CARE HOME ADULTS 18-65
Pia - 46 Princes Street, 46 Princes Street Nuneaton Warwickshire CV11 5NW Lead Inspector
Sheila Briddick Unannounced 08 July 2005 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 - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Pia - Princes Street, 46 Address 46 Princes Street Nuneaton Warwickshire CV11 5NW 02476 353581 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 Ms Angela Rynn PC Care home only 7 Category(ies) of LD learning disability (7) registration, with number of places Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 12 January 2005 Brief Description of the Service: 46 Princes Street is a registered care home for seven adults with learning disabilities. People in Action provides 24 hour care and support for the people living in the home. The home is located in the centre of the town of Nuneaton, North Warwickshire, and as such is close to all local services and facilities the town has to offer. It is a two-storey building with gardens to the front and rear of the property. There are 8 single bedrooms, one having a shower en-suite facility. One of the bedrooms is used as the sleeping/office for staff. Two of the bedrooms are located on the ground floor. The ground floor bathroom/toilet has a walk-in shower facility and bath, which has an electrically operated bath seat. There is another shower facility and separate toilet and bathroom/toilet located on the first floor. The shared facilities in the home consist of a large lounge, kitchen with dining area and well maintained garden to the rear of the property. The garden provides separate areas of privacy, has a greenhouse and a vegetable patch. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over two visits, totalling four hours and was unannounced. All people living in the home were met and spoken with during the inspection and their views are included in this report. Staff on duty at the time of the visits and the registered manager were also met and their views included in this report. A tour of the premises took place and care and home records were examined. What the service does well: What has improved since the last inspection?
Development is taking place in the care planning review system to ensure that service users views are included on the care plan review record and that reviews take place on a regular basis. As part of the review process care management assessments have taken place for placements funded by the local authority. The staffing levels in this home are now more consistent and this has enabled the staff team to work together to be more proactive and less reactive to service user needs. Decisions being made by service users are now being recorded on their care plan and personal diaries are being used to record social activities only. Contact has been made with local advocacy services for service users to access if they wish. Staff are accessing training in the Protection of Vulnerable Adults (POVA), as part of the Learning Disability
Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 6 Award Framework (LDAF). The record of food provision in the home is now more comprehensive and informative evidencing that a well-balanced and healthy diet is provided. Mobility equipment has recently been installed in the home for maintaining independence and moving people safely. 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 - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 standard(s) 2 Perspective service users can be sure that their individual needs and aspirations will be identified by people competent to do so as part of the process of coming to live in the home. EVIDENCE: Three care plans were seen at this inspection visit, one of which was for a service user recently admitted to the home. A care management assessment was maintained on the care plan file and this has been completed prior to the person coming to live in the home. The home had carried out its own needs assessment with the involvement of the service user, during the trial period of living in the home. The assessment was to a high standard and very comprehensive covering all areas of the living environment, health and social care needs of the person. Risks to the service user in their previous living environment had been reviewed against those of the new environment. The service user was being supported to maintain previous activities enjoyed in the community and this included a horse riding. All information necessary for health care needs and previous healthcare history had been obtained. Referrals had been made to appropriate specialists following assessment of identified needs and this included referral to speech and language therapy services. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 standard(s) 6, 7 and 9 The people living in this home are having opportunity to review their care plan. The care plan review process could be more robust to reflect the ongoing development of individuals that is taking place. People are being supported to make decisions about their lives, including risks, as part of an independent lifestyle. EVIDENCE: Care Management Reviews are taking place annually. The assessed needs of service users living in the home and not supported through the care management process are not having their assessed needs reviewed on an annual basis using the homes own management tool. Healthcare needs are assessed however through Primary Care Services. Care plan reviews are taking place with service users and two care plan reviews were examined at this visit. The review process is itself being reviewed by the registered manager and some improvement has taken place in the content of the review program. This included making a record of the care plan programme reviewed and action necessary as part of that review. The views of the service user, and a record to identify the need for a change or not is not being made. Without this the home cannot show ongoing development of individual service users in meeting their personal goals or that the service is addressing changing needs
Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 10 appropriately. A senior worker has been identified to lead the care plan review program. A record is being made on care plan programmes of decisions individual service users are making regarding specific needs and this has included decision-making in healthcare and financial management. At the time of the visit staff were observed a support service users to make decisions about everyday activities and this included, choices about food and daily activities. Comprehensive risk assessments are in place and these focus on positive outcomes for service users. Strategies in place to minimise risk are reviewed regularly however, involvement of the service user during the risk management review was not evident on the care plans seen. The support of specialist services to meet specific needs had been sought, and this included psychology services, speech and language and occupational therapy services. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 standard(s) 12 and 13 People living in this home have opportunity to live ordinary and meaningful lives appropriate to their needs and wishes. People are supported and enabled to be part of the local community in which they live and lifestyle in the home promotes and respects service user’s rights and responsibilities. EVIDENCE: A number of activities were taking place at the time of this visit, which included access to individual day services, work experience and activities in the community. Service users have been encouraged to access college activities appropriate to their needs and this included numeracy, literacy and art. A service user showed the inspector the vegetable garden and talked about the support they had in growing vegetables, which were then enjoyed by everyone. A service user talked about swimming and horse riding activities they enjoy regularly. Speaking with service users, staff and reading of diaries show that a wide variety of activities is being accessed which includes shopping locally, visits to the pub, eating out, trips to the local parks, leisure complexes and the zoo. The home has its own transport but also accesses local taxi services and public transport.
