CARE HOME ADULTS 18-65
Robinsfield Robinsfield 35 Whyteleafe Road Caterham Surrey CR3 5EJ Lead Inspector
Marianne Barham Unannounced Inspection 23rd January 2006 12:20 Robinsfield DS0000013766.V260667.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 Robinsfield DS0000013766.V260667.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. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Robinsfield Address Robinsfield 35 Whyteleafe Road Caterham Surrey CR3 5EJ 01883 330070 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) Welmede Housing Association Ltd Ms Jacky Barker Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: Up to 5 persons 21-55 YEARS WITH ONE NAMED PERSON BEING IN THE AGE RANGE 17-21 YEARS Persons with learning disabilities accommodated at the home may also have an additional physical disability 25th October 2005 Date of last inspection Brief Description of the Service: Robinsfield is a large property located in Caterham within walking distance of local shops and bus routes. The home is located on the ground floor of the property, with the first floor being occupied by tenants of supported living flats, run separately to the home. The main entrance to the property is shared with the supported living tenants and the laundry and staff sleep-in room is located in the entrance hall. The main door to the home is kept locked at all times to ensure the safety and security of the tenants. The home is owned and managed by Welmede Housing Association and provides accommodation and care to six tenants who have a learning disability and also physical disabilities. The accommodation comprises of six single occupancy bedrooms, a large kitchen/diner, a comfortable lounge, two bathrooms and a shower room. There is a good range of adaptations and facilities fitted throughout the home to enable the home to meet the needs of the tenants. There is a well-kept garden to the rear of the property, shared with the supported living tenants, and parking for several cars to the front. The home does not have its own vehicle and tenants are picked up and dropped off by the transport of the various Day Centres they attend. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 12.20pm by Marianne Barham, regulation inspector on behalf of Vera Bulbeck, lead inspector for the service. The inspection was undertaken over a period of three hours and was the second inspection in the Commission for Social Care Inspection year April 2005 to March 2006. The registered manager Ms Jacky Barker was present, records relating to the care of the tenants and management of the home were examined and a tour of the premises was undertaken during this inspection. The inspector was able to speak with three members of the staff team who gave their views on the service provided. The manager informed the inspector that the service users of the home prefer to be known as tenants and will therefore be referred to as such throughout this report. The tenants were unable to express their views of the care and services provided by the home verbally or through sign language, however they appeared to be relaxed, well cared for and comfortable in the presence of members of staff. What the service does well:
The home has an established, trained staff team who know the tenants very well and this is reflected in the caring informal interactions observed between the staff and the tenants during this inspection. Members of staff spoken with said that they received enough training and supervision to carry out their jobs and were supported by the manager. All said that they enjoyed working in the home and were committed to providing the best care to the tenants of the home. Tenants bedrooms are pleasantly decorated and comfortably furnished according to each person’s individual taste. All rooms were personalised with tenants’ own belongings and reflected their different interests and preferences. The home encourages and supports tenants to maintain contact with their families and friends and has sought an independent advocate for those without any close family. Good systems are in place for assessing the individual needs of tenants and planning their care, with the tenants and their families or representatives being fully involved in the process. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
It was disappointing to see that two requirements made at the last inspection had not been met. These were to ensure all staff working in the home had a Criminal Records Bureau check undertaken and to attend to the maintenance issues in the shower room. These requirements have been carried forward. The bath in the main bathroom is set very low to the ground and is not adapted for people with physical disabilities. This poses a risk to members of staff of back or knee injury as they have to either bend over the bath to help tenants to wash or kneel on the floor. A requirement has been made to have the risk posed by this assessed by a suitably qualified person, for example a moving and handling advisor or physiotherapist. A recommendation has also been made that the bath be replaced with an adapted bath more suitable to the needs of people with physical disabilities. The enamel in this bath is cracked which may cause discomfort to tenants and requirement has been made that this is repaired or replaced. The registered manager has not yet commenced the NVQ level4/Registered Managers Award course despite this being made a condition of her registration as manager of the home. A requirement has been made that she commences this course and provides written evidence to the Commission of this by 30th April 2006. There has been much improvement in the administration, recording and storage of medication in the home, however there is no procedure in place for recording medication given to families or returned by them when tenants stay away from the home. A recommendation has been made that this is done. The home has a comprehensive list of policies and procedures in place, however these are devised for the whole organisation and do not reflect the individual circumstances in the home. This was discussed with the manager and a recommendation has been made to address this.
Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 7 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. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 8 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 Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 9 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 and 2 Tenants and their families have enough information to make an informed choice about where they live, and tenants’ needs and aspirations are assessed. EVIDENCE: The home has a comprehensive statement of purpose that gives detailed information on all aspects of the facilities and services provided in the home. The service users guide gives clear information to prospective tenants in an accessible format and both documents have been reviewed and updated recently. This meets a requirement made at the last inspection on 25th October 2005. Individual assessments are carried out for each tenant and these are reviewed every six months or more frequently if necessary. The assessments cover all aspects of the person’s needs and provide detailed information and guidance for staff members to follow in order to meet their needs. Robinsfield DS0000013766.V260667.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): N/A These standards were not assessed at this inspection. Please see report dated 25th October 2005 for detail on these standards. EVIDENCE: Robinsfield DS0000013766.V260667.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): 16 The rights and responsibilities of tenants are respected and promoted by the home. EVIDENCE: Tenants are supported to make choices in their everyday lives as far as they are able. Families of tenants are consulted and encouraged to be involved the decision making process and those without family have access to an independent advocate. The home has quality assurance systems in place to gain feedback from tenants and their families and all tenants have ‘person centred’ plans formulated in consultation with them and other involved people. All members of staff receive training at induction on respecting and promoting the rights of tenants and all tenants are registered to vote. Robinsfield DS0000013766.V260667.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): 20 Tenants are protected by the home’s policies and practices for dealing with medicines. EVIDENCE: The home has a policy and procedure in place for dealing with medicines, medication in the home was seen to be stored appropriately and records maintained accurately. It was pleasing to see that medications received into the home are now signed for and there is evidence of staff receiving accredited training on the administration of medicines. The home has liaised with the supplying pharmacy and has seen a great improvement in the service provided. All handwritten entries on the medication charts are now signed by, two members of staff. These meet requirements and a recommendation made at a pharmacy inspection carried out on 25th November 2005. It was observed that there is no procedure in place for staff members to follow for the dispensing or returning of tenants’ leave medication and a recommendation has been made that clear guidance is put into place for this to reduce the risk of error. Robinsfield DS0000013766.V260667.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): N/A These standards were not assessed at this inspection. Please see report dated 25th October 2005 for detail on these standards. EVIDENCE: Robinsfield DS0000013766.V260667.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): 27 The toilets and bathrooms generally meet the tenants’ needs, however the shower room requires attention, no paper hand towels are provided and the main bath poses a risk of injury to members of staff. EVIDENCE: A requirement was made at the last inspection on 25th October 2005 to refurbish the shower room owing to there being a rusty radiator, shower head in need of replacement and mouldy tiles caused by condensation build up as the extractor fan does not work. This has not yet been done, however the inspector was able to see a letter confirming that the works are to commence on 3rd February 2006. This requirement has been carried forward. The main bathroom is of a good size and has an overhead tracking hoist system in place. It was therefore disappointing to see that there is only a standard bath set very low to the floor posing a risk of back injury to members of staff. The enamel on the bath is also badly scratched and a requirement has been made that this must be repaired or replaced to maintain the comfort of the tenants. A requirement has been made that the use of this bath is risk assessed by a person qualified to do so, for example a moving and handling advisor or
Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 15 physiotherapist and any recommendations made acted upon. A strong recommendation has been made that this bath is replaced with an adapted bath purchased in consultation with the qualified person as identified above. It was also observed that there were no paper hand towels in any of the bathroom/toilets posing a risk of cross infection and a requirement has been made to address this. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 The staff team are appropriately qualified and competent to carry out their duties, however the manager needs to commence and complete the registered managers award and NVQ level four. The tenants are generally supported and protected by the home’s recruitment policies and practices, however insufficient checks have been obtained for one member of staff. EVIDENCE: One member of the staff team holds the level three NVQ qualification and six others hold the level two. The registered manager holds the NVQ level three and is waiting to commence the level four in care and registered managers award. This was made a condition of her registration as manager of the home and a requirement has been made that she has commenced the course by 30th April 2006. Recruitment files for a number of staff members were examined and found to be in order and contained all necessary checks and information required with the exception of one file. This file was identified at the last inspection on 25th October 2005 as having no references or a Criminal Records Bureau (CRB) check and a requirement made to address this. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 17 The manager stated that several phone calls had been made to the CRB office but the check had still not been completed. One reference has been obtained since the last inspection, but one is still outstanding. The manager said that the staff member did not work unsupervised, but on further discussion it was apparent this member of staff had been giving personal care to tenants on a regular basis without direct supervision. A requirement has been made that this person’s work with tenants must be under direct supervision at all times until a satisfactory CRB check has been received. The inspector has requested that this be confirmed to the Commission in writing. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 18 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): 40 The homes policies and procedures protect the best interests and rights of the tenants. EVIDENCE: A requirement was made at the last inspection to review and update the policies and procedures in the home. These were examined and there was evidence of regular review having taken place and of staff read and sign sheets for each procedure. The procedures in place are produced by the organisation and therefore do not reflect the individual circumstances in the home. This was discussed with the manager and a recommendation has been made that local procedures to be introduced where appropriate, for example the moving in/on/changing needs or key working policies. Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X N/A Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X 1 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Robinsfield Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X X 3 X X X DS0000013766.V260667.R01.S.doc Version 5.0 Page 20 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 27 Regulation 23 (2) (b) (d) (p) Requirement The shortfalls in the shower room as identified in the main body of this report must be attended to and the area maintained in good decorative order. The scratched enamel on the bath in the main bathroom must be repaired or replaced. A risk assessment must be carried out by a person qualified to do so of the suitability of the bath in the main bathroom with regard to the risk of back injury posed to members of staff supporting tenants using the bath. The registered manager must commence the NVQ 4/Registered Managers Award and provide written evidence to the Commission that this has been done. A named member of staff must not carry out personal care duties for any tenants of the home at any time unless under direct supervision until a satisfactory CRB check has been received.
DS0000013766.V260667.R01.S.doc Timescale for action 28/02/06 2 3 27 27 23 (2) (c) 23 (2) (n) 28/02/06 28/02/06 4 32 9 (2) (b) (i) 30/04/06 5 34 19 (1) (a) 24/01/06 Robinsfield Version 5.0 Page 21 6 34 19 (1) (a) The registered person must confirm to the Commission in writing that the named member of staff is working under direct supervision as described above. 27/01/06 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 2O Good Practice Recommendations It is strongly recommended that a procedure be put into place for staff to follow when dispensing or receiving returned leave medication in order to reduce the risk or errors occurring. It is very strongly recommended that following the risk assessment as described above an adapted bath suitable to needs of physically disabled tenants be purchased and installed in the main bathroom, taking into account any recommendations made by the person carrying out the risk assessment. It is strongly recommended that the manager review the organisation policies and procedures to reflect the individual circumstances in the home. 2 27 3 40 Robinsfield DS0000013766.V260667.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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