CARE HOME ADULTS 18-65
Sense 85 Park Road Accrington Lancashire BB5 1ST Lead Inspector
Mrs Keren Nicholls Unannounced Inspection 2nd February 2006 10:30 Sense DS0000038926.V282346.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 Sense DS0000038926.V282346.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. Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sense Address 85 Park Road Accrington Lancashire BB5 1ST 01254 397937 01254 397274 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.sense.org.uk Sense North Care Home 5 Category(ies) of Sensory impairment (5) registration, with number of places Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: 85 Park Road provides 24-hour residential accommodation and personal care for 5 younger adults (aged 18 to 65 years) with sensory impairment, physical disabilities and learning disabilities. The home is part of the larger organisation of Sense, which is the largest specialist voluntary organisation in the United Kingdom working with people with deaf blindness and associated disabilities. Park Road is a detached purpose built house, located in a residential area of Accrington. It is opposite a school and within walking distance of shops, a public house and a park. There are good public transport links nearby and the home provides mini-bus transport for service users. Outside is a pleasant side garden with outdoor seating and parking for four cars at the front. On the ground floor are lounge, a smaller ‘sensory’ room, a dining room, conservatory, kitchen and laundry. There are single en-suite bedrooms on the ground and first floor. A staircase accesses the first floor. Sense DS0000038926.V282346.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 unannounced visit to Park Road in the inspection year April 2005 to April 2006. The visit took place over one day, when a total of 3.30 hours were spent on the premises. During this time the inspector spent time with four of the five people who lived at the home and looked at written information, including records. The inspector also talked to the staff on duty and looked round the home. What the service does well: What has improved since the last inspection?
The premises have been improved to better meet the needs of service users, by providing a new conservatory and completing the sensory room. Service users were also enjoying a new television and had benefited from a new lounge carpet and lounge decoration. A new cooker and dishwasher had been provided in the kitchen. The new staff team had been trained, had settled and were working well together to meet the needs of service users. They were using the regular staff meetings to put forward suggestions and comments from service users about how to improve the service. As a result, each service user now had an Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 6 individual weekly activity sheet, which ensured that each person had daily opportunities for meaningful and fulfilling activity and interest. 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. Sense DS0000038926.V282346.R01.S.doc Version 5.1 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 Sense DS0000038926.V282346.R01.S.doc Version 5.1 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): This section of standards was not assessed on this occasion. EVIDENCE: All these standards were assessed during the last inspection in August 2005. Since then, there had been no new service users. The information available for prospective service users and the admission procedures had not changed. Sense DS0000038926.V282346.R01.S.doc Version 5.1 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 Staff followed well-documented care plans that reflected each person’s needs and preferred way of life, so ensuring that service user’s health and welfare needs were met in full and aspirations were progressed. EVIDENCE: Everyone had an individual plan of care, based on a person centred approach, which helped staff to gain insight into each person’s needs and wishes. Four people’s plans were inspected. These reflected the complexity of his or her needs and detailed how these were to be met. Aims for care, including communication and coping strategies were explicit, as were any limitations, risk assessment and the reasoning behind this. One person’s plan had a social history chart, which mapped the progress from seeing care needs as problems, to the home’s approach which looked for and built on positive statements. It was clear from communicating with service users and talking to staff that this approach resulted in improving each deaf-blind person’s quality of life in terms of increasing independence, happiness, satisfaction and social inclusion. Service users’ views and best interests were at the heart of their plans and plans were updated regularly with all the people concerned with the person’s care (such as families and the deaf-blind person’s keyworker).
Sense DS0000038926.V282346.R01.S.doc Version 5.1 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): 16 Sound policies and procedures and staff training underpinned the promotion and protection of service users’ rights to independence, choice, privacy, and freedom of movement. EVIDENCE: Staff had positive attitudes towards promoting service users’ rights. Bedrooms had flashing doorbells to gain attention and staff respected the privacy of two service users who chose to stay in their rooms. Daily living routines (such as getting up/retiring, going out) were flexible and each person’s communication systems (including hand over hand, smell, touch, sign and symbol) were known and service users’ decisions respected by staff. Restrictions on lifestyle choices were minimal, were noted as part of each person’s care plan as part of a formal risk assessment and understood as being in their best interests. Everyone shared household tasks as far as they were able, such as bedroom cleaning, choosing when to make drinks and snacks and baking. Other choices were enabled by staff: For example, three service users enjoyed individual shopping trips on the day of inspection and one person went to college.
Sense DS0000038926.V282346.R01.S.doc Version 5.1 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): 18 and 19 Personal and healthcare support was provided in a flexible and individual manner, which respected service users’ privacy, dignity and independence. EVIDENCE: Personal care needs were recorded in care plans and staff helped service users sensitively and discreetly throughout the visit. Each person had a detailed routine plan and a keyworker, to ensure care continuity. However, each person exercised choice within the routine. For example, two people decided to lunch at different times. Healthcare needs were closely monitored by each person’s individual way of communicating, by staff observation and by interpretation of service user behaviours. GP, outpatient and other medical check visits were planned and recorded and service users supported to attend clinics. One person communicated how her quality of life had improved by recent appropriate dental treatment. Comprehensive records of healthcare observations were kept, which provided further evidence of how staff identified need and supported people through treatments. Appropriate professionals oversaw specialist needs and each person had assessed aids for living and mobility. Staff had received thorough training in moving and guiding service users and in use of aids and equipment.
