Inspection on 19/12/05 for Priory Close (3)

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Priory Close (3) 11/08/08

Priory Close (3) 06/06/07

Priory Close (3) 29/06/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Priory Close (3) 3 Priory Close Aigburth Liverpool Merseyside L17 7EG Lead Inspector Beate Roth Unannounced Inspection 19th December 2005 9:15 Priory Close (3) DS0000025316.V273126.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 Priory Close (3) DS0000025316.V273126.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. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Priory Close (3) Address 3 Priory Close Aigburth Liverpool Merseyside L17 7EG 0151 727 1886 9999 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) www.c-i-c.co.uk. Community Integrated Care Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st July 2005 Brief Description of the Service: 3 Priory Close is registered to provide care for three adults with a learning disability. 3 Priory Close is a detached bungalow, there are three single bedrooms, a large lounge, kitchen and an office. Laundry facilities are situated in the garage. There is a garden to the rear of the home with a patio and grass areas. There is wheelchair access to the property. Bathing aids are provided. The home is situated in a quiet cul-de-sac in the Riverside district of Liverpool. Local shops and amenities can be found a mile or so from the home. Otterspool Promenade and local parkland are within walking distance. The home has access to a minibus, which has a lift. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a morning. During the inspection time was spent in the office examining records and policies and procedures and talking to the acting manager. Staff were spoken with. A tour of the home was undertaken. Staff were observed delivering care to service users. What the service does well: What has improved since the last inspection? What they could do better: An application to register a manager for the home needs to be undertaken in order to ensure that an individual who has the necessary skills, knowledge and experience is managing the home. The delay in making this application is not acceptable. Improvements to the way contracts/statement of terms and conditions are drawn up needs to be improved in order to fully support service users. Further steps need to take place to ensure that all staff have received appropriate training for the work they undertake. The records of staff recruitment must contain evidence that all the required information has been obtained in order to show that the staff working with service users are competent and suitable to care for vulnerable adults. Further activities that promote the social and personal developmental needs of a service user are to be provided. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 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. Priory Close (3) DS0000025316.V273126.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 Priory Close (3) DS0000025316.V273126.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): 1, 2, 3 and 5 Information is available to enable a representative of a service user to make a decision about whether the home is suitable. The needs of a service user are not being fully met by the activities provided. The way in which the contracts/statement of terms and conditions are drawn up do not fully support service users. EVIDENCE: Information is available to enable the representatives of service users to make a decision about the suitability of the home. The service user guide contains the required information. A guide that is more accessible to the service users living at the home would be beneficial. It is suggested that further information on the arrangements for service users to engage in social activities, hobbies and leisure interests could be included. No new service users have come to live at the home since the last inspection. Records indicated that prospective service users would have a full assessment, which includes obtaining the views of the service user, relatives and health and social care professionals as appropriate. Prospective service users would be able to visit the home to meet the existing service user and staff and view the home. The records for the existing service users provided little background information on their lives before they came to live at the home. Where possible, this information should be obtained and documented as it may contribute to the current care planning for service users. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 9 There is a wide variance of need between the service users. The service provided is not at present offering sufficient activities that would meet the intellectual and social development needs of a service user. Discussions with the acting manager and staff indicated that this is being addressed and it is anticipated that the service user will begin a college course and go swimming in the New Year. Since the last inspection steps have been taken to ensure that all staff have up to date training in moving and handling, food hygiene and first aid. At the last inspection it was reported that insufficient numbers of staff had received training around administering rectal diazepam. This is administered in accordance with a care plan. Since the last inspection 3 staff have been provided with this training. A further training course to provide this training to the remaining staff has been rescheduled to the early New Year. Staff who are to perform this procedure must be provided with up to date training by an individual who is appropriately qualified. There is information around the communication needs of service users in their care plans. It is recommended that this be expanded upon. Service users would perhaps benefit from personal communication dictionaries. Contracts between the service users and Community Integrated Care are available. One contract has not been signed by any party, the other contracts have been signed by managers from Community Integrated Care. There is no evidence of the agreement of the service user, their family or an advocate. The service users are currently paying towards the cost of the home’s minibus. Evidence of agreement to this arrangement from the service user, their family or an advocate was also not available. An individual who is independent of Community Integrated Care, such as a relative or advocate should be involved in all financial matters to ensure that an objective individual is representing the interests of service users who are not able to make such decisions for themselves. Priory Close (3) DS0000025316.V273126.