Inspection on 08/11/05 for Ryan Q.C. Homes, Farthings

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ryan Q.C. Homes, Farthings 07/02/07

Ryan Q.C. Homes, Farthings 16/02/06

Ryan Q.C. Homes, Farthings 04/01/05

Ryan Q.C. Homes, Farthings 13/05/04

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Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Ryan Q.C. Homes, Farthings 86 Lumbertubs Lane Boothville Northampton Northants NN3 6AH Lead Inspector Mrs Helen Wilson Unannounced Inspection 8th November 2005 18.30 Ryan Q.C. Homes, Farthings DS0000012905.V249873.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 Ryan Q.C. Homes, Farthings DS0000012905.V249873.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. Ryan Q.C. Homes, Farthings DS0000012905.V249873.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ryan Q.C. Homes, Farthings Address 86 Lumbertubs Lane Boothville Northampton Northants NN3 6AH 01604 643726 01604 492770 laurierqch@aol.com 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) Mrs Margaret Laurie Duggan Mrs Margaret Laurie Duggan Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ryan Q.C. Homes, Farthings DS0000012905.V249873.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4 January 2005 Brief Description of the Service: The Farthings is one of two homes run by Ryan Q.C. Homes and provides personal care for up to six younger adults who have learning disabilities. The home is situated in a residential suburb of Northampton and is indistinguishable from neighbouring houses. The home is a detached house with large private gardens and provides all single occupancy bedrooms. Ryan Q.C. Homes, Farthings DS0000012905.V249873.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of Inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon the outcomes for people who use the service and their views about the service they receive. This was an unannounced inspection lasting two and a half hours carried out on a Tuesday evening when all service users were at home with two staff members. The primary method of inspection used was ‘case tracking’ which involved selecting one person living at the home and tracking the care they receive through review of their records, observations and conversations with service users and care staff. The registered manager was on holiday and the home’s operation being overseen by a senior carer; the deputy manager arrived later to assist with any inspection issues. What the service does well: What has improved since the last inspection? Four staff members, including the registered manager, have recently enrolled for assessment for a Level 4 National Vocational Qualification in management. Ryan Q.C. Homes, Farthings DS0000012905.V249873.R01.S.doc Version 5.0 Page 6 The care plan records have been redesigned to be more understandable for the service users with pictures describing care tasks. These however have not yet been put into use. 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. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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 Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): 5 Contracts have been discussed, explained and signed between the home and service users and their families. EVIDENCE: Signed contracts were noted in service users case files and staff described how the information had been individually explained to people living at the home. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): 6,7,8 The home ensures that service users are given opportunities to make decisions and everyday choices. EVIDENCE: The case file examined showed that the home’s manager works with the service user to make decisions about their daily life, plans and choices. Staff and service users have an easy rapport in conversation resulting in decisions and choices being negotiated and discussed. Service users are able to visit their families and friends and bring visitors to the home. Service users have been asked to help design notices/invitations to the Christmas party and to decide who should be invited to attend. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): 11,12,13,14,15,16,17 Service users lead ordinary lives with opportunities for social activities and continuing education. EVIDENCE: The home organises an annual holiday for service users accompanied by staff. Service users spoke about their routines and interests and said that they had active and stimulating activities both in and out of the home. Service users go to various day centres and community work places on weekdays, some people attend local college courses such as cooking and gardening. Social outings are arranged including visits to a local arts and craft evening. Staff confirmed that service users are enabled to develop independent living skills such as personal shopping. The home encourages and supports service users to maintain regular contact with family and visitors are welcome at the house. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): 20 The home has failed to ensure that a safe, consistent system of medication administration is operated and this potentially puts service users at risk. EVIDENCE: Whilst case files are well arranged into sections, the content of documents relating to health matters for one service user was incomplete and not used for cross referencing to medication administration sheets. Staff on duty confirmed that staff communicate issues verbally at daily shift handover however important information as a result may not then be recorded on file. Medication administration records and medication stock were checked for service user “AJ” and it was found that a supply of one specific tablet was not being administered according to the instructions on the pharmacy label nor according to the instructions detailed on the home’s typed Medication Administration Record sheet relating to dosage and frequency. Medication Administration Record sheets evidence use of nursing-type instructions such as “nocte” and “tds” and this is not acceptable guidance for care staff. Ryan Q.C. Homes, Farthings DS0000012905.V249873.R01.S.doc Version 5.0 Page 12 An Immediate Requirement was made during the inspection for urgent action to ensure administration of medication required by service users, discussion with the General practitioners involved and removal of nursing instructions. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): EVIDENCE: These standards were not inspected. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): 24,25,27,28,30 The home is comfortable and well furnished, suitable for the needs of people living there. EVIDENCE: The home appears comfortable, homely and reasonably maintained, with adequate space for the six service users currently in residence. Two bedrooms were seen and were comfortably furnished and personalised. There are two bathrooms in the house, one containing a bath and one a shower. A new en-suite facility is being installed in a ground floor bedroom to assist the existing service user. The home was clean and tidy at the time of the Inspection. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): 31,32,33,35 Staff are experienced and trained which directly supports the service users. EVIDENCE: Staff rosters do not clearly state which manager is on-call leaving staff to ring round some three/four people should support be required. These arrangements and telephone numbers should be clear and immediately to hand for staff. Staff on shift were enthusiastic, experienced and knowledgeable about the needs of the individual service users. Personal care/support for service users was carried out professionally and in private. The person in charge of the home confirmed that he had received appropriate training for his role as a shift leader and that he is to recommence the National Vocational Qualification Level 3 in care. The home has a high ratio of care staff holding National Vocational Qualifications. Service users spoke positively about the staff at the home and were confident in conversation with them Ryan Q.C. Homes, Farthings DS0000012905.V249873.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): 37,40,41 The home fails to provide effective and efficient management of records and policies and therefore potentially puts staff’ and service users’ interests at risk. EVIDENCE: The manager and three others on the staff team have started an NVQ course in management at level 4. The requirements of standard 37 will be met on the manager’s completion of this course. The manager has 3 deputy managers to support her across both homes and it was clear that record management was an area for development at the recent inspection of the sister home. The office environment and the record systems were poor and in disarray. The registered manager said then that an office system was going to be set up at The Farthings but this has not been done. Whilst case files are well arranged into sections, the content of documents relating to health matters for one service user was not completed for some months and not used for cross reference nor information to medication administration sheets. Staff on duty confirmed that staff usually communicate Ryan Q.C. Homes, Farthings DS0000012905.V249873.R01.S.doc Version 5.0 Page 17 issues verbally at daily shift handover however important information as a result may not then be recorded on file. The home has been revising the range of policies, procedures, and care plan formats to make them more appropriate and pictorial for use by service users. From checking of a case file there was no evidence, other than new staff photographs, that revised written forms had been subsequently introduced. Ryan Q.C. Homes, Farthings DS0000012905.V249873.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 X X X 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ryan Q.C. Homes, Farthings Score X X 1 X Standard No 37 38 39 40 41 42 43 Score 2 X X 2 1 X X DS0000012905.V249873.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 YA20 Regulation 12,13(2) Requirement The home must ensure that prescribed medication is administered in accordance with the directions of the prescribing General Practitioner. This was an Immediate Requirement made during the inspection on 8/11/05. Staff rosters must identify for each shift the name and contact telephone number for the manager on-call for emergency support. Individual service user’s records and the home’s record system must be up-to-date, detailed and accurate. Timescale for action 11/11/05 2 YA33 18 31/12/05 3 YA40YA41 17, Schedule 3 and 4 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. No. 1 Refer to Standard YA37 Good Practice Recommendations The Registered Manager should continue to complete the National Vocational Qualification Level 4 in Management. DS0000012905.V249873.R01.S.doc Version 5.0 Page 20 Ryan Q.C. Homes, Farthings Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Ryan Q.C. 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