Sense DS0000038926.V282346.R01.S.doc Version 5.1 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): This section of standards was not assessed on this occasion. EVIDENCE: This section of standards was not assessed on this occasion but was assessed during the last inspection in August 2005. Since then, there had been no changes to the detailed policies and procedures or staff training for complaints and for the protection from harm of service users. Service users raised no concerns during this visit. Sense DS0000038926.V282346.R01.S.doc Version 5.1 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 and 26 The house was non-institutional and suitable for the stated purpose of supporting younger adults who have a sensory impairment and related disabilities. EVIDENCE: The house is spacious, near to local transport, shops and other amenities. The furniture, fittings and decoration were of good quality, domestic in style and renewed regularly. The home was bright, warm, clean and comfortable with a good standard of décor and maintenance. The property was necessarily clutter-free, but service user’s personal belongings and artwork gave the house a ‘homely’ feel. The addition of a new conservatory and improvements to the sensory room had increased service user choice and comfort. The home had been designed for people with sight and hearing loss, with aids and adaptations to enable independence. For example grab rails and colour contrasts on the stairs, a pull cord alarm system, loop system in the lounge, text phone, minicom and alarm to the front door. Wide doorways had ‘objects of reference’ nearby, to enable recognition of the purpose of the room (e.g. knives and forks and spoon to denote the kitchen and dining room). Raised and textured letters were fitted to some doors to allow tactile identification. Bathrooms had mobility aids and adaptations.
Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 14 The home was well maintained and service users had benefited from a new conservatory, which was nearly ready for use, upgrading of equipment in the sensory room, and new décor and carpet in the lounge. Staff explained the loop system was to be reactivated following the installation of a new TV. Each deaf blind person had a spacious single en-suite bedroom, which was private with door lock and doorbell with light. En-suites were either bath or shower. Service users had personalised their bedrooms with their own belongings and enjoyed spending time in their private space. All the service users who were at home gave many indications from their behaviours, body language and individual ways of communicating that they were happy living at Park Road. They clearly felt at home and freely used all the rooms as they pleased. Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 35 A well-trained and competent staff team, who understood their own and other’s roles and responsibilities, met service users health and welfare needs. EVIDENCE: Staff were confident in their abilities and demonstrated good understanding of their roles in achieving the home’s aims and objectives. Keyworkers had meaningful relationships with service users. All the staff team understood and acted appropriately to support service users fluctuating needs with tact, professionalism, respect and good humour. Service users confirmed through their interactions that they liked and got on well with all the staff on duty. Staff related well to service users’ personal interests and ensured that each person had an interesting and enjoyable day, although staffing levels that evening meant one person was unable to go out as planned. Staff had undertaken documented and certificated induction; foundation; and on-going training in care support and the special needs of deaf blind people. Everyone thought the training was extremely good and thorough. Training underpinned the knowledge staff had of individual’s care plans and their roles in meeting service user’s goals and aspirations. Staff were still unclear about a previous recommendation: how compliance with the General Social Care Council’s codes of practice should improve the lives of service users at Park Road.
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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, 42 and 43 The home used an effective quality assurance system to listen to and act on service users views and opinions. Thorough training and sound practices promoted and protected everyone’s health and safety. An acting manager was running the home well, pending the start of a newly appointed manager. EVIDENCE: An acting manager adhered to policies and procedures and was running the home well, pending the start of a newly appointed manager, who is yet to be registered with the Commission. The lines of accountability within the home were clearly defined with care workers and administration staff being clear as to their roles and responsibilities, senior staff on call and support from the wider organisation. The overall management was sound, with the organisation providing appropriate insurances, human resources planning, financial planning and control and supervision and appraisal of the manager. Service users made their views and opinions known through their individual ways of communicating. Throughout the inspection, service users confirmed their opinions in different ways (for example, through action, sign, behaviour,
Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 17 body language) and it was clear from staff reactions that their views were taken seriously and acted upon. Every service user had a staff keyworker, who ensured the manager had feedback from the deaf blind person about the way in which they perceived the service and who made sure that their personal development was linked to their care plan. Service users relatives also acted as advocates in influencing change and securing improvements and their involvement was recorded. The home organises an annual ‘family day’ and has a fund raising committee of family and friends, which provided further opportunities for gathering feedback and involving stakeholders. Staff explained that they have weekly team meetings and agendas showed that suggestions from staff and service users were discussed. External quality monitoring was provided by monthly inspections from headquarters staff. The home had excellent health and safety systems and staff protected the health and safety of everyone at the home by following procedures: All the staff had thorough induction and on going training in moving and guiding service users, first aid, fire safety, infection control and food hygiene. Regular ‘refresher’ courses were held. The fire system was tested each week and regular fire drills recorded. Accidents were reported according to procedure and Control of Substances Hazardous to Health (COSHH) risk was assessed and monitored. Qualified people carried out up to date electrical, gas and other checks. A recorded annual health and safety audit was conducted and the home used a written ‘Person Centred Risk Analysis and Management System’ to good effect. Water, refrigerator and freezer temperatures were monitored. Safety notices were posted. In light of the recent break-in, for the safety and security of all at the home, it might be wise to secure the window restrictors and ensure the window locks are used, pending the results of discussion with professional security advisers. Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 2 32 X 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 2 X 4 X X 2 3 Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA31 Good Practice Recommendations This recommendation carried forward from the last inspection: The manager should ensure that staff are familiar with the GSCC codes of conduct, and how compliance with these codes improves the lives of service users (31.5) The newly appointed manager should seek registration with the Commission as soon as possible (37.1) This recommendation carried forward from the last two inspections: The current method of recording marks and bruises found with the cause unknown should be reviewed to allow for more thorough recording to take place. That staff use the window locks and that window restrictors are secured, so they cannot be unhooked (42.3v). 2. 3. YA37 YA42 4. YA42 Sense DS0000038926.V282346.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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