surveys with service users are forwarded to the Commission for Social Care Inspection. 28/02/06 01/12/05 15/12/05 19/11/05 30/04/06 Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 21 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 YA19 YA20 YA39 Good Practice Recommendations It is recommended that the support of Dietician Services be sought as part of meeting the needs of people with osteoporosis. Pharmacy support should be sought from a pharmacist regarding the effect fruit juices may have on prescribed medicine. It is recommended that advocacy support is available to service users when completing questionnaires about the service provision. This could be accessed through their day services. Pia - Manor Court Road, 132/4 DS0000004227.V264908.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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