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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 and 20 The people living in this home are having their personal support needs and health care needs met in a manner that promotes and supports their independence, privacy and dignity. The home is eager to improve their current system for medicine management to ensure the health and well being of service users. EVIDENCE: Care plans seen show that the personal support needs of individuals and how they are to be moved, supported and transferred have been identified. This includes the preferred needs for getting up and going to bed, bathing, personal hygiene and appearance. Mobility equipment people need to promote their independence and safety has been installed and this includes bath rails and more recently provision of an overhead hoist in one-bedroom. There is significant evidence that the specialist services of physiotherapists, occupational therapists and speech therapists is being sought to meet specialist needs. Decisions being made by service users regarding their health care and hospital treatment have been recorded on their care plan, this has included the advice that was given to the service user to enable an informed decision to be made. A process for reviewing this decision with the service user to meet changing needs has not been identified, which should include the changing risks to their health and well-being and resources that staff may need to access for supporting the service user with future decision-making making.
Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 13 Examination of medication records demonstrated that medicines were being administered as prescribed. However, balances of medicines from previous cycles had not been carried over on to the current Medicine Administrations Record, (MAR) chart. When required, (PRN), medication did not always have sufficient written protocols for staff to refer for their administration, including indications for use on timescales before further advice should be sought from GPs. PRN medicine prescribed by psychology services however was informative with specific and clear guidance for staff to follow. Quantities of Lorazepam being administered were not recorded on the MAR chart but on a separate record sheet. The current prescription for each service user is held in the home although this is not alongside the current MAR chart. Staff spoken with were knowledgeable and informative about the medication needs of people living in the home and had accessed training in the administration of medicines. Staff competency in the administration of medicine is not routinely being audited. Service users consent to medication is obtained when possible and recorded on their care plan. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 standard(s) 23 Staffs knowledge and understanding of adult protection issues provides a safe environment to protect service users from abuse. EVIDENCE: All staff working in the home are working towards achieving the Learning Disability Award Framework, LDAF. Staff spoken with have accessed this training and confirmed that the protection of vulnerable adults from abuse is included in the award framework training. There is evidence in the home on care plan files and healthcare records to show that staff work closely with specialist services, including psychology and mental health services, in meeting the specific needs of service users. This includes provision of written guidelines/protocols for staff to follow when supporting service users with specific needs. Specialist services are also supporting meeting the training needs of staff in developing skills to meet specific service user needs. Service users are supported to understand their own specific needs, which includes accessing drop-in sessions for managing stress. Service users understood that their money was ‘looked after in the house’ and they took their own money when shopping. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 standard(s) The standard of the environment within this home is good providing service users with an attractive and homely place to live. EVIDENCE: Shared areas of the home and individual bedrooms reflect the particular lifestyle and needs of the people who are living there. The home is accessible to all relevant community facilities and services and is homely, clean, safe and comfortable. The people living in the home were observed to be able to freely access all shared areas and appeared comfortable in their environment. Recent investment has enabled the purchase of new carpeting for corridors, hallways and staircases. Service users are able to choose to move bedrooms when a vacancy occurs. New service users coming to live in the home are able to bring their own furniture with them and choose a new décor for their bedroom. Staff spoken with said that facilities in the home were sufficient and this included having enough room in bathrooms to meet service user needs safely and provision of laundry equipment. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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) 33, 34 and 35 The home has an effective staff team who listen to service users, understand their needs and have opportunity to develop and maintain skills necessary to meet changing needs. EVIDENCE: Staff duty at the time of the visit were observed to be accessible and approachable to service users, good listeners and communicators. Staff spoken with felt that they had the competencies to carry out the tasks required of them and were able to access training appropriate to service needs. This included training in challenging behaviour, administration of medication, communication and moving and handling. Staff spoken with confirmed that they discuss their training needs as part of supervision with the registered manager. Staff are waiting for training in the new overhead hoisting equipment that has recently been acquired for a service user. New staff spoken with had completed induction training that included safe practice and positive communication. A joint training course has been planned with day service and psychology services around the specific needs of a service user. Staff spoken with had either achieved an NVQ 2 Award in Care or working towards achieving the Award. Team meetings are held on a regular basis and minutes maintained. All areas of the service provision and service user needs are discussed at team meetings. There was sufficient staff on duty at the time of this to meet individual needs of service users and this included individual shopping activities and meeting
Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 17 personal care needs. The staffing rota shows that staffing is consistently flexible to meet needs, which includes evenings and weekends. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 The quality assurance and quality monitoring systems in place are not robust enough to demonstrate the homes success in achieving its aims and objectives or year on year development for each service user. EVIDENCE: There are systems in place for measuring the success of the home in achieving its aims and objectives and this includes monthly provider visits with a report being forwarded to the Commission for Social Care Inspection. An action plan and feedback sheet following team meetings is forwarded to a senior manager for People in Action along with a monthly review of activities that have taken place in the home. As previously mentioned in this report the care plan review system is being reviewed to make provision for including the views of service users at each care plan review. The care plan review process currently however does not demonstrate year-on-year development for each individual and this must be addressed as part of the review of the system. The registered manager does not have a process for monitoring the regularity and quality of care plan reviews. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 19 People in Action have developed a service user questionnaire, (What I Think about My Home), and this is being completed as a group activity by service users at their house meetings, supported by a member of staff. Service users have not been offered the opportunity to complete this questionnaire independently with advocacy support from a friend, family member or day service care worker. The views of family members and other professionals involved in the service have not routinely been sought. Service users spoken with were familiar about the inspection process and the role of the inspector. Action had been progressed within agreed timescales to implement requirements identified in the last inspection report. Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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 3 x x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x x x x Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Pia - 46 Princes Street, Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 Page 21 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 6 Regulation 15 Requirement The record of the care and plan review must include the views of the service user when possible and the reason for any change or no change being necessary to the care plan programme. An annual assessment of needs, using the homes own assessment tool, must take place with service users whose placement is not funded by the local authority. The views of service users when possible must be included when reviewing risk assessment strategies in place to protect them from harm. Decisions being made regarding health care needs must be reviewed with them on an annual basis and as needs and associated risks to their health change. All medication held in the home must be carried forward and recorded on the new Medicine Administration Record (MAR) chart. All when required medication must have written protocol to support their use safely. Their
E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Timescale for action September 15, 2005 2. 6 14 January 30, 2006 3. 9 15 September 15, 2005 4. 19 12 September 15, 2005 5. 20 13 August 30, 2005 6. 20 13 August 30, 2005
Page 22 Pia - 46 Princes Street, Version 1.40 7. 8. 20 39 13 24 9. 39 24 use must be reviewed on a regular basis and stock regularly replaced. A record of all medicine administered in the home must be recorded on the MAR chart. The registered manager must develop systems for quality assurance to include the regularity and quality of care plan reviews to reflect the ongoing development of service users. The registered manager must seek the views of family members, friends or advocates and other professionals as part of monitoring the quality of the service provision. July 9, 2005 October 30, 2005 January 1, 2006 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. Refer to Standard 19 Good Practice Recommendations It is recommended that the staff team seek appropriate resources that may be necessary in supporting future decisions service users will be required to make regarding their specialist health care needs. It is recommended that staff competency in admistering medicines is audited on a regular basis. It is recommended that service users are offered the opportunity to complete service user questionnaire is independently with appropriate advocacy support. 2. 3. 20 39 Pia - 46 Princes Street, E53 s4447 Pia Princes St v239058 080705 Stage 4.doc Version 1.40 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
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