Inspection on 11/08/08 for Priory Close (3)

This inspection was carried out on 11th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Priory Close (3) 06/06/07

Priory Close (3) 29/06/06

Priory Close (3) 19/12/05

Priory Close (3) 01/07/05

Priory Close (3) 20/01/05

Priory Close (3) 07/07/04

Priory Close (3) 04/02/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Priory Close (3) 3 Priory Close Aigburth Liverpool Merseyside L17 7EG Lead Inspector Peter Cresswell Unannounced Inspection 11 August 2008 09:45 th DS0000025316.V363548.R01.S.doc Version 5.2 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 DS0000025316.V363548.R01.S.doc Version 5.2 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. DS0000025316.V363548.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Close (3) Address 3 Priory Close Aigburth Liverpool Merseyside L17 7EG 0151 727 1886 F/P 0151 727 1886 No email www.c-i-c.co.uk Community Integrated Care 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) Alan Morris Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000025316.V363548.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2007 Brief Description of the Service: 3 Priory Close is registered to provide care for three adults with a learning disability. It is a detached bungalow with three single bedrooms, a large lounge, a kitchen and an office. There are laundry facilities in the garage and the back garden has a patio and grassed area. The property is accessible to wheelchair users and bathing aids are provided. Priory Close is a quiet cul-desac on part of the former Garden Festival site near to Otterspool promenade in south Liverpool. Local shops and amenities can be found a mile or so from the home and a bus route to Liverpool city centre is nearby. The registered owners are Community Integrated Care (CIC), a large social care charity and the building itself is owned by a housing association. The home’s fees are in the region of £368 per week. DS0000025316.V363548.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection included an unannounced site visit. We spoke to the registered manager and the other member of staff who was on duty. We looked at all parts of the home and examined care plans, medication, fire safety records and financial records. The manager of the home had completed a CSCI Annual Quality Assurance Assessment (AQAA) some weeks before we visited. What the service does well: What has improved since the last inspection? What they could do better: Staffing needs to be reviewed to make sure that there are enough staff on duty at all times to support the service users in the activities that they enjoy. Wide ranging reviews need to be held to establish how the needs of the service users can be fully met and that they do not suffer as a result of the circumstances of other service users. DS0000025316.V363548.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. DS0000025316.V363548.R01.S.doc Version 5.2 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 DS0000025316.V363548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2. People who use this service experience good quality outcomes in this area. Anyone considering moving into the home would be fully assessed and have information about the services provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no admissions to Priory Close since we last visited – or indeed for five years - so it was not possible to further assess the home’s admission procedures. The owners, Community Integrated Care (CIC), have well established procedures for admitting people to their services. Two of the service users have been at Priory Close for many years, the other for about five years. Should there be a change of people living at the home very careful consideration must be given to the issue of compatibility. The statement of purpose gives fairly detailed information about the type and level of services the home provides. It has been updated to clarify the transport situation. It says that ‘There is an opportunity to contribute towards the running and maintenance costs of the home vehicle’. The vehicle is a minibus which is owned by CIC and has been adapted to carry wheelchairs. The statement is still out of date in some other respects, though, referring, for instance, to the ‘National Care Standards Commission’, which ceased to exist two years ago and was replaced by the Commission for Social Care Inspection (CSCI). It should be updated. DS0000025316.V363548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. People who use this service experience adequate quality outcomes in this area. Care plans provide a great deal of information to ensure that they receive appropriate support but some need to be reviewed to ensure everyone is able to live their daily lives as they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the care plans, essential lifestyle plans and risk assessments for all three people who live at Priory Close. The care plans are detailed and provide good information about how people like to be supported in their personal care needs and daily routines. The plans also include information regarding the need for service users to receive gender appropriate personal care and specific support and personal items that are important to them. Since we last visited they have been updated to include details of people’s sensory impairments. People take part in the daily routines of the home to the best of their abilities. There is an issue concerning the challenges presented by the (involuntary) behaviour of one of the service users in the home that seriously affects the well being of the other service users. It would not be appropriate to discuss this behaviour in any detail in a public report. However, one of the other service users in particular has, according to the manager, had her quality of DS0000025316.V363548.R01.S.doc Version 5.2 Page 10 life adversely affected by the situation. This is reflected to some extent in the daily reports made by staff though from our discussion with the manager and staff it may be that the reports do not fully reflect the impact on the other service