CARE HOME ADULTS 18-65
SCIC - Glebe Road, 26 26 Glebe Road Stratford On Avon Warwickshire CV37 9JU Lead Inspector
Kevin Ward Unannounced Inspection 7th December 2005 08:00 SCIC - Glebe Road, 26 DS0000004468.V270700.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 SCIC - Glebe Road, 26 DS0000004468.V270700.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. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service SCIC - Glebe Road, 26 Address 26 Glebe Road Stratford On Avon Warwickshire CV37 9JU 01789 298709 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) Stratford & District Mencap Mrs Alexandra Louise Arnold Care Home 4 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (1) of places SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. NVQ level 4 The Registered Manager achieve qualifications in both management and care including the Registered Managers Awared, by 2005. Learning Difficulty Award The Registered Manager pursues a professional qualification in the field of learning difficulty by undertaking the Learning Difficulty Award Framework level 3 by 2004. Successful completion of above awards The Registered Manager to notify the National Care Standards Commission upon successful completion of the above and immediately in the event that the Registered Manager fails to achieve it or that the Registered Manager ceases, for whatever reason, to undertake the stated training. Age Range of Residents People admitted to the home must be in the age range of 18 to 64 years. 14th July 2005 3. 4. Date of last inspection Brief Description of the Service: Glebe Road is a semi-detached house, which offers long-term accommodation for four adults who have learning disabilities. The current service users are all men. The property is rented from a housing association, with staff being provided by Stratford and District Mencap. It is not distinguishable as a care home from the other properties in the road. Car parking is limited. There are gardens to the front and rear of the property. Neighbours have right of way across the back garden, which it was advised does not impact on the service users safety. On the ground floor there is a lounge, kitchen and separate dining room, shower room/toilet, sleeping-in room/office. On the first floor there are four single bedrooms and a bathroom. The house is on the outskirts of Stratford, which is accessible by a regular bus service. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was time limited and focused mainly on reviewing progress made to meet previous requirements and recommendations and inspecting some of the core Standards that were not assessed at the last inspection. The inspection involved talking with the people who live in the home as they went about their morning routines and looking in their bedrooms with their permission. A number of policies and records were also seen, such as day notes and health and safety records. Since the last inspection one person has left the home to live elsewhere. There are currently three men living at the home. What the service does well: What has improved since the last inspection?
Since the last inspection the number of staffing hours available to the home has been increased to help provide more time for staff to support people and to help them get out and about when they need to, mainly at weekends. Comments made by the people living at the home confirmed that they had recently received extra support to go Christmas shopping and that they are routinely supported to take part in grocery shopping. People confirmed that they had been supported to go on a number of day trips and outings during the summer. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 6 The manager explained that a new information pack, including a service user guide has been devised for the people living at the home telling them more about the service. The manager said that the new information would be given to people shortly. Since the last inspection regular visits have taken place to monitor the work of the home to keep the senior management team informed. Reports are being sent to the manager so that she is able to address any issues that might be identified from these visits. 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. SCIC - Glebe Road, 26 DS0000004468.V270700.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 SCIC - Glebe Road, 26 DS0000004468.V270700.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): These Standards were not assessed at this inspection. There have been no new people admitted to the home since the last inspection. EVIDENCE: SCIC - Glebe Road, 26 DS0000004468.V270700.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 People’s needs, following their reviews, have yet to be fully reflected in the home’s new care plans, so that staff are clear about any changes to people’s care that may need to be addressed. The people living at the home are supported to make everyday living decisions and to pass comment on the home so that they can exercise some control over their lives. An action plan to address issues identified in the service users consultation process would confirm that people’s concerns, or shortfalls in the process, are satisfactorily addressed. EVIDENCE: The home’s care plans provide a good range of relevant information to assist staff to provide appropriate support to the people living at the home. However there is an outstanding requirement made at the last inspection to update people’s care plans in the new, more accessible format that has been devised to help people to understand the contents of their plans more easily. With the exception of one person who has recently left the home, it is now over a year since the home’s care plans have been properly updated.
SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 10 The manager explained that she has not managed to review the care plans due to competing work pressures and because she is still waiting for social work care plans to be sent to her, following people’s care reviews, involving their social workers, which took place earlier this year. On the morning of the inspection people were seen to go about their breakfast routine and to take part in household chores before they went to their day services, including loading the dishwasher, wiping the dining table, and mopping the kitchen floor. One person was also seen to use the washing machine with help from a member of staff. Comments made by the people living at the home confirmed that they are involved in shopping for groceries and agreeing the home’s weekly menus and are supported to shop to choose their own clothes and other personal items. Entries in the service users’ meeting log indicate that staff routinely check that people are happy at the home. A service user consultation exercise that took place earlier in the year indicated a number of concerns about the home. The manager explained that this reflected service users confusion over some of the questions rather than being a true reflection about how they see the home. Comments made by two people with verbal communication skills, during the inspection, indicated that they were very happy and enjoyed living at the home. Service users financial records are locked away for safekeeping. A sample examination of expenditure records indicates that appropriate procedures are in place for recording and accounting for people’s money, including money withdrawn from the bank and daily expenditure. Letters were seen on service users files, giving their consent to receive support to manage and safeguard their monies. The manager stated that access to people’s cash cared is restricted to herself and a senior support worker and that the organisation’s financial manager carries out an audit of people’s money. The manager agreed to send the inspector a copy of the most recent audit report. SCIC - Glebe Road, 26 DS0000004468.V270700.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): 13 and 15 The home supports people to take part in a reasonable level of activities and outings so that they are able to benefit from life in the community. EVIDENCE: During the weekdays service users attend Avon Bank day service, run by Social services. One person stays at home on Wednesdays, in keeping wishes, and staff support is made available to provide the assistance he requires. Comments made by the people living at the home confirmed that they have recently been supported to go Christmas shopping to buy presents. People also said that they have a number of Christmas parties planned through their day services and other clubs that they attend in the evenings. An examination of the staff rotas confirmed that the home manages to achieve double staffing on some weekend shifts to enable people to get and out and about, e.g. one person likes to attend a car boot sale. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 12 The manager confirmed that this is due to improve further in the new-year as a new member of staff is rotad to carry out more shifts at the home. Comments made by service users and staff explained that people have been supported to attend a number of outings during the summertime, including Weston-Super-Mare, Cotswold Wild Life Park, Drayton Manor Park, Blenheim palace and a mystery tour. A second trip to Weston-Super-Mare had also recently taken place for people to see the winter lights turned on. Comments made by the manager indicate that the home seeks to provide a reasonable level of outings and activities taking account of people’s advancing age and energy levels. As previously noted, comments made by the people living at the home confirmed that they are supported to shop for groceries and to choose their own clothing and personal items. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 13 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): 21 The home needs to ascertain the wishes of service users in the event of their death so that proper plans are recorded and their wishes respected. EVIDENCE: There is an outstanding need for the manager to ascertain the wishes of service users (and their relatives) in the event of their death. The manager stated that this work has not yet been completed due to competing priorities. It is important that this addressed as the service users living at the home are of advanced age and it is important that these matters are agreed whilst people are in good health and able to give their views. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Information and procedures are in place for service users and staff so that people are able to raise their concerns in order that they can be investigated. Procedures and training are provided so that staff are equipped to respond to any suspicions of abuse. The addition of the contact details of relevant managers, to whom any suspicions are to be reported, would make for a more robust procedure. EVIDENCE: The manager stated that there have been no complaints made to the home since the last inspection. As previously noted service users have monthly meetings. The agenda / record of these meetings indicates that people are provided the opportunity to raise any concerns they have and to comment on the service they receive. Each service user has been issued with accessible complaints information (seen in bedrooms) and a stamped addressed envelope that they can post to the head office, to alert senior managers to their concerns, if necessary. A complaints policy and procedure was seen to be available in the home’s policy file, including the contact details of relevant people to address their concerns to, including the Commission for Social Care Inspection. Comments made by staff confirmed that they have been provided with prevention of abuse training at various times within the last two years. The manager stated that most recently this was strongly emphasised and discussed at the organisations Annual General Meeting that was attended by most staff. An adult protection procedure is in place at the home to inform staff of the appropriate measures to take to report any suspicions of abuse.
SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 15 The manager agreed to attach a copy of the relevant managers contact details to the back of the procedure so that staff are clear about how should report any concerns. A whistleblowing procedure is in place at the home to enable staff to report any concerns they might have about the manner in which the service is run. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 16 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 26 Glebe Rd provides comfortable, clean, homely accommodation for people to live in comfortably. EVIDENCE: During the year action has been taken to redecorate the hall landing and stairs and new curtains have been hung in some areas. A new tiled floor has also been laid in the kitchen and the bathroom has been fully refurbished to add to the improvements for people. A new carpet has been purchased for the lounge and during the last year improvements have been made to the fire alarm so that it now includes flashing lights as well as alarm bells. The home is not designed to meet the needs of wheelchair users or people with significant disabilities. People’s bedrooms were seen to be clean and comfortable and evidence was on show to indicate that people have been supported to personalise these areas to their own liking, (e.g. posters and family photographs) SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 17 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): 33 and 35 Staffing levels have improved since the last inspection so that people are properly supported at the home. The home provides staff with access to appropriate training so that they are equipped to carry out their work effectively. EVIDENCE: As previously noted there remains an outstanding requirement to update people’s care plans in the new format following their reviews, involving social workers earlier this year. The manager explained that this is mainly due to other competing work of higher priority. Currently the home employs a manager and a senior support worker to attend to administration matters at the home. The manager explained that the senior support worker is employed for 30 hours, half of which is given over to administration tasks. Since the last inspection there has been an overall increase in the number of care hours available at the home for the three people who currently use the home. The number of hours available has risen from 100 hours per week to 140 hours. The home is closed during the day most days whilst service users attend day services. The manager seeks to provide two staff on duty on some weekend shifts to enable people to get out when they wish to do so. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 18 The manager said that this would be further improved in the new-year when a new member of staff has had time to complete her induction. One member of staff sleeps at the home at nights so that people have some one to help when they need it. Comments made by staff during the inspection confirmed that they receive access to a good range of training opportunities. The manager explained that the training record is being updated for the home and agreed to send a copy to the inspector when it has been completed. A sample examination of training certificates confirmed that staff are being provide with a good range of health and safety related training, such as food hygiene, first aid, fire safety, moving and handling and medication as well as NVQ training courses to support good practice at the home. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 19 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): 37,41 and 42 There are shortfalls in the homes accident records hot water risk assessments that need to be addressed to confirm that service users are appropriately safeguarded against unnecessary risks. The manager is completing training to confirm she is equipped to carry out her role at the home. EVIDENCE: The manager reported that she has completed the Registered Managers Award and that her work has been sent be verified by external assessors before her qualification can be confirmed. The manager also said that she is intending to start the NVQ 4 in carer qualification in the new year. An accident record book is in place for recording accidents to service users and staff. However the records of individual accidents are torn out and filed at the head office, which does not allow the inspector to inspect these records. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 20 Lockable cabinets are in place for the storage of confidential information. However the office / sleep-in room is very cramped and leaves little room for staff to work in. The manager stated that plans are in place to re arrange the space to provide more desk space. The staff recruitment files are currently held at the main head office as the staff team works across other service run by the organisation. Staff recruitment files were inspected at the last inspection, 14th June 05. At the last inspection it was noted that the gas maintenance check was overdue. An examination of the home’s gas safety certificates confirmed that this has since been addressed and that the home’s gas appliances have been checked. An examination of the home’s fire log confirmed that the fire alarms and emergency lights are being routinely tested and that fire drills are regularly carried out. A record is also in place at the home to demonstrate that the home’s first aid supplies are routinely checked to ensure that they are well stocked. A hot water record is kept at the home, which demonstrates that hot water temperatures are rising well above the safe level of 43 degrees centigrade. The hot water temperature in one person’s bedroom was tested during the inspection and was over 60 degrees centigrade. SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 21 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 2 2 x x x Standard No 24 25 26 27 28 29 30
STAFFING Score 4 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
SCIC - Glebe Road, 26 Score x x x 1 Standard No 37 38 39 40 41 42 43 Score x x x x x 2 2 DS0000004468.V270700.R01.S.doc Version 5.0 Page 22 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 YA6 Regulation 15 Requirement Complete the work that has started to devise new care plans. Ensure all care plans are updated promptly. (Outstanding from the last inspection timescale – 14/7/05 The Responsible individual is required to seek an action plan from the manager to address any concerns raised by service users, as part of this years annual consultation process / to clarify any shortfalls in the interview process so that this can be improved upon in future. Send a copy of the most recent audit report of service users monies to the Commission for Social Care Inspection as evidence that people’s monies have been audited. Work is required to establish the wishes of service users (and their relatives) in the event of death. (Outstanding from previous inspections). Timescale for action 31/01/06 2 YA7 24 31/12/05 3 YA7 12 (1) (a) 20/01/06 4 YA21 15 (1) 28/02/06 SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 23 5 YA23 13 (6) 6 YA33 18 8 YA37 9 9 YA42 13 (4) (c) 10 YA43 Schedule 3 Include within the adult protection procedures the contact details of people to be informed in the event any suspicions of abuse come to the attention of staff. (Outstanding from the last inspection timescale 30/7/05) The Responsible Individual is required to review the time made available for the manager and senior support worker to address administration tasks, so as to meet the competing priorities and to ensure that there is sufficient time available for reviewing care plans. The manager is required to show a copy of her Registered Managers Award certificate to an inspector at the Commission for Social Care Inspection when it is awarded so that a copy may be taken. Risk assess the hot water temperature at all outlets that are used by service users and fit regulator valves where necessary to avoid the possibility of scalding. Service users accident records must be kept at the home for future inspections. 31/12/05 31/01/06 28/02/06 31/12/05 31/01/06 SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations SCIC - Glebe Road, 26 DS0000004468.V270700.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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