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): 6 and 7 Care planning reflects the assessed and changing needs of service users. EVIDENCE: A sample of service user plans were examined. These cover the information recommended in the National Minimum Standards and there was evidence that these plans are subject to a review. The records indicated that consultation takes place with relevant professionals regarding meeting the needs of service users. A daily record is made regarding the well being of service users. A member of staff interviewed was knowledgeable about the needs of the service users. The records and a discussion with staff indicated that service users are assisted to make decisions about their lives in accordance with their abilities. Records of service users likes and dislikes and preferences around daily living, such as what time they like to get up and the activities they enjoy goes to ensuring service users choices are respected. Further written information around how the service users communicate their needs would also assist in this process. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 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 the following standard(s): 11, 12, 13, 16 and 17 The activities do not fully promote the social and personal developmental needs of all service users. Service users’ emotional and social needs are met through the arrangements for ensuring they are part of the local community and through the daily routines at the home. EVIDENCE: There is a written record of the activities service users take part in each week. Since the last inspection there has been some improvement to the staffing levels, which means there is more flexibility for service users to undertake individual activities. The activities provided in general meet the needs of the service users. However, the service provided is not at present offering sufficient activities that would meet the social and developmental needs of one service user. Since the last inspection the service user has been provided with individual activities with staff and multi-professional discussions have taken place and appropriate activities have been identified. A college course and swimming are being arranged. At the last inspection the staff interviewed reported that they consider that this service user needs to be provided with more stimulating activities. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 12 Both the records show and staff indicated that service users take part in community life. Local shops and amenities can be found a mile or so from the home. Otterspool Promenade and local parkland are within walking distance. The home has access to a minibus. Discussions with the staff and observations confirmed that the home’s routines are flexible as much as possible. The records inspected indicated the support service users need in their daily lives in order to make choices and encourage independence. The service user plans detail likes and dislikes and any dietary requirements. A record of food provided is maintained and indicated that in general a variety of different foods are provided at evening meal times. A discussion took place with the acting manager around varying the choices offered at lunch-time in accordance with the needs and likes of the service users. Advice is obtained from a dietician if this is required. Priory Close (3) DS0000025316.V273126.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): 19 and 20 The health needs of service users are met. EVIDENCE: Records indicate that staff support the health care needs of service users and that medical interventions are sought as and when necessary. The accident records indicated that there have been no recorded accidents since the last inspection. The home administers service users medication. A sample of records indicates all medication administered is recorded and there are policies and detailed procedures in place to ensure the safety of service users. Since the last inspection, there has been a change to the pharmacist who supplies the medication. Blister packed medication is not now colour coded. It is recommended that the blister packed medication is colour coded for ease of administration and that a photograph of the service user is attached to guard against errors in administration. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 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 the following standard(s): 22 and 23 The service users could benefit from the home’s complaints procedure being more user friendly. Service users are protected by the adult protection procedures in place at the home. 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. Consideration could be given to making the complaint procedure more suitable to the needs of the service users living at the home. It is acknowledged that the current service users may not benefit from this. Staff spoken with were aware of the complaint procedure and what to do if they are approached with a complaint. No complaints have been made to the Commission for Social Care Inspection about the home since the last inspection and no complaints have been made to the home. The home has an adult protection procedure and a copy of the Liverpool City Council’s adult protection procedures is also available. A whistle blowing policy is available. The staff spoken with had received training in the adult protection procedure. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 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, 29 and 30 The home is well presented and provides a comfortable and pleasant environment for service users. EVIDENCE: A tour of the home indicated that the home is well maintained and comfortably furnished. The floor in the bathroom was lifting in one small area. The acting manager addressed this at the time of the inspection. The home was registered prior to the introduction of National Minimum Standards. The size of the bedrooms does not comply with the current space standards outlined in the National Minimum Standards. There is a large living room available for communal living. The kitchen is quite small so meals tend to be eaten in the living room or service users bedrooms if they require. A suitably adapted shower room is provided. There is a pleasant, well-maintained garden available for service users. This comprises a grass and patio area. There is ramped access to the garden through the kitchen and patio doors. Access to the front door is via two small steps. There is a garage available, which is used as a laundry room and for storage. At the time of the inspection the garage contained some old furnishings and boxes that were to be disposed of. This limits access to service users and Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 16 could be a potential fire hazard. The acting manager reported that these items are to be cleared prior to Christmas. Specialist equipment to maximise service users independence is provided following a suitable assessment. The home was clean. Staff have designated responsibilities for ensuring the cleanliness and tidiness of the home. Priory Close (3) DS0000025316.V273126.