CARE HOME ADULTS 18-65
Sefton Street, 132 132 Sefton Street Southport Merseyside PR8 5DB Lead Inspector
Mr Paul Kenyon Unannounced Inspection 2nd March 2006 13:00 Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 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 Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 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. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sefton Street, 132 Address 132 Sefton Street Southport Merseyside PR8 5DB 01704 530329 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) www.peterhouseschool.org Autism Initiatives Mr Roger Cameron King Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 3 LD Date of last inspection 24th and 27th October 2005 Brief Description of the Service: 132 Sefton Street is an older, semi-detached property providing care and accommodation for three adults with learning disabilities, specifically with Autism. It is situated in a residential area of Southport, close to public transport and the amenities that the town has to offer. The home provides accommodation over two floors with the service users’ individual bedrooms situated on the first floor. There are two bathrooms for service users to share with one including a shower facility. The communal space includes a large dining/kitchen area and a lounge. The home has a pleasant rear garden including decked area including garden furniture suitable for service users and their visitors. This is easily accessed. The home is part of a Voluntary Organisation known as Autism Initiatives. Stephen Halewood currently manages the service. He has applied to become the Registered Manager of the home and is undergoing the registration process with the Commission for Social Care Inspection. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection to be held at 132 Sefton Street this inspection year (April 2005 to March 2006) and was unannounced. The National Minimum Standards for Younger Adults were used to measure the standard of care provided within the home. The Inspector was able to hold discussions with one resident who was present at the start of the inspection. This individual did not provide any specific views about his experiences of living at 132 Sefton Street. The two other residents were out for the most part of the inspection. There communication needs are such that they were unable to give any views about the service although the Inspector had the opportunity to speak to the parents of one resident who were attending a review. The rest of the inspection included discussions with staff, discussions with the Acting Manager, a tour of the premises and an examination of records relating to the support people receive. In total the visit lasted three hours. What the service does well:
The service is good at enabling residents to make decisions about their lives. A recommendation is raised about providing information about external advocacy services. The service is good at facilitating leisure activities for residents with the use of local facilities as well as the use of local educational facilities if these are wished to be used. The service is good at promoting links with families and friends. The service is good at including residents in daily routines within the house. The service is good at meeting the nutritional needs of residents and offering them choice and as much independence as possible. The service is good at taking the independence of resident into account when determining the level of personal support they need. The service is good at meeting the health and emotional needs of residents. The service provides a staffing team who have the experience and qualifications to support the three individuals living at Sefton Street.
Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 6 The service provides support to residents form a staff team that has received training in mandatory topics as well as those issues that are linked to the needs of residents. The service is well managed by an individual who has the necessary qualifications and experience to fulfil the role although this person needs their registration to be confirmed by the Commission For Social Care Inspection. The nature of the disability of residents is such that it is not always possible to gain comments about their experiences with using the service. One person is able to communicate verbally yet did not focus through conversations on his experiences to date. Records did confirm at this visit that the views of this person are taken into account with those members of staff who are more familiar to him and recorded. The parents of one residents were present in the home attending a review of the supported provided to their relation. They agreed to speak with the Inspector. Essentially they were happy with the support provided. They considered their relation to be safe and well supported. Staff communicate with them on a regular basis and consider the home to be very homely and comfortable. What has improved since the last inspection?
