Inspection on 01/12/05 for Shakespeare Way (4)

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shakespeare Way (4) 28/01/09

Shakespeare Way (4) 20/03/08

Shakespeare Way (4) 15/08/06

Shakespeare Way (4) 01/03/06

Shakespeare Way (4) 28/02/05

Shakespeare Way (4) 25/01/05

Shakespeare Way (4) 26/03/04

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Hillview Farm

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Shakespeare Way (4) Aylesbury Bucks HP20 1JF Lead Inspector Mr Rob Smith Unannounced Inspection 1st December 2005 1.30 Shakespeare Way (4) DS0000023049.V268120.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 Shakespeare Way (4) DS0000023049.V268120.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. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Shakespeare Way (4) Address Aylesbury Bucks HP20 1JF 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) 01296 426332 jackieaklippel@yahoo.co.uk www.macintyrecharity.org MacIntyre Care Miss Jaqueline Klippel Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2005 Brief Description of the Service: 4, Shakespeare Way is situated a short distance from the town centre of Aylesbury, where a variety of shops and other local amenities can be found. The town is served by local public transport, including rail and bus links. Bus routes pass within walking distance of the home. 4, Shakespeare Way is owned by the organisation MacIntyre Care. A manager is in post to carry out the day-to-day running of the home, and is supported by a team of care staff. The home provides accommodation for up to six adults with learning disabilities. The home works with service users who have developed moderate levels of independent living skills so that the role of staff is essentially one of support and guidance. All service users are accommodated in single bedrooms, and the home contains a kitchen, dining room, lounge, two bathrooms, three toilets, a staff office, and a utility room. All service users bedrooms, as well as bathrooms and toilets, have lockable doors to ensure security, privacy and dignity. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report of an unannounced visit undertaken between 1.30 and 5.30 p.m. The visit involved discussion with staff on duty, examination of a range of key records for the home and a sample of service user files and a check of the physical environment. Informal discussion was held with service users on their return from day time activities. In order to clarify some particular points a subsequent brief meeting was held with the manager on 12/12/05. What the service does well: What has improved since the last inspection? 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. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 6 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 Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 7 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): No new service users had been admitted to the home since the last inspection so this standard was not inspected on this occasion. EVIDENCE: Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 8 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): 7,8,9 The home continued to fully involve service users in the planning and execution of their care arrangements and to support them in taking appropriate levels of risk. ( Stds 7,8,9) EVIDENCE: The ethos of the home was essentially for staff to work alongside service users to facilitate their choices and preferences and provide opportunities for service users to develop their skills and independent decision-making within a safe framework of staff oversight. Discussion with staff on duty and service users and observation of practice confirmed this continued to be the case. Staff spoken with, who were both relatively new to the services explained how they had had to adjust their initial expectations and carry out tasks with, rather than for, service users. Staff and service users were able to describe how service users made choices with appropriate guidance, in relation to leisure opportunities (including holidays), decoration and equipping of the house and their own rooms, meals and menus and overall management of their day to day care. Service users Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 9 confirmed they were involved in planning their future care options, a good example being the service user who was hoping to move onto a more independent setting with his partner who lived in another care home. Service users continued to share responsibility for basic tasks around the house, which they carried out on a rota basis. Service users also cooked the evening meal under staff supervision and guidance. Service users were also allowed to spend defined periods of time out on their own and for short periods the home itself might be left unstaffed. The risk assessments governing these activities were not evaluated on this occasion but will be checked at the next inspection. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Through both day time work-related and leisure time activities service users had ample opportunity to take part in age and peer group activities that incorporated access to community resources. (Stds 12,13,14). The home offered appropriate support for maintenance of personal and family relationships. (Std 15) EVIDENCE: The service users at the home worked during most week days at MacIntyre day services in Milton Keynes, which offered a range of relevant work and developmental settings involving opportunities for contact and relationships with peer groups and the local community. In their leisure time service users were largely free to choose what activities they wished to undertake and this involved making use of community resources in the Aylesbury area, for example visits to local shops, cinema and football matches. The home supported services users in maintaining contact with family and discussion with staff and service users about Christmas arrangements Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 11 confirmed for example that a number of service users would be spending at least part of their holiday period with family members. One service user was being appropriately supported in maintaining a relationship with a service user in another local care home with planning going ahead to identify a future placement where they might live together. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 12 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): 18,19 Service users’ support needs were appropriately identified and met (Stds 18,19) EVIDENCE: The sample of two files looked at confirmed that service users’ support needs were clearly identified as part of the person-centred planning and review process in which they played a central role. Each service user was allocated a link worker from the staff team who maintained a primary focus on ensuring their various needs were appropriately and consistently met by the home. As part of this process each service user had a ‘home’ day with their link worker on a regular basis, which offered opportunities to discuss and plan aspects of their care, carry out personal shopping and simply have some dedicated personal time way from the group. Files seen showed appropriate identification of the range of services user needs and how they would be met. Monthly summaries on files provided evidence that those needs were being met. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 13 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): 22,23 The views of service users on both an individual and group basis were elicited and taken account of. Clear policy, procedure and training expectations of staff helped ensure service users were protected. EVIDENCE: Discussion with staff, service users and examination of files and ‘house’ meeting minutes confirmed that the home actively sought the views of services users on a range of issues, covering both their personal care arrangements and the day to day running of the home. As already noted this was reflected at a pragmatic level of activities, menus, house and room decoration as well as in more complex aspects of personal care planning where the ethos of person centred planning focused primarily on the needs and wishes of service users themselves. It was also evident that staff were particularly sensitive to the views of service users over the potential return of one service user currently placed elsewhere on a short-term basis. The home and organisation had clear complaints processes in place. The home’s records indicated there had been one relatively minor complaint since the last inspection. MacIntyre had clear policy and procedures in place governing adult protection matters, backed by access to training on adult protection for staff. CSCI was not aware of any incidents or concerns of an adult protection nature arising since the last inspection. However discussion with staff indicated that the behaviour of one of the residents, involving the causing of injury to a staff Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 14 member and subsequent more concerning incidents, had been a source of concern. A subsequent meeting with the manager, who was not on duty at the time of this inspection, clarified that reasonable initial steps had been taken to safeguard the welfare of staff and residents by the introduction of higher staffing levels before further deterioration in the situation necessitated alternative interim placement, pending re-assessment of needs. There was some confusion about the process and nature of notifications to CSCI around the series of events relating to this service user. It appeared that the notification around initial events although sent had, for some reason, not been received by CSCI. But it was clarified in discussion with the manager that subsequent serious events were not separately notified. The opportunity was taken to clarify what sort of events needed formal notification and the value of liaising with CSCI about events where the need to report was less obviously clear. A requirement addressing these issues has been made. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 15 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): 24,25,26,27,28,30 The physical environment was well maintained and being upgraded to meet the needs of service users more appropriately. The space and facilities in the home satisfactorily met service users needs. EVIDENCE: The home was well equipped and comfortably furnished in communal areas, and presented a homely non-institutional atmosphere. Standards of décor and cleanliness were high. At the time of the inspection refurbishment was being carried out to address the shortfalls in bathrooms and toilets highlighted in last year’s inspection. The end result should be significant improvement on previous facilities. Each services user had their own bedroom, which was lockable with them holding a key. The inspector was invited to see two of the bedrooms, which were well furnished and equipped and decorated to the preference of each service user. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 16 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): 33,36 Staffing levels were adequate to meet the needs of service users Staff were appropriately supported in their work. EVIDENCE: The home operated with a small permanent staff team supplemented with extra hours from time to time, depending on service users’ needs and activities in the home. Staff predominantly worked alone with two staff being on duty if transport cover was needed or particular activities were on requiring more staff support and assistance. Discussion with staff indicated they felt the current level of cover was adequate to meet the needs of current service users and provide safety for staff and service users. It was confirmed at this visit and in the subsequent meeting with the manager that the challenging behaviour of one service user, prior to temporary placement elsewhere had necessitated the use of additional agency staff input to provide higher staffing ratios to ensure staff and service user safety. The manager confirmed that, as part of the reassessment of this person’s possible return to Shakespeare Way, the need for more staffing cover would be addressed. Staff spoken with, who were both relatively new to the role, said they felt well supported within the home by means of induction, training and supervision as Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 17 well as access to ongoing advice and support from more established members of staff. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 18 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): 37,38,40, The home was appropriately organised and managed and run to the benefit of service users (Stds 37,38) Practice in the home was supported by a good range of policies and procedures. (Std 30) EVIDENCE: Observation of staff practice and scrutiny of key records and a sample of service users’ files confirmed that the staff team was clear about their various roles and responsibilities and well organised in their day to day work. Despite the current redeployment elsewhere of the manager for part of the working week (see below) it appeared she was well on top of matters at the home and readily available as a point of leadership and advice for the staff team. It emerged in later discussion with the manager that she was currently deployed for three days a week in supporting communication practice development at other MacIntyre services. While this was an evidently useful Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 19 and important piece of work, and feedback from staff was that the manager’s absences were adequately covered by the existing team, CSCI had not been informed of this temporary change in management arrangements so as to form a view with regard to the impact on overall staffing and day to day management of the home. The manager indicated the current arrangement would cease in February. CSCI is prepared to support this arrangement until then but the need to keep CSCI informed of any such significant changes in the future was emphasised and has been made a recommendation of this inspection. Regular monthly monitoring visits on behalf of the proprietor were being carried out. Not all copies of recent visit reports were readily available at the first visit but were accessed at the follow-up meeting with the manager. These reports do need to be available to relevant parties, including inspectors, at all times and a recommendation has been made to that effect. Staff had access to a good range of policy, procedure and guidance, which had been approved centrally by CSCI. Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 20 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 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Shakespeare Way (4) Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x x x DS0000023049.V268120.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No ( in the areas covered by this 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 YA23 Regulation 27 Requirement That the home ensures all relevant notifications are made to CSCI in relation to events that may have an impact on service user welfare Timescale for action 31/12/05 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 Refer to Standard YA37 YA41 Good Practice Recommendations That any temporary changes to managerial arrangements in the home are formally notified to CSCI That reports of visits conducted under Regulation 26 are readily available for scrutiny at all times Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Shakespeare Way (4) DS0000023049.V268120.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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