CARE HOME ADULTS 18-65
Shamu 126 Regent Road Hanley Stoke on Trent Staffordshire ST1 3AY Lead Inspector
Jane Capron Unannounced Inspection 2nd November 2005 09:15 Shamu DS0000064026.V263605.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 Shamu DS0000064026.V263605.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. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Shamu Address 126 Regent Road Hanley Stoke on Trent Staffordshire ST1 3AY 01782 208590 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) Delam Care Ltd Mrs Pauline Adams Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Shamu residential care home provides care for six service users who have a learning disability. Some of the service users also experience mental ill health. It is owned by Delam Care, a company that owns five similar care homes in the vicinity. Accommodation is provided in single bedrooms, four of which are located on the ground floor. The communal areas included a lounge and separate dining room, a domestic kitchen and a laundry shared with the adjacent care home. The home had a small garden area at the front and a larger area at the rear with a grassed area and trees and flower borders. This has facilities for service users to sit in the garden. The home had a shower room downstairs and a bathroom upstairs. The home is located in an area of Hanley with access to some local shops and a 20 minute walk to the main shopping area. The service users can attend a local college and have the opportunity to undertake activities. The home had the support of a part time activity staff member. The staff employed the home also undertake activities and trips out with the service users. The aim of the home is to promote the independence of the service users and to support and encourage them to develop their life skills. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day and lasted approximately 3.5 hours. During the inspection discussions took place with several residents over their experiences of living at Shamu. Discussions took place with the staff member on duty and with the Care Manager. A sample of support plans was examined as well as a sample of residents’ finances and the medication procedure. Since the last inspection there have been no complaints and no additional visits have been made to the home. What the service does well:
Residents spoken to liked living at the home. They liked the food provided and were involved in meal preparation and food shopping. Residents stated that the staff responded to their requests for particular meals. The home listened to the views of the residents and they participated in a range of activities within the home. Residents stated that they had resident meetings where they discussed such issues as the food served, activities and trips they wanted to take part in and any issues of concern over living at the home. Residents were supported to undertake independent living tasks such shopping, going to the bank, vacuuming and cleaning and keeping their bedroom tidy and doing their laundry. Residents were able to attend college with some attending several sessions a week. Courses included sewing, gardening, painting and decorating and art and drama. The home offered some activities both in and out of the home. Residents stated that they went to the pub and several went to a local club weekly. One resident played for a football team. Within the home the residents had undertaken DVD evenings, baking, card making and beauty evenings. The home had completed comprehensive support plans, which had been reviewed by the staff with the resident. The home was meeting the personal and health care needs of the residents. Residents stated that they attended the doctor when they felt ill, that they had eye and dental checks and received foot and nail care. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 6 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. Shamu DS0000064026.V263605.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 Shamu DS0000064026.V263605.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): 3 The home was able to meet the needs of the current residents and took account of the wishes of the residents. EVIDENCE: The home’s residents have lived at the home for a number of years and there have been no recent admissions. The home was fully aware of the residents’ needs and able to respond to these. The staff were aware the support each resident needed and were alert to changes that may be a sign of mental ill health. All new staff received basic training relating to the conditions of the residents and received induction training. The home had developed relationships with local health care services and there was evidence of positive multi agency working taking place. The home involved advocates when necessary. The home had procedures in place to consult with residents in order to ascertain their wishes for the future. Shamu DS0000064026.V263605.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): 6,7,8,10 The care planning systems in place involved the residents and provided staff with the necessary information to meet the needs of the residents. The home procedures ensured that the views of residents were sought and that they made decisions over their lives and over aspects of running the home. The residents participated in a range of tasks around the home. The home’s procedures ensured that information relating to residents was kept confidential and was handled appropriately. EVIDENCE: Each resident had an individual support plan that outlined his or her needs. These covered their health and personal care needs, their education and domestic needs as well as social and financial needs. The plans outlined the support needed to achieve the outcomes. The staff and the resident reviewed support plans. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 10 Residents confirmed that the staff consulted them over a range of issues associated with living in the home. This included seeking their views over meals, the staff, activities and holidays. Residents confirmed that they made decisions over their lives. They chose whether to go to college and over which courses to attend. They were involved in choosing the menus. They went shopping and bought and chose their own clothes. They stated they were involved in choosing decorations for the home. Advocates were involved when necessary to assist in decision-making. The home had identified the amount and type of support needed to assist the residents to manage their own money. All residents were involved in managing their money and went to the bank to get money out. Residents stated that they helped with domestic tasks around the home including cleaning and tidying their own bedrooms, assisting with meal preparation, laying and clearing the table and doing the washing up. Shamu DS0000064026.V263605.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): 12,13,14,15,16 The home provided the opportunity for residents to engage in education, social and leisure activities both in and out of the home providing residents with the opportunity to have a full and varied lifestyle. The residents were supported to maintain and develop relationships with friends and relatives. The flexible routines within the home respected the rights and choices of the residents. EVIDENCE: Five of the residents had chosen to take up the opportunity of attending college with some attending several days a week. Courses included art and drama, sewing, painting and decorating and gardening. The home also supported residents to engage in a number of social activities. Some attended the local pub and the Dolphins club weekly. The residents went on occasional trips, for example to the theatre and meals out. Within the home there were
Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 12 beauty nights, boards games, DVD nights and some craftwork. All residents had TVs in their bedrooms. One resident spent time on their play station and played in a football team. Residents confirmed that they regularly accessed the community using the local health care services, the bank, local shops, and the local pub and using local social and leisure facilities. Residents confirmed that they spent time with friends and several regularly visited their family often spending nights with them. The home routines were flexibly whilst taking account of individual’s daily schedules. Residents were able to spend time either in the communal areas or in their bedroom. They could attend to their personal hygiene when they wished. Breakfast was taken when residents got up. Other meals were taken within a flexible time framework depending on what was occurring at the home. Residents were provided with a bedroom and front door key. They had unrestricted access to the home. Shamu DS0000064026.V263605.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): 19,20 The health care needs of the residents were being well met with evidence of multi agency working taking place. The home medication procedures were not ensuring that current assessments were provided for residents that self medicated and that staff received medication training prior to administering medication, which potentially placed residents at risk. EVIDENCE: The support plans clearly demonstrated that the health care needs of the residents were being addressed. Residents stated that they saw the GP when they felt ill, that they had dental and eye checks and received nail and foot care. Residents were supported by staff to attend outpatient appointments. The general and mental health of the residents were monitored and actions taken if concerns were evident. The home worked closely with mental health specialists. The weight of all the residents was being monitored. The home operated a monitored dosage system for the administration of medication. Medication was being stored appropriately. Medication records were being completed. Residents that self medicated had a secure place in
Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 14 their rooms in which to keep their medication. The home could not evidence that an assessment had been completed to ensure that residents could safely self medicate. Most staff had received training in the administration of medication. This training was not always completed before a staff member was expected to administer medication. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 15 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): 23 The home’s procedures and the training received by staff were increasing the level of residents’ protection from abuse. EVIDENCE: The home had a procedure for responding to incidents of alleged abuse. Staff had received training in adult protection and were able to describe how they would respond to an alleged incident. The training had included the signs and symptoms of abuse. The home had a system in place for the administration of service users finances. Records were being kept over expenditure and these were being internally checked on a daily basis. Shamu DS0000064026.V263605.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): 24,26,27,28 The home generally provided the residents with a domestic and homely environment but there were some areas that needed to be decorated and the accommodation would be improved by the shower room being upgraded. Residents were provided with suitable bedroom accommodation which they could personalise and where they could enjoy privacy. EVIDENCE: The home was located close to other care homes owned by the same company. It was within walking distance of the park and local health care services and shops. It was a 20-minute walk to the shopping centre at Hanley. The home provided single bedroom accommodation and had suitable communal rooms with a lounge, separate dining room and domestic style kitchen. The home shared a laundry with the adjoining care home. The home had a bathroom and separate toilet upstairs and a shower room and toilet downstairs. These were suitable for the residents although the environment would be improved by the upgrading of the shower room. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 17 The premises were generally satisfactory decorated in a domestic and homely style but some decorating was needed. This included the corridors and some bedroom accommodation. Minor repairs were being undertaken. Bedrooms provided suitable furniture and provided residents with seating. All bedrooms were lockable and residents held keys. A lockable box was supplied in each bedroom. Bedrooms were personalised showing the interests and personalities of their occupants. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 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): 32,33,35 The staff were aware of the aims of the home and the individual needs of the residents thus being able to provide the necessary support to residents to encourage them to be as independent as possible and to make choices over their lives. The home’s training plans and support for staff to gain qualifications should benefit the residents by providing them with more skilled and knowledgeable staff. The staffing levels were adequate to provide the necessary support to the residents. EVIDENCE: The home provided a minimum of one staff on duty at all times during the day and one staff sleeping in over night. In addition there were times during the week when there were two staff on duty, one of which may be the Care Manager. This level of staffing provided the opportunity for some one to one support, residents to be supported at college and the opportunity for residents to be supported to do some activities both in and out of the home. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 19 Residents stated that they got on well with staff and that they supported them when needed. Staff were aware of the individual needs of the residents and were aware of the type and level of support each needed. Staff were aware of their role in supporting the residents to be as independent as possible. The company provided the staff with support on a 24 hours basis through having a senior staff member contactable at all times. The home had individual training profiles for each staff members that identified the training needed and when training was undertaken. All new staff undertook induction training. One of the staff had achieved NVQ level 2 and the other staff were in the process of undertaking the qualification. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 41,42 The home’s Health and Safety procedures were providing a generally safe environment but there were certain areas that needed to be addressed to remove potential risks to the residents. In most areas the residents were benefiting from competent management of the home however there was no evidence of current business insurance in place which could lead to adverse consequences for the residents. EVIDENCE: The home had a health and safety policy and had procedures in place for safe working practices. Staff had received training in health and safety, fire safety, lifting and handling, food hygiene and emergency first aid. Some staff had received training in first aid. Procedures were in place for the safe use and storage of hazardous substances and staff confirmed that products were kept in a locked cupboard. The home maintained records for the servicing of fire Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 21 prevention equipment, electrical appliances, and water temperatures. The home had the necessary current electrical and gas safety certificates. A number of radiators had not been covered and those in the bathrooms particularly could be a hazard. The company provided the manager with supervision and had procedures in place for budget monitoring and human resource planning. The home was not displaying a valid insurance certificate. Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 22 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 3 X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 X 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Shamu Score X 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 2 DS0000064026.V263605.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES 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 20 Regulation 13(2) & (4) 13(2) & 18(1) 23(2)(c )&(d) Requirement To ensure that assessment is completed to ensure that residents are able to self medicate safely. To ensure that staff receive training in medication prior to undertake administration of medication. To ensure that the home is suitably decorated (previous timescale not met) i. Specifically the corridors and ii. Bedrooms To provide training in infection control (Previous timescale not met) To ensure that hot surfaces do not cause a hazard to residents particularly those in the bathroom and shower room (previous timescale not met) To provide the CSCI with confirmation that the home has the necessary insurance in place. Timescale for action 06/11/05 2. 20 06/11/05 3. YA24 01/04/06 4. 5. YA42 YA42 18(1)(i) 13(4) 01/02/06 01/01/06 6. 43 25(2)(e) 09/11/05 Shamu DS0000064026.V263605.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. 1. Refer to Standard YA27 Good Practice Recommendations To provide suitable shower facilities Shamu DS0000064026.V263605.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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