CARE HOME ADULTS 18-65 Saeeda 17 Green Lane Redruth Cornwall TR15 1JY
Lead Inspector Stephen Baber Announced 04 May 2005 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 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 Stationary 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. Saeeda Version 1.10 Page 3 SERVICE INFORMATION
Name of service Saeeda Address 17 Green Lane Redruth Cornwall TR15 1JY 01543 420020 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Swallowcourt Ltd Mrs Lynette Horne Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Saeeda Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Saeeda Is registered under The Care Standards Act 2000 to provide personal care and accommodation to 8 service users with a learning disability. Date of last inspection January 2005 Brief Description of the Service: Saeeda is a care home providing residential accommodation to a maximum of eight adults with a learning disability. The aim is to provide a good quality of care and to work with service users to maximise their independence. Service users are supported to maintain contact with their families and to be involved in the local community. The staff team encourage independence in personal skills. The service users live as a community – for example going on group holidays together. The home is an attractive Victorian property situated close to Redruth town centre. The home is situated within easy reach of the town of Redruth with good access to transport and all the facilities of the town. The company provide free transport for outings out. Service users are provided with individual furnished bedrooms and a shared bathrooms and shower rooms. The home is undergoing major upgrading work to all areas throughout the home. At present there is a kitchen on the lower ground floor and dining room and lounge on the ground floor. The company have invested substantially in the recent months to improve the decoration and fabric of the home. The home has a small garden and there is parkig for two cars. Service users attend a range of day activities which are mainly commissioned by the Cornwall County Council Social Services Department. Swallowcourt employs a manager and team of staff to provide care and support for the service users living in the home. The managing director and senior managers from outside of the home are available to provide additional specialist input as and when it is required.
Saeeda Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the home’s annual inspection programme on May 4 2005 starting at 8.30 am and finishing at 18:30 p.m. The inspector was at the home for ten hours. The manager completed a preinspection questionnaire, which was presented on the day of the inspection. The inspector undertook the following activities whilst at the home 1. Inspection of records, including assessment information and care plans 2. Discussion with the manager of the home on how it operates on a day-today basis 3. Inspection of the building 4. Interview with 4 members of staff and discussion with the managing director and learning disability manager for the company. 5. Individual interviews with each of the 7 service users. 6. Observation of the daily life of the home. 7.No relatives were present on the day of the inspection. What the service does well:
The service users in the home have lived there for several years and are well settled at Saeeda. The house is comfortable and homely, with a small garden at the side of the building with parking spaces for two cars at the back. It is in the town of Redruth and the town centre is within easy walking distance. There are good public transport routes and the home shares a vehicle with its sister homes. The service users enjoy a wide range of activities inside and outside of the home, including attendance at the local college, voluntary work, social events and sporting activities. They are encouraged to keep in touch with their families and meet with people from outside of the home. Service user showed their rooms to me, which was comfortable and personalised. All of the service users said that they enjoyed most of the activities provided for them at the home and that they are free to do whatever they wish. Service users go shopping for the household food with the manager; take it in turns to do household tasks. Mealtimes are flexible which is a great improvement and they can make themselves drinks whenever they wish. They all said that they are satisfied with the food provided to them. They are encouraged to eat healthily and always have access to fresh fruit and healthy snacks. Saeeda Version 1.10 Page 6 Service users are encouraged to be independent in their personal care and take pride in looking smart and fashionably dressed. They enjoy going out shopping for their personal effects and clothes. This is another improvement All of the service users said that they feel safe in the home and would be able to talk to somebody if they were unhappy about their care. The company are committed to providing training for all staff and it was evident to the inspector that this was having benefits for all staff. The company employ a training manager who oversees the training of all staff. The service users said they enjoy living at Saeeda. What has improved since the last inspection? What they could do better:
Policies and procedures should be updated and reviewed to provide guidance to all staff and service users in order to protect their health and welfare. Whenever possible the service users and their representative should be encouraged to participate in the care planning so that agreement can be reached on the care to be given. Better evidence that staff have been given basic training in key areas of health and safety and first aid is also needed, particularly for those staff left alone in charge of the home at night.