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): 32, 33, 34 and 35 Service users are supported by the staffing levels at the home and the training provided to staff. The recruitment records do not demonstrate that service users are protected by the homes recruitment practices. EVIDENCE: The rotas for a 4-week period were examined. These indicated that there are two staff on duty from 8.00am until 8.00pm, with a third member of staff on duty for 3-4 shifts per week. At night there is a waking member of staff. As already indicated since the last inspection there are now further occasions when there are 3 staff on duty. This allows for individual activities to take place with the service users. There has also been an improvement in the ability of one service user to walk with an aid. At the last inspection a member of staff said that it is difficult for 2 members of staff to take all 3 service users out together, and if there are only 2 staff it can sometimes mean not getting off the minibus. At this inspection staff reported that 2 staff can take all 3 service users out with all 3 service users getting off the bus. On the day of the inspection staff took the service users Christmas shopping. One new member of staff has been employed since the last inspection. The records of recruitment were examined. There was evidence of a satisfactory Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 18 CRB and POVA check and a health reference. There was no evidence of all the required information having been obtained. Community Integrated care has its own training department which offers a variety of training to staff. Since the last inspection, the records of training have improved. Records indicate that all staff have received health and safety training relevant to their work. Since the last inspection a further member of staff has completed an NVQ in care. The home has 50 of staff with this qualification and additional staff are currently undertaking this course. A 3 day induction and 4 day foundation training course is provided to new staff. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The management arrangements at the home do not promote the wellbeing of the service users. EVIDENCE: A requirement has been made at the last two inspections that the registered person must appoint an individual to manage the home and that in the interim an application by the acting manager to become the registered manager must be made to the CSCI. This has not been addressed. The acting manager has been managing the home for 2 years. The delay in providing an application to register the acting manager is not acceptable. An assessment of the acting managers skills, knowledge and experience to run the home cannot be made until a formal application for registration is made to CSCI. The acting manager is currently undertaking an NVQ Level 4 in care and management. The Service Manager carries out an audit of service users’ health and welfare, accidents, risk assessments both personal and environmental, and staffing levels. A financial audit is conducted once a year by the parent company. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 20 There is an annual survey sent out to relatives of service users asking for their views of the home from Head Office. There are policies and procedures to promote safe working practices. A sample of safety check records in relation to the gas, portable appliances, fire alarm and emergency lighting tests and maintenance checks were examined and found to be in order. An up to date electrical wiring certificate was not available. There was evidence that all staff had received fire safety training. Fire safety training is not being provided at frequencies recommended by the fire service of 6 monthly for day staff and 3 monthly for night staff. A risk assessment for the use of a bed rail is now being reviewed on a monthly basis. This assessment did not indicate whether the service user continues to need the bed rails and any changes to their needs. Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 2 X 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X 3 3 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 1 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Priory Close (3) Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 1 X 3 X X 2 X DS0000025316.V273126.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA3 Regulation 18 Requirement The registered person must ensure that all staff are provided with up to date training in the administering of rectal diazepam by an individual who is appropriately qualified to provide it (previous timescale of 01/10/05 not met). The registered person must ensure that there is evidence available, that agreement has been sought from the service user, where appropriate, family/advocate regarding the service users contributing towards the cost of the homes vehicle. The registered person must ensure that further activities that promote the social and personal development of the service user identified with the acting manager are provided in accordance with their wishes. Timescale for action 19/01/06 2. YA5 5 19/03/06 3. YA12 16 19/01/06 4. YA24 13 The registered person must 26/12/05 ensure that the garage is cleared DS0000025316.V273126.R01.S.doc Version 5.0 Page 23 Priory Close (3) of rubbish which limits access to service users and could be a potential fire hazard. 5. YA34 17 The registered person must 19/12/05 ensure that the records of recruitment contain evidence that all the information detailed in Schedule 4 of The Care Homes Regulations 2001 has been obtained (previous timescale of 01/07/05 not met). The registered person must appoint an individual to manage the home. In the interim an application by the acting manager to become the registered manager must be made to CSCI (previous timescale of 01/08/05 not met). The registered person must ensure that fire safety training is provided to day staff on a 6 monthly basis and night staff on a 3 monthly basis. The registered person must ensure that the monthly review of the risk assessment for the use of a bed rail indicates any changes to the service users needs. The registered person must forward a copy of a current electrical wiring certificate for the home to CSCI. 19/01/06 6. YA37 8 7. YA42 23 19/12/05 8. YA42 13 19/12/05 9. YA42 23 19/01/06 Priory Close (3) DS0000025316.V273126.R01.S.doc Version 5.0 Page 24 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 YA1 Good Practice Recommendations A service user guide that is more suited to the abilities of the service users should be made available. Further information on the arrangements for service users to engage in social activities, hobbies and leisure interests should be included in the service user guide. Further background information about the service users’ lives before they came to live at the home should be obtained and documented. Further written information around communication should be made available for staff to ensure that they and future staff can as far as possible communicate effectively with each service user. The registered person should consider the introduction of an independent advocate for the service user who does not have family members to act on their behalf. It is recommended that the blister packed medication is colour coded for ease of administration and that a photograph of the service user is attached to guard against errors in administration. The service users may benefit from the homes complaints procedure being made more suited to their needs. 2. YA2 3. YA3 4. YA5 5. YA20 6. 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