CARE HOME ADULTS 18-65
St Annes Road East (85) 85 St Annes Road East St Annes Lancashire FY8 3NF Lead Inspector
Lesley Plant Unannounced Inspection 1st December 2005 1.30 St Annes Road East (85) DS0000009887.V259798.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 St Annes Road East (85) DS0000009887.V259798.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. St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Annes Road East (85) Address 85 St Annes Road East St Annes Lancashire FY8 3NF 01253 712547 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.unitedresponse.org.uk United Response Mr Stephen Turner Care Home 6 Category(ies) of Learning disability (6) registration, with number of places St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th August 2005 Brief Description of the Service: 85 St Annes Road East is a small care home for adults with learning disabilities, registered for six people. The well-established national charitable organisation United Response is the registered provider. The home is a semi-detached three-storey house providing good access to local services and amenities. The organisation provides a vehicle to enable people living at the home to take part in leisure activities and access amenities. The staff team support individuals in all aspects of daily living according to their assessed needs and as identified via the care planning process. Individuals are supported and encouraged to develop their independence and take part in all aspects of community living. The service adopts an active support approach, providing people with practical day-to-day support, in order that individuals can take as much control of their lives as possible. The staff team are supported by an experienced management team and an organisation, which clearly values its employees and the people who use the service. St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, started at 1.30 pm and took place over three hours. The registered manager and the team manager were not on duty at the time of this inspection. The inspector spoke with four members of staff and two of the four people living at the home. Medication and care records were inspected and some of the written policies were viewed. One person living at the home was supported to complete a feedback comment card. Information was also gained from the pre inspection questionnaire, completed by the team manager. Key standards not assessed at this inspection will have been addressed at the previous inspection on the 9th August 2005. What the service does well: What has improved since the last inspection?
As recommended at the last inspection, information in the individual charter has been updated to reflect the six- monthly review process. Support plans and risk assessments are now reviewed more regularly. A good plan is in place to support an individual to take more control of her medication. The risk assessments regarding the challenging behaviour of one person have been reviewed and there is now a risk assessment in place for an individual who uses a kettle in her bedroom. St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 6 Good work continues with one individual who has made a great deal of progress in joining the group for meals and going out of the home, activities which have been difficult for her in the past. Good progress has been made with qualification training, in that over 50 of the regular staff team have achieved NVQ level 2 or 3. 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. St Annes Road East (85) DS0000009887.V259798.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 St Annes Road East (85) DS0000009887.V259798.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): 5 The individual charter clearly explains what the service provides and the terms and conditions for those living at the home. EVIDENCE: The individual charter (contract) provided with the Service User Guide, clearly details what the service will provide and the rights of the individual. This is printed with pictures and symbols in order for it to be more easily understood by those living at the home. As recommended at the last inspection the information relating to care planning has been updated to reflect the sixmonthly review process. St Annes Road East (85) DS0000009887.V259798.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 and 9 Support plans and risk assessments are being reviewed more regularly, which means that changing needs can be met. EVIDENCE: File information includes communication profiles, risk assessments and risk management strategies, daily routines, weekly activities, personal care guidance, medical profiles and individual goals. At the last inspection concerns were raised regarding one individual who was showing increased incidence of challenging behaviour, but had not had his support plan reviewed. Progress has been made, in that a staff meeting has been held to discuss approaches, and risk assessments, protocols and guidance for staff have been reviewed. The support plan was reviewed in October. Although the staff on duty agreed that this has helped, not all staff appeared aware of the newly revised guidance. Generally communication appears good, but the registered manager is advised to ensure consistent communication within the team. Good work continues with one individual who has made a great deal of progress in joining the group for meals and going out of the home, activities which have been difficult for her in the past. The two people spoken to both stated that they felt well cared for by the staff at the home.