Saeeda Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Saeeda Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Saeeda Version 1.10 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 standard(s) 1,2 4and 5.The home has a clearly written statement of purpose and service users’ guide that meets with the national minimum standards and regulations. Service users that will be admitted to the home will be assessed prior to their admission to the home to ensure that their needs could be met there. Initial visit to the home would be arranged and contracts for all service users are given EVIDENCE: The home’s current statement of purpose and service users’ guide have been updated and now include all the information required by regulation, including information on the staff currently employed to work in the home, their qualifications and experience. No new service users have been admitted to the home for some time although there is one vacancy. Interviews with the service users indicated that those currently resident in the home are very familiar with the services provided to them there. The manager has compiled assessment formats in readiness for a future admission. The manager discussed the assessment procedures and initial visit she would implement for prospective service users. The prospective service user would visit initially with their social worker, then again to have a meal and meet the service users. The current service users all have a standard local commissioning authority contract. Individual supplementary conditions, and agreements are recorded in the care plans. Saeeda Version 1.10 Page 10 Saeeda Version 1.10 Page 11 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 standard(s) 6,9,10Service users have detailed written care plans and are familiar with their contents. They are supported by detailed written risk assessments, to which they have provided written agreement and service users know that information about them is handled with confidence.. EVIDENCE: Service user’s written care plans have been completely reviewed. The inspector discussed with the manager adapting them to meet the needs of learning disability. Reviews will also have to be introduced at least once every six months. Care plans should be agreed with the service users and their representatives before they are implemented. Service users have some literacy skills and are able to directly contribute to their personal records. The inspector discussed with the manager translating the care plans into formats that could be understood by the service users that have limited literacy skills. The manager explained to the inspector that she works closely with all community professionals to promote the welfare and wellbeing of the service users. New risk assessments have been introduced and the manager and staff are going to introduce competence assessments to allow some service users greater independence. Reviews must be introduced. A new policy on
Saeeda Version 1.10 Page 12 confidentiality has been introduced to the staff. All staff should be trained in confidentiality and know that the company are registered under the Data protection Act 1998 and in the best interests of the service user. Saeeda Version 1.10 Page 13 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 standard(s) 11, 12, 15 and 17. Service users enjoy a wide range of activities in and out of the home in accordance with their assessed needs, preferences and written care plans. They are encouraged to maintain contact with their families and develop relationships with others in accordance with their risk assessments and abilities. Meals provide daily variation and interest for service users living in the home. EVIDENCE: Service users enjoy a broad range of activities in accordance with the home’s statement of purpose and their individual needs and preferences, in and out of the home. The manager said service users daily activities are planned individually on a weekly basis and gave examples of how she has assisted them to further develop their daily activities outside of the home. Service users attend training centres, horticultural activities, local colleges, leisure facilities and voluntary work placements. Free transport is provided by the company to assist staff who organise social functions and take service users to pubs, restaurants, places of interest in the local community and local shops. They help service users to maintain family links and develop friendships and
Saeeda Version 1.10 Page 14 relationships in accordance with their individual risk assessments. The service users showed me the photographs that been taken when they went to the Bird of Paradise Park Service users are encouraged to eat healthily. At present the staff prepare the main meal of the day. To assist the more independent service users encouragement should be given in all aspects of food preparation and development of their skills and independence in this respect. Service users go shopping for household food and choose what they want to eat. The situation of the kitchen on the lower ground floor is not ideal and could be dangerous. The company are going to address this when the improvements take place. Mealtimes are flexible to meet individual needs and the service users said that they enjoy the meals they receive. Fresh fruit is available at all times. Saeeda Version 1.10 Page 15 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 standard(s) 18,19 and 20. Service users’ personal support needs are fully met in accordance with their written care plans and individual needs. All staff have received medication training to ensure service users are not placed at risk. EVIDENCE: The management and staff offer support and guidance to service users with regard to their personal care, hygiene and what to wear. Their individual care plans and risk assessments detail the personal support they require. The service users told the inspector that they enjoy going out to buy their clothes and toiletries. All appeared smartly and fashionably dressed and take pride in their appearances. They also told me that they could please themselves what time they get up in the mornings and go to bed at night. This is a big change from the previous regime when there were set times for getting up and going to bed. Another area of improvement is with the management and administration of medication. All of the staff has completed the safe handling of medicines training and the home’s written policies and procedures have been updated and improved to reflect current best practice. Saeeda Version 1.10 Page 16 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 standard(s) 22 and 23. There are systems in place to ensure that service users are protected from abuse, neglect and self-harm. Policies, procedures and staff training that underpin protection of service users from abuse, neglect and self-harm are provided by the training manager and multi disciplinary agencies. EVIDENCE: The company training manager provides training in adult protection for all staff and supports the manager in personalise it to the servicethat is provided. There are corporate policies and procedures on Adult Protection and all staff receive training from induction. Staff are familiar with actions that they are expected to take in this respect. All of the service users