CARE HOME ADULTS 18-65
St Mark`s Road Care Home - Block A 24 St Marks Road Derby DE21 6AH Lead Inspector
Vanessa Davies Unannounced Inspection 22nd October 2007 08:30 DS0000063066.V352767.R01.S.doc Version 5.2 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 DS0000063066.V352767.R01.S.doc Version 5.2 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. DS0000063066.V352767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Mark`s Road Care Home - Block A Address 24 St Marks Road Derby DE21 6AH 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) 01332 294066 01332 242338 24stmarksroad@robinia.co.uk 26stmarksroad@robinia.co.uk The Robinia Group PLC Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000063066.V352767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2006 Brief Description of the Service: Robinia Care Group is the responsible provider for 24 St Marks Road. The home is located on the same site as another home owned by this organisation and the same Registered Manager is responsible for both homes. The home was purpose built to a high standard and registered in July 2005, to provide personal care and accommodation for up to 8 people in the category of learning disability, aged between 18 and 65 years of age. At the present time the group of people living at the home are all aged under 30 years. The home is situated in Chaddesden just outside Derby City centre and is close to local amenities. A car park in available at the front of the premises and a garden at the rear. The home provides a spacious environment with all rooms being of single occupancy with en-suite shower facilities. DS0000063066.V352767.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report is written from information received from the manager before the visit, information gathered by reading records during the visit and observing service users and staff throughout the visit. The fees for the home range from £80,446.08 - £101,182.12 per year. What the service does well: What has improved since the last inspection?
Newly appointed staff are now given a structured induction programme, which includes relevant training needed, this was evident on the day of the visit. Staff have received the training necessary to undertake their duties safely. DS0000063066.V352767.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. DS0000063066.V352767.R01.S.doc Version 5.2 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 DS0000063066.V352767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed information gathered prior to admission helps to ensure that the staff are able to meet the needs of the service users. EVIDENCE: Each of the files held a pre-admission assessment. There was also detailed, valuable information within the files relating to life before moving into St Marks Road. Files included reports from Speech and Language therapist, a Community Care Assessment and other assessments relating to the needs of the service users. A lot of the information within the files had clearly been gathered with the help of the families of the service users concerned. One file examined contained a large amount of out of date information, making it difficult to follow, the manager did state that he intended to review the files and archive information no longer needed. DS0000063066.V352767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed information within the care plans and risk assessments helps to ensure that changing needs are met. EVIDENCE: Each file examined held detailed information to enable the staff to meet the changing needs of the service users. It was evident on the day of the visit that service users are supported to make their own decisions as much as possible. The manager is introducing a new care planning system, which includes targets, aspirations and progress, one file examined did not have any information regarding this. However the manager did state that he had arranged a review regarding the service user and the documentation would be completed then. Service user records are all stored securely. DS0000063066.V352767.R01.S.doc Version 5.2 Page 10 All of the records are written in an easy to understand format, using simple English and pictures. It was evident on the day of the visit that service users independence is promoted, one service user was preparing to go out, discussing her day with staff. Service user files evidenced choice and promotion of independence. Each of the files had relevant risk assessments in place, relating to accessing the community and suitability of an activity. However as discussed with the manager the risk assessments and care plans are confusing and files need to be reorganised to ensure they are accessible to service users and new staff. DS0000063066.V352767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Offering a range of activities and involving the service users in this process helps to promote independence and improve quality of life. EVIDENCE: The Manager and staff provide an individual activity plan for each service user, this is included in the support plan. Each of the service users have access to a range of activities and this was evident on the day of the visit observing the service users and staff. However files did not evidence a range of activities, and the details of activities was poor and should be kept up to date to evidence what actually does happen each day. Service users access the local community on a regular basis. Service users are offered a healthy diet and are encouraged to participate in developing the menu and to be involved with the shopping.