users. At the request of a consultant a detailed record has been kept of the behaviour referred to, but there is no parallel record of how it has affected the other service users. The manager agreed with us that it would be a good idea to do this. Although there have been attempts to resolve the situation they have tended to concentrate solely on the behaviour itself rather than the effect which it has on other people’s lives. The care plans are regularly reviewed by the manager but there was no evidence of a major review of the plan for the person most affected by the situation. This is not acceptable and the owners should arrange a review involving everyone affected in her care with a view to improving her quality of life. This person may well benefit from independent advocacy to help her express her views and experiences. DS0000025316.V363548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. People who use this service experience adequate quality outcomes in this area. People have the chance to do things that they enjoy but these can be limited by staffing levels. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the service users attends a local college one day a week. Other activities and trips out are arranged for service users on the basis of experience of what they enjoy doing. They also go on separate holidays with staff and risk assessments are carried out before they go. There had been an incident on one recent holiday which is mentioned elsewhere in this report. The behaviour issues mentioned above also affect the way in which staff can support activities. The manager told us that the home has good relationships with other people living in the close. Records indicate that staff support people to maintain positive relation ships with family members and friends. One service user, for instance, regularly visits her mother and stays overnight. Friends and family are welcome in the home. DS0000025316.V363548.R01.S.doc Version 5.2 Page 12 The home does not have a dining table and chairs so service users eat their meals in the lounge. The menu is varied and provides a range of different meals including curries and pasta. Food is bought in local shops and supermarkets, with service users going on the shopping trips. DS0000025316.V363548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People who use this service experience adequate quality outcomes in this area. Service users’ health needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans indicate that the people who live at Priory Close receive personal care and support in an appropriate way. There are detailed records of the involvement of health care and other professionals. This has not yet, of course, resolved the situation referred to in earlier sections of this report. We checked a sample of the medication given to residents. The Medication Administration Record sheets were in order and medication was securely stored. Where medication is to be administered ‘as required’ (PRN) there should always be written guidance as to the circumstances in which it is to be given. This had been done for some such medicines but not for all of them. The staff did understand when it should be used but it is important that this is always available in writing. DS0000025316.V363548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People who use this service experience good quality outcomes in this area. There are procedures in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed complaints procedure with timescales for action and responses to concerns raised. There is also a shorter version that is made available to service users and their family/advocates. The home has an adult protection procedure and a copy of the Liverpool City Council’s safeguarding procedures. There is also a whistle blowing policy. Staff have received training in safeguarding procedures. The manager had recently implemented safeguarding procedures following one service user’s return from holiday and two of the home’s staff had been suspended on full pay to allow the incident to be investigated. The appropriate authorities, including the CSCI, had been informed and social workers and police investigating the matter had visited the home. When such people do call, the home should keep an accurate record of who they are and when they visited. In view of the ongoing investigation it is not appropriate to report further on the alleged incident as the investigation was not complete and the staff remain suspended. DS0000025316.V363548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. People who use this service experience good quality outcomes in this area. The home is well furnished and maintained, providing a comfortable environment for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The bungalow is homely and does not stand out from other properties in the road. When we visited it was clean and free from any odours and nearly all of the issues raised in the last report had been remedied. A wood laminate floor covering had been fitted in the lounge. With no rugs this is not especially homely but is well suited to the two wheelchairs. A new lounge suite had been bought and the room had been redecorated. Two of the service users can use the sofas but they are not suitable for the other and the owners should consider buying a specialist chair so that she does not have to spend all of her time in her wheelchair. Each service user has their own bedroom and they were all clean and appropriately furnished. Each has a specialist bed and where bedrails are used there are risk assessments on file. The tiling in the shower room had been repaired. There was some mould on the shower but the manager said that the grid is removed and power-washed every week. It may be that this needs to be done more often. The kitchen was clean though the units are now rather old and approaching the time when they may need to DS0000025316.V363548.R01.S.doc Version 5.2 Page 16 be replaced. The back garden has a grassed area, which was badly in need of mowing, and a greenhouse. The owners may want to review the contract for the garden maintenance contract to ensure that the garden is properly maintained through the year. The far end of the garden is very steep and unusable by the service users. It is very bare and unattractive at the moment and it should be possible to landscape this area or at least plant – for instance – wildflowers under the trees to make it more attractive for the service users when they are using the garden. DS0000025316.V363548.