Inspection on 13/10/05 for Pia - 136 abc Manor Court Road

This inspection was carried out on 13th 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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pia - 136 abc Manor Court Road 21/06/06

Pia - 136 abc Manor Court Road 12/05/05

Pia - 136 abc Manor Court Road 08/09/04

Pia - 136 abc Manor Court Road 14/04/04

Pia - 136 abc Manor Court Road 02/03/04

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

CARE HOME ADULTS 18-65 Pia - Manor Court Road, 136 abc 136a Manor Court Road Nuneaton Warwickshire CV11 5HQ Lead Inspector Sheila Briddick Unannounced Inspection 13th October 2005 09:30 Pia - Manor Court Road, 136 abc DS0000004474.V258333.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, 136 abc DS0000004474.V258333.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, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Pia - Manor Court Road, 136 abc Address 136a Manor Court Road Nuneaton Warwickshire CV11 5HQ 02476 643776 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 Mrs Julie Ann Morrissey Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: 136 Manor Court Road is a registered care home for four people with learning disabilities. People in Action provides 24 hours care and support for the people living in the home. The home is situated on one of the main routes into the town of Nuneaton, which is easily accessed by the people living in the home. The ground floor accommodation consists of a kitchen and lounge, two service user bedrooms, each having an ensuite facility. On the first floor of the property there are two service user bedrooms, a lounge, bathroom with toilet and an office/sleeping room for staff. There is a large garden at the rear of the property, which provides lawned and patio areas. There is parking space for one car in the driveway to the house. Pia - Manor Court Road, 136 abc DS0000004474.V258333.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 13 October 2005, and was the second inspection of the home for this inspection year. A tour of the building took place and service user and management of the home records were examined. The people living in the home and staff supporting them were involved in the inspection process and their views are included in this report. Since the last inspection a an additional visit was made to the home as part of monitoring requirements made following a Regulation 37 Notification to the Commission for Social Care Inspection which evidenced poor management of medicine administration. The registered manager has reviewed the management of medication in the home as a result of this visit and reference to this is included in this report. What the service does well: What has improved since the last inspection? Care plan reviews are now being reviewed more regularly with changes and actions necessary being documented on the review notes. Medication management has been reviewed as a result of requirements made on a recent additional visit to the home. Competency of staff in medication administration is slowly improving through monitoring their skills, retraining and individual supervision. Support service users require at nighttime has been reviewed and a waking night staff cover is now in place. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 6 A positive outcome from this change is that the lounge is now no longer used for staff on sleep in duty means service users have access to the lounge at all times. Training opportunities for staff have been increased with a wide variety of courses, including equal opportunity and diversity, challenging behaviour and dementia care now being readily available. Continuing investment in this environment is supporting the homes philosophy of providing a warm and welcoming place in which people can live and work 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, 136 abc DS0000004474.V258333.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, 136 abc DS0000004474.V258333.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): Standards 2 and 4 People coming to live in this home have an opportunity to visit the home, and people living there, to enable them to make an informed choice about living in the home and for the staff working in the home to be sure they will be able to meet the person’s assessed needs. EVIDENCE: A new service user’s care plan was examined and this showed the referral to live in the home had been made through the care management process including assessment. There was documented evidence of consultation with the service user and a family member about coming to live in the home, and this included the service users involvement in the care management assessment. Whilst the family member was happy for the service user to move from the previous environment to this home records shows that the service user was unsure about this move. Staff spoken with said that the new service user had made several visits prior to living there permanently. The three-month settling in period for the service user has yet to be completed and although the service user appeared happy and relaxed in their new setting they will be able to give their views more formally at the review of their placement. The people living in the home said they were happy that another person had come to live with them and staff said that people were living together well. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 9 There was an inventory of the service users belongings on their care plan but this had not been reviewed following their move to be sure that all their possessions were with them. The care plan was very informative and detailed however review notes and changes of address had been handwritten onto the care plan. The inspector was informed that eventually this would be more formally implemented of the care plan format. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 10 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): Standards 6 and 9 There is a clear care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The care plan reviewing process is not documenting the views of the service user or the reason for any change of action on the care plan, which is necessary to show that the service is meeting individual needs, choices and goals. EVIDENCE: There is evidence on care plans that close working relationships have been developed with health professionals, including psychologists, neurologists and community learning disability nurses when agreeing and amending care plan programs as needs change. Staff spoken word, who were key workers for service users, said they were in the process of completing six monthly reviews with service users. Care plan programs show amendments following reviews however there was no evidence of the involvement of service users in care plan reviewing or documentation of their views regarding their own personal aims and objectives. Significant progress has been made in ensuring that written protocols and guidelines to meet specialist requirements have been agreed with specialist Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 11 services, including psychologists, speech and language therapists, occupational therapists and physiotherapists and these are included on the care plan. Risks to service users have been identified and strategies put in place to minimise any identified risk. Risk assessments are being completed for new equipment that has been provided to meet specific needs. Action taken to minimise risk includes training for staff in the safe use of the equipment. Staff are signing to confirm their understanding of the risk assessment and use of the equipment. Staff spoken with was familiar with the competency and ability of the new service user coming to live in the home however possible risks for the service user in the environment had not been recorded on their care plan. During this visit the staff at duty were observed to have a full understanding of the individual and specific needs of the people they were supporting. They were meeting the individual needs of people sensitively and appropriately, promoting independence where possible and offering choice. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 12 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): These standards were not looked out on this occasion. EVIDENCE: Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 20 The health needs of service users are well met with evidence of good multidisciplinary working taking place on a regular basis. The system for the administration of medication is slowly improving with documented evidence of the action being taken to ensure that medicine is being given to service users safely. EVIDENCE: Individual healthcare support in this home is dealt with sensitively and being reviewed and maintained through consultation and support of specialist health care services. This includes psychology services, neurology, community learning disability nurses, occupational therapists, physiotherapists and chiropody services. Documented evidence on care plans shows that reviews are taking place promptly as need to change, appointments with specialists are being kept and that equipment necessary to support and maintain mobility is being used safely. Community Learning Disability Nurses completed health action planning with service users in 2004, reviewing the identified needs in health action plans is now overdue. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 14 Service users talked to the inspector about their mobility needs and their satisfaction with equipment that was supporting this. This included a new bed, walking frame, chair and hoist. Staff were observed to be using the equipment with service users sensitively and safely. Staff reacted promptly and appropriately to service users concerns regarding feeling unwell, informing the service user of the action that was necessary to help them feel better. Staff were observed giving medication to service users and when doing so demonstrated an understanding of the procedures in place for medicine to be given safely. This included checking medicine against the Medication Administration Record (MAR) chart record for dosage and direction for administration, and the recording procedure for medication to be given as required (PRN). Staff demonstrated some understanding of the clinical needs of service users but the understanding was weak around reasons why specific medicine had been prescribed and the effect this has on the service user’s medical condition. Written protocols are in place for medication to be given PRN although instruction for the PRN administration for the application of a skin cream was on a yellow post it note attached to the service users Marr Chart. Robust procedures are now in place for ensuring that medication held in the home is stored and administered safely. This includes monitoring of staff competency, shift leaders checking medication stock at handover of shift, senior managers monitoring all medication records on a regular basis, documenting shortfalls and action to be taken to minimise risk, which includes retraining of staff. There is documented evidence that risks to service users are now minimising. Staff spoken word said ‘I triple check medicine before I give this’, ‘I am in the middle of long-distance training in the administration of medicine, the course is really good’, and ‘we discuss medication at team meetings and have worked hard to get things right’. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 23 There are policies and procedures in place to ensure that service users are protected from harm and visit providing a safe environment to protect service users from abuse. EVIDENCE: Throughout the inspection visit service users appeared happy and relaxed with the people working with them. Staff spoken with were familiar with the policies in place for the protection of people from harm, and this included completing training in challenging behaviour and the Protection of Vulnerable Adults (POVA). Records in relation to accidents and incidents in the home were examined and it was seen that where appropriate the Commission for Social Care Inspection had been informed and appropriate action, including risk assessment review, had taken place. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 29 The people in this home are being supported with moving and handling equipment to promote their independence by a staff team that has been assessed as competent to do so safely. EVIDENCE: There is documented evidence of the home working closely with occupational therapy and physiotherapy services in the provision of specialist equipment which includes, standing frames, hoists for lifting and moving, appropriate bathroom fittings and specialist electronically operated beds. Service users were familiar with all the equipment that was available to support their moving needs and talked to the inspector about this. It was obvious from the comments made that they were pleased and satisfied with the new equipment provided to them. Staff working with service users were observed to use the equipment sensitively, safely and appropriately. Maintenance records show that arrangements are in place for the maintenance of all moving and handling equipment. Call alarm systems are in place that are suitable for the needs and ability of the people using them. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 35 The training and development programme in place in this service is ensuring that people are being supported by a staff team who are competent to carry out the tasks required of them. EVIDENCE: There is a training and development plan for the home that is linked to the home’s service aims and service user’s individual needs. Staff spoken with had accessed training in epilepsy, foot care, autism, communication, (which included Makaton), Protection of Vulnerable Adults, Dementia Care Awareness, Learning Disability Award Framework and NVQ Level 2. They confirmed they discussed their training needs during supervision with the registered manager. People in Action have nominated a responsible person for the training and development programme and staff spoken with at this inspection spoke highly of this persons competency and dedication to seeking out appropriate training courses to meet individual and specific needs within the service. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 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): Standard 42 EVIDENCE: People in Action have established policies and procedures to ensure that the people living in this home are protected from harm through safe working practice, and compliance with relevant legislation. Staff spoken with confirmed that they had undergone training in moving and handling, fire safety, first aid, food hygiene and infection control. Examination of records held in the home showed that risk assessments have been completed for the safe storage of hazardous substances, the control of legionella and hot water surfaces, use of equipment and general access in and around of the home. Review dates for the risk assessments were outstanding. Testing of fire safety equipment is carried out via an external agency and there is a nominated member of staff for ensuring weekly tests of fire alarms and emergency lighting are completed. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 19 The nominated member of staff has recently left the home and no other person has been identified to take on this responsibility therefore weekly monitoring of tests of alarms, emergency lighting, and hot water temperatures had not taken place since the 9th September 2005. The accident record for the home was examined and it was found that a report of all accidents or injuries is forwarded to the Commission for Social Care Inspection. The stairs carpet is showing signs of wear and tear, which does not promote effective cleaning and also has the potential to cause a fall on the stairs through tripping on exposed/worn threads. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pia - Manor Court Road, 136 abc Score X 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 x DS0000004474.V258333.R01.S.doc Version 5.0 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. Standard YA2 Regulation 14 Requirement A documented review must take place with service users after a ‘settling in’ period of three months to review whether the placement is meeting needs. An audit of personal belongings brought into the home by new service users must take place, be documented on the care plan including action taken to replace/find any missing articles if necessary. Service users must take part in the review of their care plan programmes and their involvement views, when possible, on decisions being made documented. Risks to service users coming to live in the home must be identified with them, including being left alone in the home, and action taken to minimise any risk must be documented on the care plan. All when required medication must have written protocol to support their use and filed on the care plan. Timescale for action 13/01/06 2. YA2 12 14/10/05 3. YA6 15 30/12/05 4. YA9 13 14/10/05 5. YA20 13 14/10/05 Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 22 6. YA19 15 7. YA42 23 8. YA42 23 Health Action Plans must be reviewed annually and outcomes of actions taken to meet needs documented. Fire alarms and emergency lighting in the home must be tested weekly and a record of the test documented. Risk assessments for the home environment, service user and staff activities and COSHH procedures must be reviewed annually and outcomes documented. 14/12/05 14/10/05 14/12/05 Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. Refer to Standard YA6 YA20 YA42 Good Practice Recommendations It is recommended that changes to care plans be amended into the care plan format. It is recommended that staff have opportunity to develop an understanding of the function of medicine being prescribed for specific needs. It is recommended that the stair carpet be replaced with new to promote effective cleaning and safe access. Pia - Manor Court Road, 136 abc DS0000004474.V258333.R01.S.doc Version 5.0 Page 24 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 © 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 - Manor Court Road, 136 abc DS0000004474.V258333.R01.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. 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. 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