Inspection on 14/04/05 for Pia - 45 Old Hinckley Road

This inspection was carried out on 14th April 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 but made no statutory requirements on the home.

Other inspections for this house

Pia - 45 Old Hinckley Road 16/05/07

Pia - 45 Old Hinckley Road 11/04/06

Pia - 45 Old Hinckley Road 20/09/05

Pia - 45 Old Hinckley Road 19/08/04

Pia - 45 Old Hinckley Road 21/04/04

Pia - 45 Old Hinckley Road 02/02/04

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Polesworth Group 70 Long Street

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 PIA - 45 Old Hinckley Road 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA Lead Inspector Martin Brown Unannounced 14 April 2005 13:00 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 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 Stationary 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 - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service PIA - 45 Old Hinckley Road Address 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA 02476 382960 02476 640146 Telephone number Fax number Email 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 Miss Kay Louise Ward PC 6 Category(ies) of LD 6 registration, with number of places PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 19 August 2004 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 benefitting from a degree of seperateness 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. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 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 standard(s) 1,2 Information about the home focuses more on the organisation than the actual home, and does not help service users make an informed decision about this home. The home failed to fully verify information about a new admission in one instance, leading to important information being inaccurate. EVIDENCE: The home has information available and assessment processes for new admissions. There have been three new admissions to the home since the last inspection. Assessments were seen to have been made, as well as introductory visits. However, in one instance, too much reliance had been placed on information provided, without it being fully checked out, with the resultant discovery that one person had a great deal more difficulty managing stairs than had been realised. The manager advised that lessons have been learnt from this and that all such received information will in future be checked out by the home as a priority. The service user guide did not wholly reflect the current situation of the home, the manager advised that this is to be reviewed. Statements such as ‘access to a garden’ is not reflected by current state of the garden, which is overgrown. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 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 standard(s) 6,7,9 Service users have individual care plans, which fully document, in the case of service users who have been there more than a few months, assessed needs. Plans are regularly reviewed to reflect changing needs. The needs of more recent arrivals are not so fully documented. Service users are not fully consulted on all choices within the home. EVIDENCE: Detailed individual plans of care were seen, that included person-centred, user-friendly plans clearly expressing likes, dislikes, interests, and risks and how they are managed. Individual risk assessments were in place; the manager advised that they are being revised. There were also plans giving further details of medical conditions and their implications for care. Service users also had life history files, consisting mostly of photographs of activities such as holidays. Daily files are also kept, recording information relevant to specific needs, such as dietary or medical. Daily individual care plans are still to be completed for more recent arrivals. The manager advised that these are being completed; they will be looked at on the next inspection. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 9 On the day of the inspection, five of the six residents were at home, spending much of the time sitting in the lounge. The television was on, and programmes changed and videos put on without any real consultation with service users, as staff were making assumptions about what residents may or may not wish to watch. Staff stated that these assumptions, based on experience, were correct. In contrast, staff were seen to take time and effort to ensure that service users were able to choose drinks that they wished to have. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 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 standard(s) 12,13,14,15,16,17 On the day of the inspection, few service users were able to take part in meaningful activities because there were not enough staff on duty to support them. Some service users have activities within the wider community. Service users are offered a healthy diet that takes account of preferences and dietary needs. EVIDENCE: One service user was at a day service; the other five were all at home and spent much of the day in the lounge, owing to there not being enough staff on duty that day for them to take part in more meaningful activities. One service user had a hospital appointment, followed by shopping, later in the day. Staff stated that because of support needs, and sudden staff sickness, service users were unable to go out earlier in the day. Activities records, and staff rotas, indicated that this was an unusual occurrence. Two service users have regular day service provided by outside agencies; the manager advised that structured day activity is being sought for the more recent arrivals. Staff were able to discuss service users’ preferred activities, and how they were catered for, as recorded in care plans. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 11 The manager advised that the home encouraged family contact, but that this is limited, in most instances, owing to factors beyond the home’s control or influence. Individual care records and photographs demonstrated family contacts. A healthy supply of food was noted; dietary considerations were taken unto account. Issues of food storage are discussed elsewhere in this report. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 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 standard(s) 18,19,20 Health care and personal care support is provided by appropriately trained staff, and changes in needs particularly related to health, are responded to rapidly. Good, clear guidance assisted the appropriate administration of medication. EVIDENCE: Observation of staff/service user interaction, discussion with staff, and examination of individuals’ files demonstrated that personal and healthcare support is appropriate. There is regular and prompt support from local and specialist professionals; this was observed on the day, enabling health problems to be dealt with effectively. A GP visit did not take place in private, but as this was a brief observation visit that did not involve any examination, or issues of confidentiality, this was seen as acceptable on this occasion. The manager and staff stated they were aware of the need for privacy and dignity where any examination or confidentiality is involved. The procedures for the storage, handling and administration of medication were seen to be satisfactory, with good, clear guidelines and information on medication. Blister packs are used for the majority of medication, other than for the most recently arrived service users, where medication is still liable to change. There are no controlled drugs now being administered. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 13 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 standard(s) 22,23 Service users appeared content on the day of the inspection; in spite of spending much of the day doing very little. It was unclear whether this indicated a genuine contentment or low expectations. The home is to look at ways in which service users feelings about their life can be further ascertained. Being better able to articulate complaints should be seen as part of this process. EVIDENCE: The complaint book was seen. There were no complaints. The manager acknowledged the difficulties of assisting service users in making or articulating complaints, and continues to seek advocacy support for service users. Finances were checked during the visit by the service manager, who was undertaking the monthly Regulation 26 visit. She advised that they were satisfactory, apart from one shortcoming with regards to the booking out of monies, which was highlighted and is to be addressed and rectified. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 14 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 standard(s) 24-28,30 The home does not initially present as welcoming, and areas of the home are in poor decorative order with some areas not being homely. The procedure for the disposal of clinical waste is not wholly satisfactory. EVIDENCE: The fireplace had been removed in the lounge to make more space. There is now wooden flooring. The consequent effect has been to make the lounge appear bare, and institutional. The focal point of the room, other than the television, is now an imposing and rather unattractive radiator. Staff and management agreed that sensitive redecoration is urgently required. Bedrooms are of a good size; the manager advised that they are due for redecoration; most would benefit from this to varying degrees. Rooms have been personalised, again to varying degrees; there is less evidence of this in rooms more recently occupied. Toilet and bathing arrangements involve one walk-in shower and toilet shared by two service users, one toilet/bathroom upstairs, effectively for the use of the service users there, one toilet/bathroom in the downstairs flat for the service user there, leaving two service users to share access to the ‘communal’ downstairs bathroom/toilet. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 15 This leaves the issue of access to this one toilet if the bath is occupied. It is recommended that another toilet is provided to alleviate this problem; in the meantime, a procedure must be produced to show how this is effectively managed at present. The lounge kitchen/area is a shared, open plan space. Potatoes and other vegetables were stored in an area that was obviously the dining area; that is, by the dining table, near the radiator. The garden area was overgrown and the outside area contains clutter and rubbish, such as a bed head board, broken chair, and cotsides. On a positive note, the area by the side of the home was tidy, with herbs being grown by staff. The outside toilet was full of bagged rubbish; some of it clinical waste, in a bin in the toilet, awaiting removal to the clinical waste bin. The bin did not have a lid on it; the lid was replaced by staff when this was pointed out. This toilet is either to be used as a toilet, or as a storage area; not as both/either. The manager advised that the toilet is to be removed. The procedure for managing clinical waste must be clearly stated and adhered to by all staff. The laundry has been refurbished, and is now able to meet the requirements of service users in safe and hygienic way. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,36 During this inspection it was immediately apparent that having only three staff on duty resulted in very little meaningful activity being able to take place for service users, and that therefore, four staff should always be regarded as the acceptable minimum in order for service users’ quality of life not to suffer. EVIDENCE: On the morning of the inspection, there were only three staff on duty, owing to sickness. Discussion with the staff and manager, and examination of the rota, indicated that this was a rare occurrence. Having only three staff meant that, whilst service users’ immediate needs could be met, no activities, either individual or outside the home, could satisfactorily take place. There is always one waking night staff, and one sleeping-in staff; the manager advised that this is normally one of each gender, to ensure that any personal care able to be provided appropriately. A cross gender policy must be in place to ensure that this always takes place. Staff files were available in the home to be examined; the sample looked at demonstrated sound recruitment procedures, with satisfactory Criminal Records Bureau checks seen for the most recent recruits. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 17 Files include photocopies of relevant documents; the manager agreed to sign to evidence that the originals have been seen, as well to confirm when satisfactory Criminal Records Bureau checks have been seen. Staff supervision records were seen; annual appraisals are still to be done; Dawn Clarke, service manager, advised that training for managers to implement this is about to be undertaken. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 The home has addressed previous health and safety requirements, but needs to continue to be vigilant to ensure that service user health and safety is not compromised by easily avoided shortcomings. The home has not yet devised ways of effectively soliciting service users’ views. EVIDENCE: There was little evidence at present of a system for soliciting service users’ views. A blank Quality Assurance form, “What I think about my home” was seen. This is being implemented in some People in Action homes. The manager advised that the high nature of service users’ needs, as well as the difficulty of accessing advocacy support, is making appropriate Quality Assurance difficult, and that the home is still exploring the most effective way to evidence that service users’ views are taken into account. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 19 Outstanding health and safety issues had been addressed. However, the disposal of clinical waste is not dealt with appropriately at all times, as detailed in standard 30, Infection Control. The home must ensure that frozen food is stored safely. One freezer had a lid that was missing a hinge. This is to be disposed of. The manager advised that this would be done by the end of the week. The door of another freezer was incompletely closed, resulting in food inside having to be thrown away. The manager is to ensure that staff are fully aware of the importance of properly storing frozen food and properly closing freezer doors. An annual development plan for the home was seen, covering the year up to August 2005, including objectives to have the garden fully accessible and to ensure every service user has an appropriate holiday. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 24 25 26 Score 2 2 3 Version 1.20 Page 20 PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 2 3 x Score 27 28 29 30 STAFFING 3 2 x 2 Standard No 11 12 13 14 15 16 17 2 2 2 2 3 3 2 Standard No 31 32 33 34 35 36 Score 2 x x 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 21 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 1 2 Regulation 5 2 Requirement The home must ensure that the Service User Guide is accurate and up-to-date. Information concerning the assessed needs of prospective service users must be verified by the homes own assessment. The home must ensure that sufficient activities are available to meet service users needs, and that sufficient staff, or outside agencies, are available to meet these needs. An action plan for the redecoration of the lounge is required. A rolling programme for the redecoration of bedrooms must be in place The garden requires attention to make it accessible. The use of the outside toilet must be clarified, as must the procedure for the disposal of clinical waste. A cross gender policy for night staffing must be available. The manager is confirm in staff files that originals of relevant documents have been seen. Annual appraisals of staff are to Timescale for action 25/6/05 25/5/05 3. 11 12 25/5/05 4. 5. 6. 7. 24 25 28 30 23 23 23 16 25/5/05 25/5/05 25/5/05 25/5/05 8. 9. 10. 31 34 36 12(4) 19 18 25/5/05 25/5/05 25/5/05 Page 22 PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 take place. 11. 39,7,8 24 Service usersviews and those of 25/5/05 significant others must be sought and taken into account.(A previous requirement to develop and use a questionaire for feedback has not yet been met). The home must demonstrate 25/5/05 that staff are ensuring that service users are fully consulted in choices in their day-to-day lives. The home must demonstrate 25/5/05 that it is ensuring that the storage of frozen food is safe. 12. 8 12 13. 42,17 12 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 27 17 Good Practice Recommendations The home should consider additional indoor toilet facilities. Vegetables should be stored in a more appropriate place. PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 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 © 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 PIA - 45 Old Hinckley Road E53 s4277 PIA Old Hinckley Road v221036 140405 Stage 4.doc Version 1.20 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!