CARE HOME ADULTS 18-65
9 Spring Gardens 9 Spring Gardens Maghull Liverpool L31 3HA Lead Inspector
Janet Mordaunt Unannounced 24th June 2005 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 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 Stationary 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. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 9 Spring Gardens Address 9 Spring Gardens Maghull Liverpool L31 3HA 0151 520 0185 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Expect Limited PC - Care Home Only 3 Category(ies) of LD - Learning Disability - 3 registration, with number of places 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 3 LD. Date of last inspection 24th November 2004 Brief Description of the Service: 9 Spring Gardens is registered as a care home for three people with a learning disability. The registered provider for this home is Sefton Support Services, which is a voluntary organisation. The registered Landlord for the property is Liverpool Housing Trust.The home is a three-bedroom bungalow, which is located in a quiet cul de sac in Maghull. The home is in keeping with others in the area and is indistinguishable as a care home.The premises are fully accessible and fitted with aids and adaptations.The home has large wellmaintained gardens and is located close to a train station and local shops.Although the home is registered for three people there are only one service user living there at present. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspection visits are required at the home each year, this was the first. The inspection was unannounced and took place over five hours. The requirements and recommendations from the last inspection report were discussed and checked with the manager. Some of these have been met, Records were examined including care plans, daily diaries, medical notes, medication sheets, staff rotas and certificates of health and safety checks. The resident who lives at the home was unable to communicate with the inspector therefore her views were not taken account of during this inspection. The resident was ‘case tracked’. Case tracking means that the inspector concentrates on the care given and experiences of one or more residents to ensure that information recorded about the person is a true reflection of all their needs and that are being met by the home. A full tour of the inside and outside of the home took place. Discussion took place with the manager and two other members of staff who were on duty. What the service does well:
An up to date care plan and risk assessments for the resident were available these are regularly reviewed and updated to include any changing needs. Records of reviews are kept in the persons care file. The healthcare needs of the resident are being consistently met. Health care records are well maintained, up to date and accurate. Staff were observed providing personal care to the resident in a sensitive and flexible manner. They maintained her privacy and dignity at all times. The service provides a structured ongoing programme of mandatory training for all staff that work at the home. The majority of the required records that are kept at the home were well maintained, up to date and accurate. The home provides aids and adaptations to meet the assessed needs of the resident. All the equipment is regularly checked to ensure its safety. Staff showed good knowledge and understanding of the needs of the resident, they have many good qualities and are skilled in the areas required. The home is comfortable, all areas were clean, tidy and generally well maintained. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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 standard(s) 1 2 & 4 A information pack is available at the home, however is was a little worn and disorganised making it difficult for current, prospective service users and their representatives to access. The information was not available in a format that enables prospective service users to make informed choice about living at the home. The homes admissions procedure for prospective residents includes trail visits so that prospective residents can try out the home before making a decision to live there. Assessments carried out for the resident show that the service is able to meet her needs. EVIDENCE: There have been no new residents admitted to the home since the last inspection. An information pack which, was available at the front entrance of the home, was viewed. It included some good information about the home, however some of the documents need replacing, as they are old and worn. A Statement of Purpose and resident Guide was included in the pack they included information for new residents about the service and facilities available at the home. The homes Statement of Purpose and Resident Guide was written in small type, this should be reviewed and if required provided in a format which can be easily accessed by current and prospective residents. Information about trial visits for prospective residents was available within the
