CARE HOME ADULTS 18-65
Rielly`s House 30 St Vincent St Stoke Plymouth PL2 1JH Lead Inspector
Brendan Hannon Announced Inspection 17th November 2005 09:45 Rielly`s House DS0000063791.V249979.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 Rielly`s House DS0000063791.V249979.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. Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Rielly`s House Address 30 St Vincent St Stoke Plymouth PL2 1JH 07745820032 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) Miss Angela Clayton Mr Paul Victor Rielly Mr Paul Victor Rielly Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Age restricted to; Service Users from the age of 30 to 65 years of age. The home is registered as a Care Home only (PC) providing care for people falling within the category MD (Mental Disorder). Date of last inspection Brief Description of the Service: This 3 bedded home was first registered on 21/04/2005. The home is a 1970s mid terrace house near to Stoke Village, in the centre of Plymouth. A full range of amenities and facilities are available within walking distance and within the greater Plymouth area. The home can accomodate up to three residents over three floors. The home is entered on the ground level where there is one bedroom, an office and the main bathroom with toilet. There are then stairs to a lower ground floor level and the communal areas. Stairs rise from the ground floor hallway to the first floor and two further bedrooms and a shower room with toilet. The two communal areas in the home are a lounge and also a kitchen/dining area. There is an area of enclosed garden and patio to the rear of the building. There is also a patio area to the front of the lower ground floor area. Residents are free to smoke under shelter to the front and back of the building but not inside. The service offered by the home is for men and women with mental health issues over the age of 30 and under the age of 65. At present all of the residents are women. The service provided at Riellys House is not designed to meet the needs of people with significant mobility issues but there is physical disability access to the ground floor facilities. The service is designed to be small and domestic in style. The present group of residents are aged between 40 and 55 and have a mixed range of abilities. Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced. Preparation for the inspection included analysis of communication with the home over the past seven months and the pre inspection questionnaire. Comment cards completed by relatives and residents were received during the inspection. An inspection plan was developed from this information. The inspector was in the home for 5.5 hours from 9.30am to 3.00pm. The inspector looked into the care of and spoke with all three residents. The whole of the building was inspected. The registered providers were spoken to at length during the inspection. Care planning files, care delivery records, medication records, personnel files, general records, and health and safety records, were inspected. What the service does well:
The new homeowners have recruited a full and stable staff team since opening the home. The homeowners and staff aim to provide a homely and comfortable place for the residents to live. The service provides good information about the home to prospective residents and their representatives enabling an informed choice to be made as to whether to use the service. The service states clearly the needs that it can meet. The delivery of resident’s care is good and is supported by adequate care planning. The service is enabling residents to make positive changes to their behaviours and the stability of their mental health. All the residents enjoy individualised lifestyles. The service supports relationships between the residents and their families, friends and professionals. The residents are consulted about and are provided with enough food that they like. Residents’ personal care is well organised and planned. The home has established strong links with general and specialist mental health services. The residents benefit from a homely, comfortable, clean and well maintained building. The new homeowners have already invested in decoration, carpets and the facilities generally in the home. Resident’s needs are met by enough adequately trained staff. The new owners have an open style of management and have clearly defined objectives for the service. They have already shown considerable skills in establishing a completely new paperwork and operating systems for the effective running of a new care home within the first seven months of operation. Rielly`s House DS0000063791.V249979.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. Rielly`s House DS0000063791.V249979.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 Rielly`s House DS0000063791.V249979.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): 1,2,3,4,5 The home provides adequate information about the service and support to allow a new resident, and their representatives, to make an informed decision to use the service. EVIDENCE: Both the Service Users Guide and the homes Statement Of Purpose were available. These documents met the requirements of the Care Homes Regulations. However some amendments should be made to accurately reflect the service delivered by the home. The information in these documents would enable potential new residents and their supporters to understand the service provided by the home. Residents and the service providers were observed and spoken to throughout the inspection. Through this observation, and through records there was good evidence to show that residents’ needs are being met. The home uses the care plan format as the format for assessing new potential residents before they enter the home. A pre admission assessment was on file for each resident. A statement of terms and conditions was signed by the resident and was kept on their personal file. The registered providers at Rielly’s House are clear about what the service provided is and what needs it can meet. Therefore new residents needs are likely to be met by the home. Rielly`s House DS0000063791.V249979.