CARE HOME ADULTS 18-65
Pia - Old Hinckley Road, 45 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA Lead Inspector
Martin Brown Key Unannounced Inspection 11th April 2006 01:00 Pia - Old Hinckley Road, 45 DS0000004277.V289020.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 Pia - Old Hinckley Road, 45 DS0000004277.V289020.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. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Pia - Old Hinckley Road, 45 Address 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA 02476 382960 02476 640146 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 Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 2005 Brief Description of the Service: 45 Old Hinckley Road is a registered care home for six people with learning disabilities. The house is a converted detached building within walking distance of Nuneaton town centre. The majority of rooms and facilities are on the ground floor. There is a ground floor flat for one service user who has been assessed as benefiting from a degree of separateness from the rest of the home, although he is encouraged to interact with the rest of the home at appropriate times. One service user has a bedroom upstairs, which is also where the staff sleeping-in room is located. There is a large garden area at the rear and car parking area at the side of the building. The garden has been made secure for the benefit of the single resident who lives on the ground floor flat. People In Action provide 24 hour care and personal support to the young adults living in the home. The fees for individuals in the home currently range from £740 to £1654 per week. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on a midweek afternoon, and lasted for four hours. The inspector was made welcome by staff and service users, and saw and spoke with all the service users, as well as the manager and the staff on duty. All were welcoming, friendly, and helpful. What the service does well: 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. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 6 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 - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 7 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 The home ensures that needs and aspirations of prospective users are assessed and can be catered for. EVIDENCE: There is a Service User Guide in place, which has been done in line with the organisation’s service user-friendly approach, with symbols and line drawings. The manager recognises that the needs of the majority of the service users at Old Hinckley Road are such that photographs and staff assistance is needed for any guide to be of real value. A service user had just been admitted on an emergency basis; she was familiar with the home, which was one of the reasons for this choice. An initial assessment regarding its suitability had been done; this was to be followed up by a meeting of all significant parties to determine the immediate and more long term possibilities. Observation and discussion showed her to be initially settling in well and feeling secure. One person has also moved back to the home after a prolonged absence. Appropriate assessments and care plans are in place for this person, and staff were seen to be aware of specific needs and wishes and how to cater for them. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 8 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 The service is working to make existing individual plans and guides more accessible and relevant to the people in the home. Service users are encouraged to make choices and are supported to take risks as part of steps towards greater independence. EVIDENCE: Care plans are in the process of being revised; at present, information is spread over a number of different files, in varying formats and styles. The manager advised that she aims to make the information more concise, and more accessible to staff and where relevant to service users. Work that had already started on this was seen. Life history work is being done, and personal plans and guides making extensive use of individual photographs are being developed, that will serve as a record of activities, likes and dislikes, and as a general point of reference to staff and the person concerned. Service users were seen to make decisions, and to be offered choices. Where choice was denied in one instance, this was satisfactorily explained and known by all staff, in line with guidelines drawn up with the relevant professionals.
Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 9 Risk assessments are in place; the home was seen to be using these in effective strategies to develop outside activities. Photographic evidence was seen and discussed of service users being gradually introduced to the concept of travelling by train. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 10 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, 17 The people living at the home are increasingly supported in individual activities designed for their enjoyment and to increase their independence and living skills. They are responding to this positively, appearing more purposeful in their interactions. The focus is now, as it should always have been, far more on enabling, than restricting. EVIDENCE: The manager advised that holidays designed to meet individual needs are currently being arranged for people living in the home, varying from introductory days and weekends away, to holidays abroad. The manager and staff advised that ‘stepping stone’ activities were taking place for individuals, such as introductions to train travel. Photographs were seen of people at Old Hinckley road enjoying such activities. Two service users were out at day services provided by other agencies, one returned form a shopping trip, pleased with her purchases. As the weather was not good, plans to go out had been amended, and activities had taken place in the house, making ‘easter’ decorations.
Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 11 The manager advised that people living in the home were encouraged to help with food preparation. This was witnessed taking place with thoughtfulness and patience, as part of preparations of fresh vegetables for the evening meal. A good stock of food, appropriately stored, was in evidence, and menus, observations, and discussion with staff showed that a good healthy variety of food that takes account of individual preferences and dietary needs continues to be provided. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 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): 18,19,20 The home is working well to meet individual health and personal support needs. Medication is managed competently by the home for the people living there. EVIDENCE: Two people at the home currently have ‘one to one ‘ support, to help ensure that their needs and wishes are met. Where one person was restricted in how much should be drunk at any one time, the reasons for this were explained and recorded, and agreed as part of the care plan agreed with outside specialists. Health and support needs are detailed in individual plans; these are currently being revised to make them more accessible to all, and to ensure that there are versions of plans available to service users in formats that are relevant to them. Examples of this work in progress was seen. The administration and recording of medication was seen to be clear and accurate, with photographs of individuals and brief details of their medication included within the recording folder. The manager agreed that it would be beneficial to have details of the purpose of each medication, and significant side effects recorded there, to inform those administering medication.
Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 13 Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 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): 22,23 Staff attentiveness and the positive, listening ethos within the home helps ensure that service users’ views are listened to and acted upon, and that they are protected from abuse, neglect, and self-harm. EVIDENCE: The home has complaints procedures and whistleblowing procedures provided by People in Action. The manager is aware of the difficulties the majority of the people living at the home have in expressing complaints or concerns, and of the need for staff to be attentive to needs and anything that may indicate dissatisfaction or unhappiness. This attentiveness was noted in plans and records and in staff interactions with and knowledge of residents. Cross-gender care issues were discussed with the manager, who was able to show protocols and agreements, which, along with robust recruitment procedures, will help to keep the risk of abuse or abuse allegations to a minimum. Staff were observed to be taking time to listen and communicate with service users, using a variety of methods tailored to individual need. The manager was aware that communication aids need to be further developed in all areas. Work in the development of picture menus and communication books was seen to be ongoing. Throughout, positive attempts were witnessed of staff encouraging communication and expression. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 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): 24, 25,26, 30 The home has become much more homely and better adapted to meet the needs of the people living there. It is clean and hygienic. The conversion of the vacant downstairs bedroom to a communal area would give more communal space, as well as giving greater en-suite privacy for the user of the adjacent bedroom. EVIDENCE: The home is much brighter and airier. Alterations are enabling a much better use of space. The manager advised that new tables are being purchased for the dining room, now that greater space has been made available there. The flooring has been improved, the lounge area is much brighter and more homely. Bedrooms continue to be improved, in line with service users’ needs and wishes. The garden area is much improved, all rubbish has been removed; the grass has been cut or removed. Although some work is still to be done, the area is now accessible and can now be seen as an amenity rather than an eyesore. All observed areas were clean, tidy and hygienic on this visit, with all hygiene matters being dealt with appropriately. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 16 The downstairs area primarily used by one service user is now more open for other residents to use as an amenity, although it is still respected as an area for this one person to use when privacy and space is a pressing need for him. The sad death of one resident has left the front bedroom vacant. As the most recent placement is using the vacant upstairs room, there is the possibility that this room may become an additional communal room. This room also has a shared en-suite facility with another room. If it became a communal room, then the other bedroom would have its own en-suite facility, rather than having to share, as previously. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 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): 34 35 36 Staff are recruited appropriately and receive suitable training to equip them to provide care and support to the people living in the home. The lack of regular supervision may impinge on staff effectiveness if not addressed. EVIDENCE: A sample of staff files and recruitment records were looked at; these were satisfactory and contained appropriate Criminal Records Bureau checks. Training records were seen to cover mandatory training needs and further training in specialist areas has been taking place. Forthcoming training dates showed that training continues to be a high priority within the organisation and is now being accessed more frequently by staff at the home. Staff spoken to were enthusiastic about training opportunities. The manager is aware that staff supervision must take place at least bi-monthly, but that it has not yet been happening with that frequency. Records that were seen of supervision were positive in their emphasis. Formats were seen for forthcoming staff appraisals. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 18 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 service is benefiting, after a prolonged period of uncertainty, from having the stability of a permanent manager in place. The needs and wishes of service users, as they are understood by staff and management, inform the development of the service. The service continues to promote the health, safety and welfare of all living in the home. EVIDENCE: The home has had a manager in place since December, and staff were appreciative of the stability provided by having a permanent, rather than an acting, manager in place. Unfortunately, and through no fault of the manager, her registration with the Commission for Social Care Inspection has not been completed and therefore remains a requirement. This is now in the process of being completed. Monthly monitoring visits by the responsible individual take place, and there are informal contacts with the relatives of service users. The manager was able to show me a development plan for the home that related to issues identified
Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 19 as needing to improve or to be achieved, giving target dates for this. The service is still reliant on staff and management interpretation of service users views and wishes to inform future developments, but actions such as the planning of individualised holidays show that the service is genuinely trying to promote and meet the views of people living in the home. Documentation seen showed that health and safety issues are managed appropriately. Hazardous substances are stored safely and documented, staff were aware of fire safety issues. No hazardous practices or items were noted, and staffing numbers and conduct indicated the safety and well-being of the people living at the home as a prime concern. Pia - Old Hinckley Road, 45 DS0000004277.V289020.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 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA36 YA37 Regulation 18(2) 10 Timescale for action Staff supervision must take place 25/06/06 at least six times a year. The registration of the manager 25/06/06 must be completed. Requirement 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 YA24 YA20 YA6 Good Practice Recommendations It is recommended that the vacant downstairs bedroom be considered for use as additional communal space. It is recommended that staff awareness of the purpose and contra-indications of medications is better supported by accessible information on this. It is recommended that work on making service user plans and guides, including communication aids, more accessible continues, and involves staff and service users as much as possible. Pia - Old Hinckley Road, 45 DS0000004277.V289020.R01.S.doc Version 5.1 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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