CARE HOME ADULTS 18-65
Respite Solutions Richmond House Greenways Carr Lane South Kirkby Pontefract WF9 3DB Lead Inspector
Tony Railton Unannounced Inspection 13th December 2005 12:30 Respite Solutions DS0000063763.V272875.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 Respite Solutions DS0000063763.V272875.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. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Respite Solutions 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) Richmond House Greenways Carr Lane South Kirkby Pontefract WF9 3DB 01977 652288 Respite Solutions Limited Mrs Alison Wilson Care Home 4 Category(ies) of Learning disability (4), Physical disability (2) registration, with number of places Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Can provide accommodation and care for respite care only. Can accommodate and provide care for four service users with a learning disability, two of whom may also have a physical disability. 8th September 2005 Date of last inspection Brief Description of the Service: Situated in a residential part of South Kirby Richmond House is a large detached house offering personal care and accommodation to four people who have learning disabilities, two of whom may also have a physical disability. Set back in its own grounds Richmond House provides parking to the front and a large, established private garden to the rear. There is wheelchair access provided for those who require it to the front and rear of the home. All accommodation offered is single and there are assisted bathing facilities provided for those who require it. The care provided by the home is underpinned by ordinary living principles and service users are encouraged and assisted to do as much for themselves’ as possible. There is a large television lounge to the rear along with a large conservatory with access to the garden. There is also a large domestic type kitchen/dining room. The home is close to a main bus route and there are local shops, public houses, churches and community centre within walking distance of the home. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a very positive and enjoyable unannounced inspection. There was the opportunity to speak to one service user, the responsible individual, registered manager and care staff. There was also the opportunity to inspect the home and examine service users case notes including assessments, risk assessments, care plans, reviews, daily and medical records. There was also the opportunity to examine staff records including references, CRB checks, staff training and supervision records. The inspector was pleased to note a lot of improvements to the care management systems within the home. It was also noted that the home continues to meet statutory requirements and nearly all minimum standards. The inspector would like to take the opportunity to thank everyone for their hospitality and cooperation throughout this very good and positive inspection. What the service does well:
Although newly registered the home has over the past 6 months demonstrated its capacity to meet the needs of service users. The environment offered is homely, comfortable and safe. Service users bedrooms are clean well maintained and service users are surrounded by their own possessions. One service user said that she likes her new home and in particular her bedroom. The homes documentation for assessing service users needs is good. The documentation for planning service users care is good. The daily records showing that service users needs have been met is also good. The quality of this information is collated and the report provided feeds the multidisciplinary reviews organised to discuss service users progress. Staff training has a high profile in the home and there was evidence to show that service users are safeguarded and protected by the staff training policies and practices. Service users are encouraged and assisted to take dull advantage of ordinary community based healthcare and leisure services in the pursuit of living an ordinary lifestyle. There was evidence to suggest that the home works very closely with service users relatives, social workers, community based mental health teams and hospital based consultants. This collaborative way of working is to be commended. It was noted that there have been marked improvements to the behaviour of both service users. Their relatives and healthcare professionals are very pleased with their progress and made comments to the registered manager. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Respite Solutions DS0000063763.V272875.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 Respite Solutions DS0000063763.V272875.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): 2&5 Service users personal and healthcare needs are assessed before they are admitted, however, they would benefit from having an individual contract or statement of terms and conditions. EVIDENCE: Service users case notes show that they have a comprehensive assessment of their personal and healthcare needs before they are admitted. Records also show that service users have Integrated Care Management Programme Assessments completed by the health and local authorities. Records also show that there are also behavioural assessments and A,B,C recording systems in place. The manager said that service users do have contracts, however, these have yet to be signed and added to service users records. The manager said that these will be signed and implemented as soon as is practicable. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 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): 6,7 & 9 Service users personal care needs are reflected in their care plans and they are encouraged and supported to make decisions about their daily lives. EVIDENCE: Service users assessments, care plans, daily records and reviews show that they are encouraged to make decisions about what they do and how they live their lives. The daily records have improved greatly and include the use of descriptive words to show and reflect when service users make decisions or show a preference. Risk assessments show that service users are expected to take certain risks as part of living an ordinary lifestyle, however, action is taken to minimise identified risks and hazards. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 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): 12,13,15,16 & 17 Service users are encouraged and supported to take part in ordinary community based age, per and culturally appropriate activities. EVIDENCE: Service users assessments, care plans and reviews along with the daily records show that service users are supported to be part of the local community. There is evidence that service users use local shops and leisure services and are assisted to participate in other community based activities. The philosophy and principles underpinning the care provided by the home is based on ordinary living principles and those of inclusion. Records show that service users are openly encouraged, supported and assisted to live as ordinary a lifestyle as possible which includes having a positive community presence. The manager and her staff team are to be commended for their efforts in promoting a positive community presence for two service users who’s behaviour can often be disruptive and may be perceived as ‘anti social’.
Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 11 Records also show that the home has a good relationship with service users relatives and that positive relationships are nurtured and encouraged. Service users are encouraged and supported to make choices regarding their meals and choice of menu. Service users are encouraged to participate in food shopping and preparing meals as part of living an ordinary lifestyle. The manager said that service users have really good appetites and providing a balanced diet is very important. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 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): 18,19 & 20 Service users receive personal support in the way they prefer and require and their individual healthcare needs are met. EVIDENCE: Service users assessment’s, care plans, reviews, medical and daily records show that their personal ad healthcare needs are met. Records also show a marked improvement to the behaviour of service users which indicates that they are happy living in the home. It also indicates that their individual personal and healthcare needs are being met. Reviews show that others such as relatives and health professionals have noticed the improvements in residents behaviour Records show that service users are encouraged and supported to use ordinary community based healthcare services. However, records also show that service users can also be supported by Community Mental Health Teams and hospital based consultants if required. The manager said that the home is currently reviewing the medication administration systems within the home. Records show that service users are protected and safeguarded by the medicine ordering, administration, storage and recording systems. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 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 & 23 Service users and their relatives views will be listened to and acted upon and service users are protected from abuse, neglect and self harm. EVIDENCE: Examination of the complaints policy and procedure shows that there is a system in place for investigating complaints. However, the manager said that the home has not received any complaints since opening earlier this year. In the absence of any complaints the inspector suggests the use of a comments book in an effort to capture any comments, good, or bad, made by visitors to the home. This could also form part of quality assurance monitoring. Staff training records show that adult abuse forms part of the training for all staff. The inspector was pleased to note that the home has a copy of Wakefield Social Services and Health Multidisciplinary Adult Abuse and Protection Policy and Procedure. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 14 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, 26 & 30 Service users live in a homely, comfortable, safe and clean environment. EVIDENCE: Inspection of the home sowed that it is homely, clean and safe. One service user showed the inspector her room which was personalised and homely. She said that she liked her room and living in the home. She appeared to be happy, comfortable and relaxed. The manager said that it is important for people to be surrounded by their own possessions. The manager also said that this bedroom is going to be redecorated as the occupant has chosen a different colour for the walls. On the day of the inspection all areas of the home were clean and hygienic. The manger said that as well as the good quality of care provided the environment is also playing a part in improving the behaviour of service users. Clearly service users like where they live including their own bedrooms. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 15 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, 34 & 35 Service users benefit from clarity of staff roles and responsibilities and from having the support of a confident and effective staff team. However, service users may benefit further from been supported by staff who have a NVQ qualification. EVIDENCE: Examination of staff records including training records show that service users are supported by an effective and competent staff team. In deed the improvements in the behaviour of service users shown in the care plans, reviews and daily records indicate that they are receiving the right kind of care and support. Once again the staff team are to be commended for their efforts in providing an environment in which service users can develop and improve. The environment created in the home is open and inclusive and staff appear to be confident and comfortable in the work that they do. Staff supervision notes show that some staff have received planned line management supervision sessions. The manager said that because the home only became operational in May this year they may not reach the six supervision sessions recommended by minimum standards, however, next year this standard will be met. Staff training records show that all staff with the exception of one who already has NVQ Level 2 are registered on National Vocational Qualification courses. The manager said that it is her aim to have all staff trained to NVQ Level 2 and above.
Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 16 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 & 42 Service users benefit from living in a well run home. However, the views of service users, their families and other visitors to the home should be sought on the quality of care provided. EVIDENCE: Records show that the registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The inspector was impressed with the positive attitude of the manager towards service users, the care they receive and their futures. Through observation and examination of the homes records including daily records and reviews it was found that the management approach of the home is open and inclusive. Service users case files including assessments, reviews and daily records show improvements in their behaviour. The manager said that these improvements have been noticed by service users families and other visiting healthcare professionals and the home has been praised for the quality of the care it provides.
Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 17 However, there was no documented evidence of these comments been made. The manager said that ways of capturing these positive comments will have to be considered. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 18 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 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Respite Solutions Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 3 x DS0000063763.V272875.R01.S.doc Version 5.0 Page 19 N/A 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 3 4 Refer to Standard YA5 YA32 YA39 YA39 Good Practice Recommendations Service users contracts should be sign by the service user or their representative and placed in their case files. 50 of care staff should have a NVQ Level 2 or above. The views of service users their families, friends and other visitors on the quality of care provided by the home should be sought. The information gathered as part of quality assurance monitoring should be collated and a report published reflecting the outcomes for service users. Respite Solutions DS0000063763.V272875.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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