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): 6,7,9,10 The delivery of resident’s care is good and is supported by adequate care planning. EVIDENCE: Resident’s care plans were sampled. Residents care planning is generally thorough. There is a thorough assessment of needs, and a care plan to plan the delivery of support in response to the residents’ needs. Though risk assessment was adequate some restrictions of personal freedom or choice had not been documented. These included for example the need for management of smoking materials and support with money management. Every resident’s individual care plan / risk assessment should include all the agreed restrictions that are in place to support the resident’s care at Rielly’s House. Care planning is being appropriately reviewed. Information is managed carefully in the home. The office/ sleep in facility and the storage within it is used effectively to maintain the confidentiality of all information. The effectiveness of the practice being delivered at Rielly’s House is clearly evidenced by the significant improvements in residents’ stability and behaviours since their arrival at the home. Rielly`s House DS0000063791.V249979.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): 15,16,17 Residents’ rights are respected. Residents receive enough, varied, good food. EVIDENCE: Only part of this section was inspected on this occasion. The providers described at length the residents’ relationships with family, friends and professionals. The management and staff at the home are actively supporting residents relationships. This information was supported by care planning and by residents’ daily records. During the inspection two residents went out one with a relative and the other with an outreach support worker from mental health services. All the residents have individualised activities depending on their interests and abilities. The providers hope to employ a new member of staff in the near future to further support residents to go out of the home for more one to one activities. The food provided record, food stocks and details of the residents food preferences showed that residents are supplied with enough, good quality food. The residents receive enough appropriate food that they like. Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 11 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 Residents’ health is maintained by meeting the residents’ personal care needs, health care needs, and through the satisfactory administration of their medication. EVIDENCE: All of the residents present in the home at the time of the inspection were seen. There was no observable evidence of any personal care issue not being met. Weight records are being maintained for all the residents. All of the residents are receiving active support from community mental health services. All the residents have had at least assessment checks with their new GP upon admission to the home. Basic dental, optician and chiropody services are made available to the residents. Records showed that residents’ health and personal care needs are being supported. None of the residents in the home manage their own medication at present. The home generally uses a monitored dosage system of medication administration. The homes medication record was good. The medication storage was clean and ordered. The staff have received external medication training. The residents can be assured that they are receiving their prescribed medication appropriately. Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 12 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 The welfare of the residents is protected through, the proper management of concerns and complaints and thorough adult protection procedures. EVIDENCE: There is a complaints procedure in the Service Users Guide. The Registered Providers were advised to display the complaints procedure privately within each client’s bedroom to ensure that contact information within it is easily available to both clients and their relatives. The home has all the appropriate anti abuse policies and procedures in place. Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 13 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): 24,25,26,27,28,30 The residents benefit from a homely, comfortable, clean and well maintained building. EVIDENCE: The home provides appropriate accommodation and facilities to meet the needs of the clients. The accommodation is adequately maintained. To the rear of the building is an enclosed and safe garden area of a reasonable size. To the front is a second small patio area with cover used by the clients mostly as a smoking area. Smoking is not allowed anywhere inside the home. The owners have carried out considerable work including, installation of sinks in bedrooms, new carpeting and work to the heating system in order to achieve registration of this small domestic style care home. The bedrooms are of a good size and there is a reasonable level of personalisation in each resident’s room depending on the client’s tastes. Furnishings and fittings in bedrooms were of good quality and all the bedrooms are carpeted. The quality of the living environment, and the standard of decoration and fixtures in the communal areas are good. The home was clean and odour free. All the bathroom and toilet doors are fitted with locks that can be overridden from the outside to ensure the residents safety. All the bedroom doors are fitted with individual locks.
Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 14 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): 32,33,34,35 Resident’s needs are met by enough staff. The home is deficient in some areas of staff recruitment practice and training. EVIDENCE: Personnel records were available in the home to verify the recruitment and training carried out for each member of staff. The providers stated that there is always an adequate number of staff on duty to meet the needs of the residents and a rota record is in place. Because of the small size of the home and the extensive care work done by one of the providers, only a small staff team is necessary. Of the four persons delivering care two have gained an NVQ2 qualification, which equals 50 of the care staff team. A training programme is being developed by the providers to ensure that residents’ needs are fully met by skilled staff. However it was unclear what basic training had been undertaken by the staff before they became employed at Rielly’s House. Copies of training certificates had not been gathered for all the staff as part of the recruitment process. All new members of staff should supply copies of training certificates to verify the basic training they have previously received. There was a structured induction format. This induction procedure had not as yet been completed by any of the staff. The providers were also advised to reorganise the induction process to show the time within which different parts of the process should be completed. It was evident that the staff did not have previous experience with a client group the same as at Rielly’s House. They
Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 15 had not had training in mental health awareness to support their practice. All members of staff should undertake basic training in the provision of mental health care to ensure that they have the skills to work with this client group. Two of the three staff did not have the two required references on their personnel file. The registered persons must in future obtain two appropriate written references for each new member of staff before they commence work at the home. The registered providers had misunderstood the need for a new Criminal Records Bureau (CRB) check for every newly employed member of staff. Though CRB checks had been applied for none had yet been cleared. Due to the small staff team and the usual lone working arrangement in the home, close supervision of staff awaiting CRB clearance is unlikely to be possible. The registered persons are required to obtain either a CRB clearance for each new member of staff before they commence work at the home, or have satisfactory arrangements in place to closely supervise the new member of staff at all times till the CRB clearance has been returned. Although all three care staff had an application form on file, no job description or contract of employment had been issued to them. Therefore staff had not received ‘a statement of terms and conditions’ (NMS34.6) nor was there evidence of an agreement with the staff member on ‘the position held, the work performed or the number of hours employed’ Schedule 4, Care Homes Regulations. Each member of staff should be issued with a contract of employment and a job description. Rielly`s House DS0000063791.V249979.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): 37,38,40,41,42 The management of the home is effective, ensuring that residents’ needs are met. EVIDENCE: Mr Paul Rielly holds the registered manager role. He has obtained an NVQ 4 in Care and the Registered Managers Award. The providers ensure that there is an open positive and welcoming atmosphere within the home. The interaction between the residents and providers throughout the inspection showed that the needs of the residents are paramount to the management. All the residents have their own individual named bank accounts and any personal money kept safe by the management is kept individually. Records are generally well maintained in the home. The following section covers Health and Safety. Fire protection system records are in place. There is a gas fire in the lounge instead of direct central heating. This appliance heats the room effectively. This gas fire should be risk assessed with regard to the needs of each resident living in the home. Though some CORGI registered work was carried out prior to registration, a CORGI registered servicing contact is not yet in place for the
Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 17 gas appliances in the home. Domestic electrical appliances were tested and certified on 17/11/05. An NIEC registered electrician should also certificate the safety of the mains wiring in the home. Window-opening restrictors have been fitted to some of the windows above ground floor or with a significant outside drop. A risk assessment was not in place for each of the relevant unrestricted windows to show that not restricting the opening of the window is safe. All window openings above ground floor level that have not been physically restricted must either be physically restricted, or a written risk assessment must be carried out that concludes that the risk of not restricting the window is acceptable. The Registered Providers stated that all of the hot water taps available to residents, except the two communal showers, had been adapted to reduce the water temperature to approximately 43 degrees centigrade at the point of use. Risk assessments should be in place for each shower to document that this situation is safe. Some of the radiators in the home have been covered. Each of the remaining uncovered radiators should be risk assessed and this assessment should be documented. Also a Legionella risk assessment should be put in place. Management of risk in the kitchen/dining area and the items within it, are continuously under consideration. This ongoing risk assessment should be documented and kept accurate at all times. Good management of health and safety protects the welfare of the residents. Rielly`s House DS0000063791.V249979.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 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 N/A 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 1 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Rielly`s House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 1 X DS0000063791.V249979.R01.S.doc Version 5.0 Page 19 NO 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 YA34 Regulation 19 Requirement The registered persons must obtain two appropriate written references for each new member of staff before they commence work at the home. The registered persons must either obtain a CRB check for each new member of staff before they commence work at the home, or have satisfactory arrangements in place to closely supervise the new member of staff till the CRB clearance has returned. All window openings above ground floor level that have not been physically restricted must either be physically restricted, or a written risk assessment must be carried out that concludes that the risk of not restricting the window is acceptable. Timescale for action 31/12/05 2 YA42 13 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 20 No. 1 2 3 4 Refer to Standard YA1 YA6 YA34 YA35 Good Practice Recommendations The Statement of Purpose and the Service Users Guide should be amended. Every resident’s individual care plan / risk assessment should include all the agreed restrictions that are in place to support the resident’s care at Reilly’s House. Each member of staff should have a contract of employment and a job description. Copies of each staff members training certificates should be kept on file. The induction procedure for new members of staff should be reorganised to show timescales and all new staff should complete their induction programme. All members of staff should undertake basic training in the provision of mental health care. The gas fire in the lounge should be risk assessed with regard to the needs of each resident in the home. A CORGI registered servicing contact should be in place for the gas appliances in the home. An NIEC electrician should certificate the safety of the mains wiring in the home. A general risk assessment should be in place for the home including; management of the kitchen area and items within it, management of unregulated hot water available to residents, i.e. the two showers, the non covered radiators in the home, and the management of risk of Legionnaires disease. 5 YA42 6 YA42 Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Rielly`s House DS0000063791.V249979.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