9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 9 Statement of Purpose it clearly described the process that the home follows for introducing new residents, the procedure includes trail visits. The residents care files contained copies of assessments carried out by the care management team and the home which showed that the home are meeting her assessed and changing needs. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9 The service provides a care plan for the resident, reviews are carried out regularly, therefore changing needs are being identified and met. A risk assessment for the use of bedrails has not been carried out potentially putting the resident at risk. Other risk assessments for the resident show that they are encouraged to take responsible risks in their lives, and they are being appropriately reviewed ensuring that they are safe and effective. Information about the resident was stored securely ensuring that their confidences are kept. EVIDENCE: 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 11 A care plan was viewed for the resident. The care plan provides a good level of information about all aspects of the resident’s life including communication, financial information, support and assistance with behaviour, mobility, health and personal care. All information in the residents care plan is regularly reviewed and changes are recorded. Records of this were available in the residents care file. Some records kept in care files are not signed and/or dated this needs to be done to ensure that all information is relevant and up-to-date. Copies of a new care planning system which is being introduced to the home was viewed, The Essential Lifestyle Plans (ELPs) will provide a great deal of information concerning the residents support needs and lifestyle, and provide an excellent basis for planning their care on an individual basis. Risk assessments for the resident were viewed, they have been reviewed and updated since the last inspection. Bedrails are fitted to the residents’ bed to reduce the risk of her falling out, there was no risk assessment in place for the use of them. This must be done to ensure that the bedrails are safe and effective. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 15 & 17 The service provides opportunities for the resident to take part in a variety of activities both at home and in the local community, which are appropriate to their needs and wishes. Relationships are encouraged so that the resident maintain contact with family and friends. The resident is encouraged to shop and eat food that is healthy and enjoyable. EVIDENCE: Records and discussion with staff showed that many opportunities are given for the resident to take part in activities of their choice. The manager and staff spoken with said that the resident is supported to go shopping for personal items as well as things for the home. They also said that they support the resident to access a variety of other activities in the local community. Daily diaries and a weekly timetable viewed for the resident showed that they are involved in a varied programme of activities. There was plenty of fresh, tinned and frozen foods kept at the home. The manager said that the resident is supported by staff to shop for food. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 13 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 19 & 20 Staff ensure that the residents dignity is preserved at all times and their right to privacy is always observed. The resident’s health care is well recorded and monitored to ensure that their health care needs are met. Medication was stored appropriately, records were well kept and staff have completed the required training to ensure the protection of the resident. EVIDENCE: The manager and staff were observed attending to the resident who was ill in bed. Records showed that the health care needs of the resident were recorded in good detail. Records about the resident’s healthcare were well kept and up to date. The manager said that staff fully support the resident to attend regular healthcare appointments, records also showed this. All medication is administered by staff. Medication was in date and stored in a locked cabinet in the kitchen. At the last inspection it was noted that some unwanted medication was kept at the home. This has since been returned to the pharmacist a record of all returned medication is kept at the home. Also at the last inspection records showed that staff who were involved in administering medication had not completed the required training, at this inspection certificates were viewed which confirmed that all staff who are involved in this process have now completed the necessary training.
9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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 standard(s) 22 & 23 There were no recorded complaints since the last inspection. The complaints procedure is not available in a format that can be easily accessed by the service user. Safeguards were in place to protect the people living in the home from abuse. EVIDENCE: Records showed that there have been no complaints made at the home since the last inspection. A complaints procedure was viewed at the home, it included details about the action and timescales involved in the process, and it also included details of the Commission for Social Care and Inspection (CSCI). The homes Complaints procedure was written in small type, this should be reviewed and if required provided in a format which can be easily accessed by residents. Copies of the procedure were available in the homes information pack and the staff handbook. A number of policies and procedures were in place to protect the safety, health and welfare of residents including a copy of Seftons Local Authority Protection of Vulnerable Adults Procedure (POVA), which clearly describes what action, must be taken in response to suspicion or evidence of abuse. Records showed that staff have completed Protection of Vulnerable Adults training. Staff spoken with showed a good awareness of the different types of abuse and their responsibility to protect vulnerable adults. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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 standard(s) 24 & 30 The inside of the home was generally well maintained, clean and tidy providing a safe and homely environment for those who live there. Some of the paving outside the back of the home is uneven and damaged in parts. This has the potential to put those who use it at risk. EVIDENCE: A full tour of the home was carried out. All areas of the inside of the house were clean, tidy and well maintained. Since the last inspection some of the required improvements have been made to the environment making it more comfortable for residents. Plants, pictures and other items have been displayed around the main bathroom giving it more homely feel. The requirement that was given for the paving in the back garden to be re laid has not yet been done. The paving is still uneven and damaged in places. The manager stated that arrangements had been made for refurbishment of the patio, however, the contractors failed to turn up at the property on the day that was agreed. Further arrangements have been made for the work to be carried out. A letter to evidence this was viewed. Several large bags of rubbish and other unwanted items were stored at the side of the house. A member of staff said that arrangements have been made to remove all the
9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 17 rubbish. The staff handbook contained a number of policies and procedures relating to cleanliness and hygiene. A member of staff showed awareness of the importance of maintaining a clean and hygienic environment for the people who live there. Staff were observed following the correct Infection Control procedures. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 34 Staff complete training that is required for them to carry out their work safely and to enable them to meet the needs of residents. The homes recruitment process ensures the protection of residents. EVIDENCE: Staff rotas showed that sufficient numbers of staff are on duty throughout the day and night. There is always usually at least two staff on duty throughout the day and one member of staff on at night to support the resident who lives there. Extra hours are provided when required to ensure that the resident’s health and social needs are met. On the day of the inspection the manager made arrangements to increase the staffing levels to meet the changing needs of the resident. Records examined and staff spoken with confirmed that staff complete training that is required as well as training that is specific to the needs of the residents. A training programme was observed at the home, forthcoming training for staff includes Health & Safety, Food Hygiene, Manual Handling and Risk Assessing. Policies and Procedures on Equal Opportunities and Recruitment and Selection of staff were available at the home. A selection of staff files were examined they included the records that are required for recruiting and selecting staff. Records and discussion with staff showed that they were involved in an induction programme during the first part of their employment at the home.
9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 19 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 39 & 42 The manager has not yet forwarded onto the Commission for Social Care and Inspection a fully completed application for her approval as registered manager to ensure that the home is being well managed. Processes are carried to ensure that resident’s views are listened to and acted upon. Policies and procedures were in place to protect the health, safety and welfare of the residents and staff. EVIDENCE: The manager has returned an application to CSCI for her approval as Registered manager of the home, however it did not include all the information required. The manager was informed that the process to approve her couldn’t continue until the application is complete. Staff were complimentary of the manager describing her as caring and approachable. Monthly visits to the home are being carried out by a representative of the company to ensure that residents are happy with the home and the way it is run. Reports following the
9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 21 visits are forwarded onto CSCI, copies are also available at the home. The manager and staff spoken with confirmed that they have completed health and safety training. Certificates were available to support this. A detailed health and safety manual was available at the home. The manual included certificates of safety checks and details of tests carried out on the environment, they were all well kept and up to date. All the required health and safety policies and procedures were available in the homes handbook. 9 Spring Gardens F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 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 2 3 x 3 x Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
9 Spring Gardens Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x x 3 F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 23 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 YA37 Regulation 8 Requirement Timescale for action 31/07/05 2. 3. 4. YA24 YA9 YA24 13(4)(a) 13(4) 23(2)(o) The registered provider must complete the application made to the Commission for a registered manager. Paving at the rear of the house 31/08/05 must be made safe. The manager must carry out a 31/07/05 risk assessment for the use of bedrails. The manager must arrange for 31/07/05 the removal of the rubbish from the side of the house. 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 YA6 YA1 Good Practice Recommendations The manager should sign and date all records kept in residents care files. The manager should reorganise and replace some of the documents in the homes information pack so that the information contained in it is more presentable and easier to locate. The manager should make the homes policies and procedures more accessible to residents.
F53 F03 9 Spring Gardens S5275 V236035 240605 Stage 4.doc Version 1.40 Page 24 3. YA40 9 Spring Gardens Commission for Social Care Inspection Burlington House, 2nd Floor, South Wing Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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