CARE HOME ADULTS 18-65
Shian 1 The Paddock High Spen Rowlands Gill Tyne & Wear NE39 2BD Lead Inspector
Miss Nic Shaw Unannounced Inspection 1st February 2006 9:10am Shian DS0000007387.V270502.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 Shian DS0000007387.V270502.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. Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Shian Address 1 The Paddock High Spen Rowlands Gill Tyne & Wear NE39 2BD 01207 545 534 01207 545 534 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) Northgate & Prudhoe NHS Trust Claire Marrs Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Shian provides ordinary housing for people with learning disabilities, all of whom were formally resident in a long stay hospital. Shian can provide personal care for 3 people. The service cannot provide nursing care. The home is a large detached bungalow situated in a residential area. There is a dining room, lounge with conservatory, kitchen and four bedrooms, one of which is a sleep-in room/office. The home is surrounded by a well maintained garden which service users can access safely. There are separate laundry and storage facilities. The home is situated close to the town centres of High Spen where a range of community facilities such as shops and public houses can be easily accessed. There are bus stops nearby which link with the main regional centres. The home also has its own transport. Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 3 hours in February 2006 and was a scheduled unannounced inspection. The inspection began early morning in order to observe the usual routines of the home over the breakfast period. The service users who live at Shian are not able to communicate their views on life in the home by use of speech and as such time was spent observing interactions between the staff and the service users as well as talking to the manager and staff. Care plans and medication records were examined and a tour of the building took place which included all communal areas. The judgements made are based on the evidence available on the day of the inspection. What the service does well: What has improved since the last inspection?
Care plans have continued to develop and provide the staff with clear step by step guidance on what they need to do to meet the service users personal care and leisure needs. Medication procedures have also improved. For example; in order to ensure staff know when and where to administer prescribed creams this level of detail is now recorded on the medication administration record. The communal lounge and bathroom have been greatly improved. The lounge has been re-decorated and new furniture, lighting and ornaments have been provided for this area. The bathroom has also been enhanced by use of colourful curtains, bath sets, plants and ornaments.
Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 6 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. Shian DS0000007387.V270502.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 Shian DS0000007387.V270502.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): These standards were not assessed on this occasion. Standard 2 was assessed as met during the last inspection. EVIDENCE: Shian DS0000007387.V270502.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&9 Care plans have much improved since the last inspection and this ensures that the service users health and personal care needs are met in a consistent manner. Although risk assessments have been carried out these do not always demonstrate fully how the service users health needs are to be met by staff. EVIDENCE: The service users care plans have greatly improved since the last inspection and it was evident that the manager and staff have worked hard in this area. Support plans outline the assistance each service user requires in relation to their personal care needs. Those viewed during this visit provided the reader with clear step by step guidance on the action they need to take to ensure that the service users are supported in a manner which they prefer, whilst at the same time ensuring that their independence is promoted. Communication dictionaries are available which contain some information on the service users method of communication. It is advised that the development of these continue to include the service users level of understanding and also key words and gestures which should be used when communicating with the service user. The staff have a good knowledge of the service users and the risks associated with their behaviour, however, this was not always clearly written down in the
Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 10 risk assessments and risk management plans. It was evident during this visit that a service users care needs had changed which has resulted in a number of risks associated with their behaviour. This service users behaviour was observed to impact upon the other people living in the home and advice was offered of the need to develop risk management strategies in relation to this so that staff are consistent in their approach and also to ensure the safety of all service users. Shian DS0000007387.V270502.R01.S.doc Version 5.1 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): 16 & 17 The daily routines encourage service users to lead independent lifestyles. A good range of meals is available to service users which meet their dietary needs. EVIDENCE: Observations made confirmed that the routines of the home are flexible. On this visit one service user demonstrated that they wished to spend time alone in the conservatory area of the home listening to music. This choice was respected by staff. During the inspection the staff spent time talking and interacting with service users involving them in the inspection process. At the beginning of this inspection one service user was having their breakfast in the dining area. The breakfast meal consisted of rivita and cheese and staff spoken to confirmed that this was this service users preference. This was observed to be a relaxed, unhurried occasion with staff offering assistance and support discreetly and sensitively. The other service users, who had finished their breakfast, were offered refreshments by the staff. Discussion with the manager and staff confirmed that a review of the menus has recently been
Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 12 carried out. A healthy diet is encouraged which includes the provision of a variety of fresh fruit and vegetables. A picture menu is being developed which is to be used by staff to further enable the service users to choose what they would like to eat. Specialist equipment has recently been purchased for one service user so that their independence can be maintained at mealtimes. Shian DS0000007387.V270502.R01.S.doc Version 5.1 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): 20 The service users are protected by the homes medication policies, procedures and practises. EVIDENCE: Medication records examined confirmed that medication is regularly reviewed with the service user’s GP and is administered to them appropriately. Where there have been changes to a service user’s medication, records confirmed that this is closely monitored by staff. This was particularly evident for one service user for whom medication has recently been changed. There were also clear guidelines in place instructing staff of when they should administer “as and when required” medication. Since the last inspection the manager has introduced a front sheet to the medication administration record which includes the names of those staff authorised to administer medication together with a specimen signature. Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Whilst service users communication skills are very limited, arrangements are in place through the complaints process to promote their safety and offer protection. However, the complaints procedure does not inform the relatives and service users that they can complain to the Commission for Social Care Inspection, therefore their rights are not fully promoted in this area. EVIDENCE: There is a complaints procedure available. This has recently been reviewed by the organisation and is available to the service users using plain language and large print. However, an examination of this document confirmed that it does not advise the complainant that they can contact the Commission for Social Care Inspection at any stage should they wish to do so. This is a legal requirement. Due to the service users communication needs, they would not be able to actively use the complaints procedure or formally make a complaint. However, the manager and staff closely monitor any changes in the service users behaviour, which may in indicate that they are unhappy. One service user is presently demonstrating a behaviour, which has a negative impact upon the other service users and staff. This is appropriately recorded and closely monitored through the care plan process. There have been no complaints made by others involved in the service users care since the last inspection. Shian DS0000007387.V270502.R01.S.doc Version 5.1 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 & 30 There have been a number of improvements made to the environment which is homely, comfortable and clean providing the service users with a safe and well maintained place in which to live. EVIDENCE: This inspection focused upon all communal areas of the home but on this occasion did not include bedrooms. Refurbishment has taken place in a number of areas and this has included the provision of new furniture, light fittings and a television for the lounge as well as new curtains, ornaments and plants for the bathroom. The conservatory area has also been enhanced with the provision of sensory equipment such as fibre optic lighting and the staff spoken to said that as a result of this one service users chooses to spend more time in this area. Future plans include the re-decoration of one service users bedroom as well as the corridor. In the past, due to one service users behaviour, very few ornaments were on display in the home. However, this practise has been reviewed and the provision of plants and ornaments throughout the home has added to the homely atmosphere. Policies and procedures are available in relation to infection control. Throughout the inspection the staff demonstrated an awareness of infection
Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 16 control and used protective gloves and aprons appropriately, however, discussion with them confirmed that they had not received formal training in relation to this issue, which is a requirement. Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 34 The service users welfare is promoted and protected by a well trained staff team, however, some of the staff need to complete NVQ training in care. Staff records are not held within the home and as such it was not possible to confirm that the service users are supported and protected by the home’s recruitment practices. EVIDENCE: Staff spoken to confirmed that they have received a range of training provided by the Trust. As well as training in relation to health and safety matters this has included other topics such as “conflict management”. Of the 13 staff, 4 have completed the NVQ level 2 qualification in care. A further 3 staff are about to commence this qualification and once they have completed this the national minimum standard of 50 will be met. Although the manager confirmed that the organisation carries out a thorough staff recruitment process there are no staff recruitment records available to inspect in the home as required by the Care Home Regulations but these are available within the organisation’s personnel department. As such it was not possible to fully assess the staff recruitment procedures in order to ensure that they are robust and protect the service users. There have bee no new staff recruited since the last inspection.
Shian DS0000007387.V270502.R01.S.doc Version 5.1 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): The above core standards were not assessed on this occasion as they were assessed as met during the last inspection. EVIDENCE: Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 19 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X X X X X x X Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4)(c) 15 2. YA22 22(7) Requirement Risk assessments and risk management strategies need to be developed as discussed within the body of the report. The complaints procedure must include the name, address and telephone number of the Commission for Social Care Inspection and inform the complainant that they can contact the Commission for Social Care Inspection at any stage. All staff must receive training in relation to infection control. 50 of care staff must have an NVQ level 2 qualification in care.(Timescale not met 31/12/05). Records of staff recruitment must be available for inspection.(Timescale not met 30/08/05). Timescale for action 30/04/06 31/05/06 3. 4. YA30 YA32 18(c)(i) 18(c)(i) 31/07/06 31/07/06 5. YA34 17(2) 31/12/05 Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Shian DS0000007387.V270502.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