DS0000063066.V352767.R01.S.doc Version 5.2 Page 12 Service users are supported to maintain regular contact with families and friends. There was little evidence of how the staff meet the cultural needs of the service users. DS0000063066.V352767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although detailed information is held within files, the files are untidy and disorganised which potentially prevents staff from meeting the service users needs. EVIDENCE: Each of the files examined detailed healthcare information, both past and present. One file had detailed information provided by the previous primary carers (parents), a report from Speech and Language 08.05.07 and a conductive education report 09.03.06. Although there are a large number of care plans and risk assessments in each of the files examined, they were very difficult to follow as the files are untidy and it is difficult to establish what is a care plan and what is a risk assessment. The manager did state that he was in the process of reviewing all care files and intended to archive information no longer used. The home has to meet a number of needs with regard to food and allergies. However one member of staff was unaware of an allergy. This is documented
DS0000063066.V352767.R01.S.doc Version 5.2 Page 14 in the care file but it is difficult to find and the manager again stated that he was in the process of reviewing the care files and would ensure that this was addressed. There was still no evidence of how the home was to meet cultural needs of service users, this was highlighted at the previous visit. Medication is stored, documented and administered appropriately. If service user have problems taking medication then as per policy, permission is sought from the GP and families regarding giving medication in food. DS0000063066.V352767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Positive approaches to whistle-blowing ensures that service users and staff feel listened to and that the issues are acted upon positively, ensuring the safety of the service users. EVIDENCE: The home has a clear complaints policy, whistle-blowing policy and Safe Guarding Adults policy and procedures. It was evident that the manager listens very clearly to any concerns the service users and their representatives may have. On the day of the visit the manager spoke with all service users prior to commencing his duties, to ensure that they were all happy. The manager ensures that all new staff undertake an induction, which includes understanding policies and procedures, this was evident on the day of inspection as there was a new member of staff on her first day. All staff have either completed or are booked onto the Safeguarding Adults training. Staff spoken with were clear about what they would do in the evident of a suspected abuse of a service user. DS0000063066.V352767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean and pleasant homely environment helps to ensure that service users are safe. EVIDENCE: The furniture is due to be replaced, the manager stated that he expected it to be delivered within the week. They are having new leather sofas in the lounge and new laminate flooring. There is a separate dining room with 2 large dining room tables and seating for 9. Each of the bedrooms seen were personalised and had an en-suite with a track hoist around the room. The home has all necessary equipment to ensure the service users are able to be moved safely without compromising their dignity. The home was very clean and free from any malodour on the day of the visit. DS0000063066.V352767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficiently trained staff on duty in relevant numbers to meet needs helps service users to feel safe and meet their full potential with the necessary support. The lack of relevant information within staff files could potentially put service users at risk. EVIDENCE: The manager stated that he had arranged training in November 2007 for Safeguarding Adults and First Aid, for staff who needed them. All staff have completed training in manual handling, fire safety and health and safety. The staffing numbers are sufficient throughout the day to meet the needs of the service users and 1 waking night, 1 sleep-in and 1 floating member of staff between the 2 adjacent bungalows in the evening. The home has a very good on-call system, a rotation between managers and all managers involved have relevant information about all of the service users they may be asked about. DS0000063066.V352767.R01.S.doc Version 5.2 Page 18 A sample of staff records was examined 3 contained only 1 written reference, the manager stated that this was being dealt with by human resources department. All staff have a Criminal Records Bureau check before commencing work, files evidenced this as did the new member of staff spoken with. DS0000063066.V352767.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A new and enthusiastic Registered Manager helps to build staff morale and have positive effects on the lives of the service users. EVIDENCE: The home has recently had a new manager, he is clearly working very hard to implement positive changes with the care planning process and the environment. He has built up relationships with the service users and takes the time to listen to them when he arrives on duty. The manager stated that he had a great deal of experience working in a care setting. DS0000063066.V352767.R01.S.doc Version 5.2 Page 20 The manager evidenced a number of monitoring methods. The home has regular monitoring visits from a manager outside the home. The fire alarm records were up to date. He stated that he had tried for a long time to arrange for new furniture to be purchased and it had now been agreed and would be delivered later in the week. It was evident that staff meetings are held on a monthly basis and the manager stated that he was trying to organise regular service user meetings too. Staff supervision is held on a monthly basis, although records were not seen it was confirmed by the manager and staff spoken with. DS0000063066.V352767.R01.S.doc Version 5.2 Page 21 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 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X DS0000063066.V352767.R01.S.doc Version 5.2 Page 22 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. 2. 3. Standard YA6 Regulation 15 13.4(c) 19(1) Schedule 2 Requirement Timescale for action 30/12/07 YA19 YA34 Care plans must be clear and concise ensuring staff are aware of the needs highlighted. Staff must be aware of the 30/12/07 health issues of service users. Staff recruitment files must 30/11/07 obtain evidence that 2 written references and proof of identity have been obtained for newly employed staff. (previous date of compliance 31/10/06) All staff working within the home must have 2 written references in place prior to appointment. 30/12/07 4. YA34 Sch 2 (5) 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 YA6 Good Practice Recommendations All documentation completed for services users should be signed and dated and completed in full, and individuals or their representatives should be consulted and included in the development of their plan, where appropriate.
DS0000063066.V352767.R01.S.doc Version 5.2 Page 23 2. YA6 The home’s management should review all care records to ensure that they are as concise as possible and present as a useful working tool rather than a depository of old information. The Personal Care Plan document should be completed for all people living at the home. Cultural needs of the service users should be detailed within the care plans. The activities list should be kept up to date to ensure that a true record of events is kept. 3. 4. 5. YA6 YA12 YA12 DS0000063066.V352767.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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