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. People who use this service experience adequate quality outcomes in this area. Staff are well trained and qualified but there are not always enough on duty to adequately support the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is normally staffed by two care staff from 8am to 8pm, with one member of staff on from 8pm overnight, when senior CIC staff are available if necessary on call. Given the absence of two suspended members of staff, the manager and the remaining staff are covering the shifts as far as possible, in order to maintain continuity for the service users, though some agency staff and CIC staff from other homes are also being used where necessary. Given the challenging behaviour mentioned earlier in the report it is plain, as pointed out at the last inspection, that two care staff are not sufficient to cope with that behaviour and also provide support and meaningful activities for the other service users. The owners should review the current staffing levels to ensure they are able to meet the changing needs of all of the service users. No new staff have started since the last inspection. The owners have well established procedures for recruitment including obtaining Criminal Records Bureau checks and references. Six staff have NVQ2 or above and the other one is due to start a course for NVQ2. CIC has a well established training programme and staff have recently attended courses on the Protection of DS0000025316.V363548.R01.S.doc Version 5.2 Page 18 Vulnerable Adults and risk assessment. Staff receive one to one supervision twice a year but this should be increased to six times a year. During our site visit we observed a relaxed relationship between staff and the service users. DS0000025316.V363548.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. People who use this service experience adequate quality outcomes in this area. The home is well managed but additional steps need to be taken to ensure that the service users’ best interests are fully taken into account. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is very experienced in homes of this size and has been registered to manage Priory Close for three years. Staff are supervised and the manager arranges team meetings. We only spoke to one member of staff apart from the manager but we formed the impression that there was a good working relationship at what must have been a difficult time. The service users have varied if generally limited means of communication but staff do their best to understand their views of how the home should be run. When possible their interests are represented by relatives but this is not possible in every case and consideration should be given to obtaining independent advocates for them, especially in view of the issues set out in earlier sections of this report. A service manager visits the home at least every month and completes a written report. All of the service users have tenancy agreements. Fire safety records DS0000025316.V363548.R01.S.doc Version 5.2 Page 20 were up to date and there was a current gas safety certificate. The electrical safety certificate had recently run out and should be renewed without delay. This is the responsibility of the housing association that owns the property. The manager keeps a record of the service users’ personal allowances. Any surplus is kept centrally by CIC in a special account. This arrangement has been notified to the CSCI and operates in all of CIC’s care homes. DS0000025316.V363548.R01.S.doc Version 5.2 Page 21 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 3 x DS0000025316.V363548.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15 Requirement Timescale for action 01/11/08 2. YA13 16 3. YA33 18 Care plans must be kept under review and where necessary a major review must be held to establish how best to meet the needs of any service user whose needs are not being met. Specifically, in conjunction with the placing authority, there needs to be an urgent review, of the needs of the service user who is particularly affected by challenging behaviour. People’s ability to access 01/11/08 community facilities and take part in activities must not be restricted because of the behaviour of other service users. Requirement remains unmet previous timescale 30/08/07 The registered person must 01/10/08 ensure that staff are employed in appropriate numbers for the health and welfare of the service users. Staffing must therefore be reviewed to provide sufficient support worker hours to ensure all service users receive the appropriate levels of support to enable them to live their chosen lifestyles. DS0000025316.V363548.R01.S.doc Version 5.2 Page 23 Requirement remains unmet previous timescale 30/08/07 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. 4. 5. 6. Refer to Standard YA1 YA5 YA6 YA20 YA28 YA29 Good Practice Recommendations The statement of purpose should be updated throughout to bring it up to date. The registered person should arrange for an independent advocate for those service users who need them. A detailed record should be kept of how challenging behaviour affects each service user. There should be written guidance for staff in respect of any medication which is to be taken ‘as required’ (PRN). The garden should be regularly maintained to make sure that it is a place that the service users can enjoy. The owners should consider buying a specialist chair for the service user who cannot use the existing lounge furniture. Staff should receive one to one supervision at least six times a year. 7. YA36 DS0000025316.V363548.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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