CARE HOME ADULTS 18-65
Ryan Q.C. Homes, The Elms The Elms 10 Repton Court The Arbours Northampton Northants NN3 3RQ Lead Inspector
Mrs Helen Wilson Unannounced Inspection 26 September 2005 16:30 Ryan Q.C. Homes, The Elms DS0000037246.V249897.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, The Elms DS0000037246.V249897.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, The Elms DS0000037246.V249897.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ryan Q.C. Homes, The Elms 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) The Elms 10 Repton Court The Arbours Northampton Northants NN3 3RQ 01604 643726 01604 492770 laurierqch@aol.com Mrs Margaret Laurie Duggan Mrs Margaret Laurie Duggan Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ryan Q.C. Homes, The Elms DS0000037246.V249897.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. There is currently one Service User within the category of LD. By agreement there will not be any further admissions of Service Users under the age of 30 years. 30 December 2005 Date of last inspection Brief Description of the Service: The Elms is one of two homes run by Ryan Q.C. Homes and provides personal care for up to three young adults who have learning disabilities. The home is situated in a cul-de-sac in a residential area of Northampton and is indistinguishable from neighbouring houses. The home is a bungalow with all bedrooms single occupancy. Ryan Q.C. Homes, The Elms DS0000037246.V249897.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. 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, discussion with service user, the manager and care staff. This Inspection was unannounced and took place over a period of three hours with time spent inspecting records and discussing the day-to-day running of the home with the manager Mrs L Duggan. What the service does well: What has improved since the last inspection? What they could do better:
The home has failed to comply with requirements of the previous inspection report and must do so urgently. For the second time at inspection it was found that the home is often left in the charge of staff under the age of twenty-one years. This is never acceptable and was a requirement of the last inspection but not remedied.
Ryan Q.C. Homes, The Elms DS0000037246.V249897.R01.S.doc Version 5.0 Page 6 The home has also failed to comply with a previous requirement relating to the administration of particular medication and delegation of this task by a District Nurse to named and trained staff members at the home. The outside of the home needs attention to the peeling paintwork and the front paved pathway used by the service users is broken and uneven. The office and administration systems were very disorganised and this was recognised in discussion by the manager. 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, The Elms DS0000037246.V249897.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, The Elms DS0000037246.V249897.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): EVIDENCE: These standards were not assessed. Ryan Q.C. Homes, The Elms DS0000037246.V249897.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 and 7. The home ensures that service users are given opportunities to make decisions and everyday choices. EVIDENCE: There was evidence on the case file of a service user that regular reviews had taken place with the Placing Authority and that care plans had been revised following the review. 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. Ryan Q.C. Homes, The Elms DS0000037246.V249897.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 and 17. The home supports the service users to lead ordinary lives with opportunities for social activities and continuing education. EVIDENCE: The home organises an annual holiday for service users accompanied by staff. One service user was helping a staff member prepare the evening meal. One service user goes to a day centre each weekday and two others are enrolled on local college courses such as animal care and countryside awareness. Social outings are arranged including visits to a local community group. The home encourages and supports service users to maintain contact with family and visitors are welcome at the house. One service user had just returned form a family visit and another was due to telephone her family. Ryan Q.C. Homes, The Elms DS0000037246.V249897.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): 19 and 20 Generally the health needs of service users are met however the home has failed to protect, and therefore puts service users at potential risk, people by seeking guidance from District nurses about specific medication administration. EVIDENCE: The manager has been in regular contact with a local GP regarding the health of one service user and is anticipating that a referral to a consultant will be offered. Medication for service users is administered by staff. The manager has not complied with a previous inspection requirement concerning a particular drug administration. The home must urgently contact the District Nurse to confirm the competence and training of staff who are delegated this task. Ryan Q.C. Homes, The Elms DS0000037246.V249897.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): EVIDENCE: These standards were not assessed. Ryan Q.C. Homes, The Elms DS0000037246.V249897.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): 24,25,28 and 30. Although the home is comfortable, there are signs that regular exterior maintenance of the premises has not been carried out resulting in a particular tripping risk to service users. EVIDENCE: The lounge/diner, kitchen and one of the bedrooms were comfortable, pleasantly decorated and homely. Other areas were not inspected. The home was clean and had no malodours. The level of lighting in the bedroom was rather dim and must be checked to ensure that adequate light, both natural and artificial, is provided so that service users’ individual needs are met. The outside of the home needs attention to the peeling paintwork and the broken paved front pathway used by the service users. Ryan Q.C. Homes, The Elms DS0000037246.V249897.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 and 36 The home has failed to ensure that appropriately aged staff are in charge and directing the care of service users. EVIDENCE: The staffing rosters showed that, despite a requirement made in December 2004, the home leaves a staff member under 21 years of age in charge of shifts on a very regular basis. This is not acceptable and must be urgently remedied. Staff files showed good recruitment procedures but the files were not kept in an organised manner with the result that the manager had to search for particular documentation elsewhere. The home has a high ratio of staff holding National Vocational Qualifications. The manager stated that staff are supervised regularly; there was no evidence in staff files to support this. Ryan Q.C. Homes, The Elms DS0000037246.V249897.R01.S.doc Version 5.0 Page 15 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 and 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 is clear that record management is an area that the manager has delegated to others. The office environment and record systems were poor and in disarray. The office, files and administration systems were very disorganised and this was recognised in discussion by the manager who said that this would be remedied. The manager was able to show that documents, such as care plans, policies and procedures, are being revised and redesigned using computer technology to simplify written information for service users. The new documents have not yet been introduced.
Ryan Q.C. Homes, The Elms DS0000037246.V249897.R01.S.doc Version 5.0 Page 16 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 X Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 x x 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 X 3 1 3 3 1 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Ryan Q.C. Homes, The Elms Score X 3 1 X Standard No 37 38 39 40 41 42 43 Score 2 X X 2 1 X X DS0000037246.V249897.R01.S.doc Version 5.0 Page 17 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement Timescale for action 15/10/05 2 YA33 3 4 YA24 YA25YA24 5 6 YA36 YA41YA40 There must be evidence that the local GP Surgery has delegated tasks such as the administration of stesolid to named and trained care staff. This was an unmet requirement from the December 2004 inspection. 18 Staff left in charge of the home at any time must be at least 21 years of age. This was an unmet requirement from the December 2004 inspection. 13(4) The paved front pathway must be repaired and made safe for use by service users. 12(1),13(4), The level of lighting in 23 bedrooms must be checked to ensure adequate light, both natural and artificial, is provided. 18(2) Staff files must include documented evidence of regular supervision sessions. 17 Policies and procedures, staff files and service users’ records must be re-organised and appropriately held for use in the home’s office.
DS0000037246.V249897.R01.S.doc 15/10/05 31/10/05 31/10/05 31/10/05 31/10/05 Ryan Q.C. Homes, The Elms Version 5.0 Page 18 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. Ryan Q.C. Homes, The Elms DS0000037246.V249897.R01.S.doc Version 5.0 Page 19 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
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