All requirements from the last visit have been addressed with the exception of two. The service has now produced risk assessments for all potential hazards that are faced by residents, in particular a risk assessment relating to one resident being in the kitchen area. The service has now ensured that risk assessments are reviewed and that they have been signed by staff to confirm their awareness of the content of such assessments. The service has now produced a complaints procedure that includes symbols to ensure that two residents have a better understanding of how they can make a complaint. The organisation, which runs the service, has now produced evidence that its representatives are visiting the service on a monthly basis in order to assess the support it provides and to produce reports outlining details of the visit. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 7 The service now has provided evidence that general risk assessments outlining hazards faced by staff through the work they do have been reviewed within annually. 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. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 5. Standard 2 was measured at the last inspection and was met. Residents still do not benefit from contracts of residency that are presented in a format appropriate to their needs or involve the resident or their families EVIDENCE: A requirement at the last inspection highlighted the need for a contract of residency to be produced that is appropriate to the communication needs of residents and provides evidence that this has been signed by the resident or their representatives. This requirement remains outstanding and is raised once more as a requirement in this report. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. Standard 6 was examined at the last inspection and was met. Residents are provided with the choice to make decisions about their lives. Risk assessments relating to activities undertaken by residents are now robust. EVIDENCE: A requirement at the last inspection highlighted the need for risk assessments to be dated when reviewed, signed by the staff team to confirm their understanding about the assessment and that assessments cover all activities pursued by residents. An examination of risk assessments noted that all assessments have now been signed by staff and are subject to regular review. The activities of one resident within the kitchen area have been risk assessed and included within the risk assessment files. Residents have the opportunity to make decisions about their lives in a number of ways and this was evidenced during the inspection. Two individuals have communication needs that require appropriate formats for communication. A symbols system has been developed for one person and this has had benefits for the other individual. One resident was witnessed using this system during the visit in order to make his wishes known to staff. This system covers choice in relation to activities, the complaints procedure and choice of food provided
Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 11 through the menu. All symbol systems are on prominent display in the house and are actively used. One person is able to communicate his wishes and there is provision within his weekly activities for choice to be made. All residents have savings accounts and the Inspector seeing passbooks during the visit confirmed this. There are differing degrees of support required in enabling support in dealing with financial matters and this is outlined within care plans. There is no information on the help that external advocacy services could provide to residents. All residents maintain contact with their families yet it is recommended that information on external groups be provided. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 12 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): 12,13,15,16 and 17. EVIDENCE: All residents undertake activities during the week with one person accessing a college course. Guidelines to activities have been devised with the involvement of the individual. This has been enhanced by a symbol system introduced for one person with no verbal communication and has had benefits for another person with limited verbal communication. Both individuals have an activity plan that can be adapted to meet the preferences of individuals from day to day. One person is interested in rambling and this was backed up by photographic evidence of this. Another person enjoys horse riding and symbols are provided to relay this preference. Both activities have also been reinforced with risk assessments. The other person is able to communicate his preferences and this is outlined in an activity programme. Included within this programme are times when this person can choose what he wishes to do. All activities are provided within the local community and the location of the house assists with this. One person’s activity preference stated that he wised to go to the library during the visit. The person was able to use this community
Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 13 facility independently. Transport is available for activities to be pursued and local transport is also available close by. Included within care and activity plans is the involvement of residents in daily routines within the home. This extends to help with household tasks as well as routines. The nature of the disability of residents is such that routine is vital to them. The written routines of one person were examined in detail and this provided a structure to the day. This was not seen as limiting rather vital to meet the emotional needs of the person involved. None of the individuals living at 132 Sefton Street have any specific nutritional needs. There is an emphasis, however, on a healthy diet and this has been linked to health check ups that have recently occurred. A menu is available yet for two people, a system of symbols is available to determine their preferences on any given day. A dining area is located within the kitchen and food is purchased from local shops. One activity plan noted in detail that one person is encouraged to plan their own menu and then be assisted with purchasing the food required. In all cases differing degrees of supervision is needed for people to assist in cooking meals in the kitchen linked to their own abilities and risk. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 14 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): 18 and 19.Standard 20 was measured at the last inspection and was met Residents receive support in a manner they require. Their physical and emotional needs are take into account EVIDENCE: No residents require direct assistance in personal care tasks from staff. There is an emphasis through care planning on prompting individuals to maintain their personal hygiene and appearance. One person is independent in this are although his care plan still retains information to ensure that levels of personal hygiene and attention to appearance are maintained. Records confirmed that all residents receive regular medical check ups or attention where necessary. These included visits to dentists, doctors, opticians and chiropodists. Annual well man clinic checks have also been attended and records, in all cases, identify the outcomes of such visits. One person has needed admission to hospital of late. The Inspector had the chance to speak with the individuals parents who felt that the whole process of planning the admission to hospital had been successful and that staff had communicated with them at all times. The person has now received and the medical intervention was successful.
Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 15 Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 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 the following standard(s): 22. Standard 23 was examined at the last inspection and was met. Residents benefit from a complaints procedure that is appropriate to their communication needs. Relatives are provided with the information they need to make a complaint if the need arises. EVIDENCE: A requirement at the last inspection highlighted the need for a complaints procedure to be developed, which would meet the communication needs of two residents. This has been done. A complaints procedure using symbols has been developed and is available for residents. The Inspector had the opportunity to speak to two relatives of one resident. They were able to confirm that while they did not have concerns about the service, they had been provided with information from the organisation about how a complaint could be made. The Commission for Social Care Inspection has received no complaints in relation to Sefton Street. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 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 the following standard(s): 30. Standard 24 was measured at the last inspection and was met. Residents benefit from a clean and hygienic home but do not benefit from clear infection control guidelines for staff in relation to laundering clothes in the kitchen area. EVIDENCE: A tour of the premises found the home to clean and hygienic. This view was reinforced by the parents of one resident who confirmed that the home always appeared to be clean One resident has a personal care need that has been addressed with the provision of specialised flooring that is easy to keep clean. Despite this personal care need, no offensive odours were detected. The washing machine is in the kitchen. This means that clothes that need to be laundered are brought into food preparation areas. The service strives to be as domestic in appearance as possible yet needs to take the siting of laundry facilities into account with food hygiene. No guidance for staff could be evidenced to ensure that the laundering of clothes does not take place at the same time as food preparation. This is raised as a requirement in this report. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35. Standard 34 was measured at the last inspection and was met. A competent, experienced and well-trained staff team supports residents EVIDENCE: Staff interactions with residents were noted during the inspection. All interactions are relaxed and positive. It is clear that staff are a key point of reference for residents. The nature of the disability of residents is taken into account by staff who ensure that residents are reassured as much as possible yet listen to their views or note their communications when the system of symbols is used. All these were witnessed during the visit. All staff have either attained or are going through NVQ Level 2 or 3 at the moment. Currently over 50 of staff have attained at least Level 2. In addition to this, a training calendar is produced by the organisation and the most recent one was examined. This includes a mix of statutory training as well as courses linked to the disabilities of residents. Inductions are carried out for staff both within the service and by the organisation. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 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, 39 and 42 Residents benefit from a well managed home. The organisation now provides evidence that representatives of it visit the home on a monthly basis to report on the quality of care it provides. Health and safety systems now promote the welfare of staff and residents. EVIDENCE: A requirement at the last inspection highlighted the need for the organisation to provide evidence that it conducts monthly visits to the service in order to assess the quality of care provided. Reports were available during the inspection to suggest that this now happens. In addition to this, reports have been provided to the Commission for Social Care Inspection. A further requirement at the last inspection highlighted the need for general risk assessments relating to work practices undertaken by the staff team to be reviewed on annual basis. A number of risk assessments were viewed and these confirmed that reviews had been undertaken. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 20 The Acting Manager has been confirmed in his post by the organisation but has yet to go through the registration procedure with the Commission for Social Care Inspection. This is ongoing. The Acting Manager has worked in the organisation for a number of years and is currently undertaking the NVQ Level 4 qualification. The Manager was able to produce his job description outlining his responsibilities for running the service. Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 3 X 3 X X 3 X Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 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 2 Standard YA5 YA5 Regulation 5 5 Requirement Contracts of residency must be in an appropriate format to meet the needs of residents. Contracts of residency must be signed by independent representatives where residents are unable to sign Guidelines must be produced to outline infection control arrangements for the use of the laundry facilities within the kitchen Timescale for action 30/06/06 30/06/06 3 YA30 13 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations Information about external advocacy services should be obtained Sefton Street, 132 DS0000005227.V284835.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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