CARE HOME ADULTS 18-65
Primrose House (Morecambe) Ltd Primrose House Middleton Road Middleton Morecambe Lancashire LA3 3JJ Lead Inspector
Mrs Joy Howson-Booth Unannounced Inspection 19th January 2006 10:00 Primrose House (Morecambe) Ltd DS0000009716.V279046.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 Primrose House (Morecambe) Ltd DS0000009716.V279046.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. Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Primrose House (Morecambe) Ltd Address 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) Primrose House Middleton Road Middleton Morecambe Lancashire LA3 3JJ 01524 853385 Primrose House (Morecambe Limited) Mr Anthony David Grundy Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: Primrose House (Morecambe) Limited is a home for up to 6 people with severe learning and physical disabilities, the present (purpose-built) building opened in 1998 but the Primrose House service has been in operation since 1988. The service was established as a charitable organisation by one of the parents of a current service user who found that there was no satisfactory service provision existing locally to meet complex needs. A Board of Trustees appointed a Registered Manager to undertake the day-to-day management of the home. A responsible person has also been appointed to monitor the service. The Board of Trustees meets on a regular basis to review the service and plan future developments. The ethos of the home is to provide quality services to people who have a profound learning and physical disability and it believes that opportunities should be provided to enable the people supported to live independent lives within the confines of their disability. Primrose House (Morecambe) Ltd DS0000009716.V279046.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 so the registered manager and staff were not aware of the visit. The inspection took place over one morning and involved observing staff with the residents, and speaking with one resident, speaking with staff on duty, the cook and the registered manager. The services provided by the home were inspected against the National Minimum Standards and looked at those key standards not assessed at the previous inspection. One care file was seen, along with other documentation in the home. Unfortunately, no comment cards were received. What the service does well: What has improved since the last inspection?
From discussions with the registered manager, the main improvements are noted as follows: There is a full complement of staff now in place at the home and the registered manager feels all the staff team are beginning to “gel” and work together much better Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 6 The person centred planning is now in place for all but one of the residents. Redecoration work continues with a new carpet in one resident’s room and another resident has been provided with a new bed. 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. Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 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 Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 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 5 were assessed and found to be met at a previous inspection EVIDENCE: Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 were assessed and met at a previous inspection EVIDENCE: Primrose House (Morecambe) Ltd DS0000009716.V279046.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): 17 Standards 11, 12, 13, 14, 15 and 16 were assessed and met at a previous inspection There are excellent arrangements and planning to ensure residents are provided with nutritional and appealing food to maintain a health lifestyle. EVIDENCE: Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 11 It was again confirmed that the meals provisions within the home remain with an individual approach to meal provision, including a range of food and drinks being supplied during the day – breakfast, brunch, lunch, tea, supper or as and when the resident indicates they wish to have something to eat or drink. The Cook was spoken with who confirmed that the meal arrangements remain as individual residents prefer. The cook has responsibility for the purchasing and stock control of food items and ensures there is a range of nutritious alternatives available. Choices are always tried should a service user indicate they do not want the original choice. Cultural/religious/medical dietary needs would be ascertained at the point of referral/assessment. Guidelines on how to support each individual service user at mealtimes (positioning, utensils, individual indications, etc), along with likes and dislikes for food are in the residents own individual care files. Primrose House (Morecambe) Ltd DS0000009716.V279046.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): 19 Standards 18 and 20 were assessed and met at a previous inspection. Arrangements to meet the health care needs of the residents are good. EVIDENCE: A requirement highlighted at the previous inspection required the home to ensure a record was maintained of all healthcare visits and specialist input. Examination of a care file during this inspection evidence that this information is now recorded on a separate sheet in individual resident’s files. Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 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 the following standard(s): 22 and 23 There are very good arrangements in place which mean residents are listened to and their views acted on. There are systems in place, and training provided, to ensure that residents are protected from abuse. EVIDENCE: The home has a complaints procedure which is accessible to relatives and visitors. Residents at the home would not be able to use this procedure but have relatives and staff who clearly act as advocates on their behalf. Only one complaint has been raised to the Commission since the last inspection. This was passed to the registered manager to investigate who confirmed that appropriate action had been taken following this. Resident’s files contain information which is linked to their individual likes and wishes including – “what’s important to and for me”; “communication aids that I use”; “responding to my communication”; and things you should know about me”. This also includes the specific ways the different residents use to communicate feelings. This enables staff to listen and act on the responses provided by those residents who are unable to verbalise their views. Only one resident in the home is able to be actively involved in the home’s meetings and it was confirmed that he enjoys contributing to these. It was confirmed that abuse awareness training is covered in both the home’s induction training programme and also in the formal LDAF (Learning
Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 14 Disabilities Award Framework) training. At present 50 of the staff have been trained in LDAF. There is an abuse procedure in place in the home which complies with the Department of Health’s document “No Secrets” and discussions with staff confirmed they have access to this and also know the procedure to follow should they have any concerns. The registered manager confirmed that staff are trained in breakaway techniques but only staff who have undertaken this training are able to work unsupervised with residents. The individual communications held on file ensure staff know how to respond to situations or when a resident may need some additional support. Key workers manage the personal finances for their key residents – these being audited on a monthly basis by either the registered manager or the deputy manager. Staff do not get involved in other financial affairs relating to the residents – these are generally undertaken by their own relatives. Primrose House (Morecambe) Ltd DS0000009716.V279046.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 and 30 Primrose House is a safe place for people to live in. Resident’s accommodation continues to be homely, comfortable, safe and well maintained. Procedures are in place to ensure the home remains clean and hygienic. EVIDENCE: A tour of the home found it to be homely and comfortable. The home has a modern layout with excellent furnishing and fittings provided in a cheerful and airy environment. All communal areas are accessible to the residents, but most need staff support to do this. There is a planned maintenance programme in place and the registered manager confirmed some minor maintenance work is to be carried out on the corridor and doorways and new blinds are to be put in place on the front door. There are no CCTV cameras in use in the home. Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 were assessed and met at a previous inspection EVIDENCE: Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 Standards 37 and 42 were assessed and met during a previous inspection There are arrangements in place to ensure a review and ongoing development of the services provided by the home EVIDENCE: It is a main part of the home’s ethos that the residents underpin the activities that take place in the home. The home has 6 monthly review meetings when all involved parties (relatives, health professionals, key workers, etc.) are invited to contribute to the person centre approach to care which is used in the home. The registered manager has previously confirmed that himself and members of the Board of Trustees meet on a monthly basis to look at ongoing work and to make developmental plans for the whole areas within the home. In addition, relatives and other professionals are invited to complete a “Quality Feedback Questionnaire” at the time of any reviews and regular reviews of systems, policies and procedures take place to maintain the homes ISO 2000 status.
Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 18 ISO 2000 being an accreditation system for documents, policies and procedures. Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 19 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 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X X X 3 X X X x Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action 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 YA24 YA23 Good Practice Recommendations To continue with the ongoing maintenance programme for the home Include telephone numbers for appropriate contacts in the adult abuse procedure for the home (e.g. the local Social Services Directorate) Primrose House (Morecambe) Ltd DS0000009716.V279046.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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