said they feel safe in the home and would be able to make a complaint if necessary. Service users have regular contact with a range of professionals and relatives from outside of the home and senior management of the company visit on a regular basis. The senior manager for the company has done a lot of work on giving back to individual service users responsibility for their persona finances with the result that all service users manage some aspects of their personal finances and they all have individual bank accounts. There are records and receipts of all transactions where staff are involved in handling service users’ money and the personal finances are reconciled by a representative of the company who visits weekly. Saeeda Version 1.10 Page 17 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 standard(s) 24, 25, 26, 27, 28, 29 and 30. Service users live in a comfortable, homely environment where they are encouraged to personalise their rooms. Major upgrading work is taking place to improve the overall environment. Bathrooms and toilets are available throughout the home for service users. EVIDENCE: Saeeda is being updated to a high standard as evidenced from the work already completed. The service users were proud to show me their rooms and all their rooms can be locked.The service users also said that they enjoy going to their rooms to enjoy the privacy. All communal parts are fully accessible to the service users.. Two bedrooms have en-suite showers. One bathroom has recently been completely refurbished and refitted. This has a low-level entry temperature-controlled shower with a drop down seat fixed to the wall. There are two toilets upstairs and one toilet downstairs. There is a separate toilet in the staff accommodation. Anti-bacterial soap and paper towels have been purchased for the home and these are provided in all the bathrooms.Because of their extensive use of the
Saeeda Version 1.10 Page 18 kitchen, service users should be given basic food hygiene training. The fire safety risk assessment has now been completed and there are records of fire drills and equipment safety checks completed on a regular basis. Records of staff fire stafety training was fully up-to-date. The home is well situated for accessing the town centre and public transport. Saeeda Version 1.10 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 and 36. There is evidence that staffing ratios have been increased. There is evidence that service users are supported and protected by the home’s recruitment policy and practices. Staff are being given training in key areas, which are essential for service users’ safety and well being. Staff are generally well supervised and receive ongoing supervision and appraisal. EVIDENCE: Saeeda employs two staff who have achieved NVQ level 2, one level three and two currently undertaking level two. There was written evidence in the home that staff have undergone enhanced CRB checks and staff profiles have been compiled. The manager has employed staff since she has taken over and evidence showed that recruitment of staff protects service users. Completed application forms and interview records evidenced this. Staff profiles evidenced the training they have completed. A staff member said they feel supported by the manager and have had good access to training and knowledge in the specialist training required for people with a learning disability. Staffing ratios are kept under constant review. Staff morale is high resulting in enthusiastic workforce that work positively with service users to improve their quality of life. Supervision and appraisal have been introduced and the records inspected were up to date and in sufficient detail.
Saeeda Version 1.10 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 40, 41and 42. Service users’ rights and best interests are fully safeguarded by the home’s current policies and procedures. The manager creates an open and transparent approach to the running of the home. Quality monitoring systems with outcomes and aims should be available to evidence that the stated aims of the home are being met. EVIDENCE: There has been a review of all written policies and procedures. Staff receives training from induction in the policies and procedures of the company. The manager has compiled a crisis policy which details all emergency cut off points and what to do if they need to call the emergency services. The inspector spoke with some service users about the complaints and fire safety procedures and they said they knew how to make a complaint and they are familiarised with the fire procedure. Staff confirmed that training in relation to health and safety, particularly in respect of staff training in key areas such as emergency
Saeeda Version 1.10 Page 21 first-aid and fire safety have been provided by the company and amanger. The Manager discussed her commitment to an open and inclusive atmosphere. The Manager has a clear vision for the home and the care of the service users. She is confident that she communicates this to the staff team. Daily handovers and staff meetings are an opportunity to raise concerns and to find solutions to problems. The Manager stated that she strives to be approachable to service users and staff. The observation of interactions during the inspection supported this. Notes from residents’ meetings were inspected and these demonstrated that the service users are able to voice their concerns. Staff stated that they appreciated the direct and open style of the manager and had a clear understanding of the aims of the home.A yearly quality assurance exercise must be carried out to ensure that the service users views underpin all self monitoring, review and development by the home. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 Standard No 24
Version 1.10 Score 3
Page 22 Saeeda INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 2
Score 25 26 27 28 29 30
STAFFING 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 x x 3 x x Standard No 31 32 33 34 35 36 Score x 3 x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 1 3 3 3 x Saeeda Version 1.10 Page 23 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 17 Regulation 16(2)(n) Requirement The service users must be assisted to be more independent and to encourage them in all aspectsof food preparation and development of skills and independence in this request. Quality assurance exercise must be carried out toascertain the service users views, re3view and development of the home Timescale for action 30th November 2005 2. 39 24 30th November 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 6 6 30 17 10 Good Practice Recommendations Care plans should be adapted more to learning disability and reviews should take place at least every six months. Care Plans should be translated into formats that can be understood by those service users who would find it easier. service users who work in the kitchen should obtain the Basic Hygiene training. Blinds should be fitted in the kitchen to give privacy to all those people who use it. All staff should be trained in confidentiakity and know that the company are registered under Data Protection Act 1998.
Version 1.10 Page 24 Saeeda Saeeda Version 1.10 Page 25 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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