St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 10 Staff have good communication skills and have built up close relationships with the people living at the home. People are supported to make decisions and evidence of this is recorded on files. Appropriate support and guidance is given to help people to make decisions about their lives. One individual is currently moving towards managing her own medication, with support from staff. People make decisions about day- to- day activities and routines, such as meals. Information regarding advocacy services is available and individuals also have family members who would advocate on their behalf as necessary. The home has a Risk Management Manual, which addresses service user risks, such as behavioural and activity risks, and also service risks such as fire, and health and safety issues. Risk assessments are signed by staff and are now reviewed more regularly. A good plan is in place to support an individual to take more control of her medication. The risk assessments regarding the challenging behaviour of one person have been reviewed and there is now a risk assessment in place for an individual who uses a kettle in her bedroom. The home has a missing persons policy and there are also individualised policies relating to certain people living at the home. St Annes Road East (85) DS0000009887.V259798.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): 16 and 17 The routines of daily living are flexible and promote independence. People are happy with the meals provided. EVIDENCE: Independence in daily routines is supported and actively promoted at all times. There is a weekly plan of set activities, with a daily chart then drawn up showing activities for that day. Discussions with staff and people living at the home confirm that there is much flexibility regarding daily routines, that individuals are fully involved in household tasks and that institutionalised practice does not take place. United Response adopts an “Active Support Approach” in care planning and service delivery, which means that rights and responsibilities are supported. Everyone living at the home is offered a front door key and a key to their bedroom. The level and quality of interaction between staff and service users is of a high standard. Files show peoples’ likes and dislikes regarding food and meals. People are supported to get involved in food shopping and meal preparation. One person talked about this and how he likes to go to the supermarket. Although there is a rotating menu in place, this is made flexible according to individuals’ activities and preferences. On the day of the inspection one person had been
St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 12 out for lunch and chose to just have a snack meal at tea- time. Information from the comment card and discussions with those living at the home, confirms that people are happy with the meals provided. St Annes Road East (85) DS0000009887.V259798.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): 20 Staff training and good practice mean that medication is handled and administered correctly. EVIDENCE: Staff undergo training at the organisations regional office prior to administering any medication. A member of staff on duty confirmed that this was part of the core- training programme undertaken by herself and that regular updates are arranged. Medication is stored in a locked cabinet in a locked cupboard. A system of blister packs is in use for the majority of medication. The two records viewed were appropriately maintained, however a discrepancy in the time of day for giving one medication was noted. This was discussed with the senior staff on duty and advised that it be checked with the GP. A risk assessment has been undertaken for one person, to start administering her own medication. The risk assessment is thorough and clear, and includes various checks. St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 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 and 23 Systems are in place to ensure that any concerns would be dealt with. Policies and staff training promote the protection of those living at the home. EVIDENCE: The pre inspection questionnaire records that no complaints have been received since the last inspection. A complaints procedure is in place, plus a pictorial guide for people living at the home. This contains photographs of senior staff, who would deal with any concern raised. One person living at the home explained that she would talk to staff about any concerns, saying; “ they all listen and would help me with anything.” United Response provides policies and guidance for staff regarding the prevention of harm. Staff on duty confirmed that they had undertaken training regarding abuse and that this is part of the core- training programme for all staff. United Response is an umbrella organisation regarding Criminal Records Bureau (CRB) clearance and all staff receive clearance at enhanced level. Records are kept of any incidence of challenging behaviour and written guidance directs staff regarding these situations. Appropriate systems are in place regarding assisting people with their finances. St Annes Road East (85) DS0000009887.V259798.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): None of the above standards were assessed at this inspection. EVIDENCE: St Annes Road East (85) DS0000009887.V259798.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): 32, 34 and 35 The good core training programme and progress with NVQ training means that people are supported by qualified and competent staff. EVIDENCE: The support team consists of seven staff including the team manager. Four of the staff have achieved NVQ level 2 or above and a further two members of staff are working towards the level 3 qualification. Some agency staff are used to make up any shortfalls in staff cover. During the inspection staff communicated effectively with the people living at the home and helped individuals to communicate with the inspector. Staff showed a good understanding of the needs of the people living at the home. United Response provides a good programme of core training, with some additional training to meet specific needs of individuals. One person living at the home has particular communication needs and further training in this area is planned for staff. Records indicate that staff maintain good professional relationships with other professionals such as GP’s. The team manager and registered manager were not available at this unannounced inspection and therefore some information relating to staff recruitment was not accessible. However, previous inspections have shown that a thorough recruitment process is carried out. An established recruitment policy is in place, with people who use the United Response service being involved in staff selection. Two written references are obtained for each staff
St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 17 member and all staff receive a staff handbook, containing comprehensive information about employment within the organisation. United Response is an umbrella organisation for Criminal Records Bureau (CRB) clearance and all staff undergo clearance at enhanced level. These staff disclosures have been viewed on a previous occasion. Information from the pre inspection questionnaire and from discussions with the staff on duty confirms that staff are appropriately trained. The organisation provides a comprehensive rolling programme of core training, which feeds into the induction process. This core training includes medication, abuse, health and safety, and food hygiene. The aim is that following successful induction and foundation training, staff will then register for NVQ level 2 or 3. The training budget is administered from the organisation’s regional office. St Annes Road East (85) DS0000009887.V259798.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 and 39 There are quality-monitoring systems in place, which take into account the views of those living at the home. EVIDENCE: The registered manager was not on duty at the home during this inspection. The registered manager has many years experience and is soon to complete the Registered Managers Award. Under the current arrangements the registered manager is responsible for four United Response care homes in St Annes. Although the team manager carries out much of the day-to-day management duties, it is important that the registered manager takes a proactive role in the management of the home. United Response quality assurance systems include targets and goals for the organisation. The home has a quality assurance manual, which staff can access. The registered manager and the United Response area manager carry out quality checks and audits. Staff have built up close relationships with people living at the home and there are informal processes in place for gaining feedback from individuals.
St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 4 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Annes Road East (85) Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x x x DS0000009887.V259798.R01.S.doc Version 5.0 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA37 Good Practice Recommendations The registered manager should achieve qualifications at Level 4 NVQ in both management and care. St Annes Road East (85) DS0000009887.V259798.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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