Inspection on 19/07/05 for St Philips Close

This inspection was carried out on 19th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Philips Close 24/04/07

St Philips Close 31/05/06

St Philips Close 29/11/05

St Philips Close 01/02/05

St Philips Close 29/07/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 St Philips Close 3 St Philips Close Middleton West Yorkshire LS10 3TR Lead Inspector Valerie Francis Unannounced 19th July 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. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Philips Address 3 St Philips Middleton Leeds LS10 3TR 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) 0113 2778068 0113 2778068 Milbury Care Service Ltd Mr John Irving Care home 4 Category(ies) of Learning disability (4) registration, with number of places St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 01.02.05 Brief Description of the Service: 3 St Philips Close is a purpose built bungalow located in a residential area of Middleton close to local amenities and public transport routes. There is roadside parking to the front of the home. There are well maintained gardens to the rear of the property that are accessible to service users. The home is registered to provide personal care for four people with learning disabilities. The accommodation includes four single bedrooms, a lounge, combined kitchen and dining room, a communal bathroom and toilet, a domestic style kitchen and separate laundry room. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. All regulated care homes have a minimum of two inspections in every twelvemonth period from April to March. This was the first visit for this inspection year. This inspection was unannounced and was carried out by one inspector on the 19 July 2005 on a weekday in July 2005. The inspection started at 12.10 and finished at 5.10pm, a total of 5 hours. The purpose of the inspection was to ensure the home was operating and being managed to a satisfactory standard in accordance with the National Minimum Standards (NMS) for Care Homes for younger Adults. The inspector spoke to several residents, staff members, the temporary manager and visiting relatives. Some of the records that are required to be kept were inspected, which included resident’s care plans, and staff rotas and training information. Over the last months the registered manager has been absent from the home. The organisation has appointed a temporary manager who has been there for several months to oversee and manage the home. Visiting relatives made positive comments about staff for the care and attention given to their relatives living at the home. They said that they were “always informed of any changes in the care of their relatives. They said they were “able to accompany relative to appointments and were able to have a say in any discussions about the health and wellbeing of their relative”. What the service does well: Visitors said, “ staff give us good support,” “ they always involve us in any thing that is going on with our relative”, “they are caring and friendly and kind.” Staff are good at collecting information about residents and the approach to care at the home is person centred. Staff are committed to provide residents with a high standard of care. Staff attend meetings with health care professional i.e. hospital appointments and recreational activities with residents in their working time and in their own time. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The resident’s care plan must cover all aspects of personal, social and healthcare needs and demonstrate how support and assistance is to be provided by staff. Any limitations placed on residents must be made only in the person’s best interests and be formally agreed and recorded with the service user, their representative and/or other professionals involved in their care. All risk to service users must be assessed and recorded and risk management strategies must be agreed with the service user and recorded in the care plan. Staff must be provided with training in regards to the change in the care needs of residents, and how to deal with the ageing process of residents. The registered provider must make sure that residents have access to staff who are known to residents at the home. Staff must have one to one supervision. The registered Provider must make sure that a registered manager is available at the home. Please contact the provider for advice of actions taken in response to this St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 8 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 St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 9 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) These standards were not assessed at this inspection. EVIDENCE: St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 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) 6,7and 8 There were no written care plans in place for assessed needs, which would enable staff to meet the all care needs identified. Risk assessments were not carried out for day to day living, which would give staff an action plan to follow to minimise the identified possible risks to the resident on day-to-day basis. EVIDENCE: Two care plans were seen, although the inspector found relevant information in regards to residents, there were no real plans to show how their needs would be met. There was clear information of the resident’s life-style, their likes and dislikes and any family involvement. There was information on activities both in and out of the home, which also involved other agencies. There was no evidence of a person centred approach to care planning, no information regarding choices and aspiration of the individual and how these would be encouraged and met. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 11 The temporary manager said training on writing care plans had been arranged for members of staff. This will allow them to use the information collected to put together clear care plans of the action being taken to meet care needs. There were some risks that had been identified but there was no plan of action how these would be minimised. Some residents identified, as being at risk when outside the home had no individual risk assessment in place. It was evident from the inspector’s observation of staff member’s interaction with residents that they provide residents with good standard of care and they wishes and choice is given due consideration. Visitors for one resident said they were involved in the care of their relative. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 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) 13 and 15. Activities are arranged in accordance to their individual needs and preferences, which allow residents to develop life skills. Participation in domestic tasks are structured, however, they are not consistent. EVIDENCE: Each resident has a daily plan with details of events and social activities including the names of the agencies providing the activities. Holidays are arranged with residents and involve consultation with their families. Residents are supported and encouraged by members of staff on holidays, days out, shopping trips and visits to community recreational activities, giving them the opportunity to take party in activities they enjoy. Residents are encouraged and supported to keep in touch with their families and friends. Members of staff assist residents to visit family and friends, who are also welcome to visit the home and relatives said they were made welcome. Invitations are also given to family and friends to attend any social events at the home. It was evident at the inspection that family contact is promoted by the home. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 13 St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 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 and 21. Staff provide residents with good support with their personal and health care. Written information and training needs to be in place to make sure the residents get the care that is appropriate for their needs, and all staff are aware of the plan of action. EVIDENCE: Although there were records of resident’s likes and dislikes seen in the files, information was not in order, which made it difficult for staff members to have access to up to date information. Discussions with members of staff indicated that the staff team worked closely with healthcare professionals in all aspect of individual health care and any problems identified were dealt with. Members of staff administered residents’ medication. These records were seen and it was noted that staff sign to show that they have given the medication to residents and if not, a note is recorded. All staff members have received training in medicine awareness, by the organisation and by Boots, the homes dispensing pharmacist. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 15 There is a policy and procedure in Safe Handling of Medicine in place, which is accessible to staff and from discussion with staff it was evident that they were confident on the ordering and administering of medication. There was information seen on one of the residents files on their last wishes and arrangements for internment. However, there was some training needed for staff on Bereavement and the changing needs of residents and the manager said training had been arranged. Relatives were encouraged to be involved in any arrangement for change in care needs. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 16 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. There is a complaints procedure that has been produced. However, residents would benefit from a format that can be easily accessed and understood. However, the home did not encourage residents to complain and reassure them that their complaint will be taken seriously. EVIDENCE: Although there is a complaint procedure that has all the required information, the complaint procedure was not in a format that they can understand. The residents also needed to be reassured that their complaints would be taken seriously. The manager said the procedure was being updated to make sure that this information is clear to residents. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 17 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 and 30. Residents live in a homely, and comfortable environment. EVIDENCE: In general the building is kept in accordance with the surrounding houses. There is CCTV in place for the outside perimeter of the building there are security gates fitted to windows. Since the last inspection, the kitchen/dining, bathroom, lounge, hallway and one resident’s bedroom has been redecorated. New furnishing and floor covering in the sitting area provided residents with furnishing and fitments that are homely with bright and cheerful colour schemes. It was apparent that some thought had been given to make sure that the home is a modern and tasteful environment. The inspector found the home to be clean and to a good standard. Members of staff and residents have access to good laundry equipment that appeared to be appropriate to meet the needs of the group and number of residents. All members of staff have been on a infection control course, to enable them to carry out their work caring for residents in the principal of infection control. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 18 Members of staff had access to moving and handling equipment to meet individual residents needs. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 19 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, 35 and 36 Residents have access to a staff team who are flexible and competent to meet the needs of the residents. Members of staff have access to training that provides them with the skills and knowledge to meet the needs of the resident group. There is a temporary manager in post who provides continuity to the team however staff have not received formal supervision. EVIDENCE: It was evident at the inspection that staff members care for residents in an atmosphere that is resident lead, staff are flexible; coming in their own time to accompany residents to health or social appointments. At the time of the inspection, there was one staff vacancy for a full time care worker, of which the hours were covered by an agency and contracted by the home to make sure that the same staff worked at the home to make sure that residents did not have different people assisting them with their personal care. There were two staff who have an NVQ qualification and two were about to start the training in September 2005. The NVQ training linked to the LDAF training. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 20 The members of staff had worked at the home for a long time and knew the residents. None of the staff had an individual training development plan. The temporary manager and the operational manager had put together a training plan for the home and staff members in the area of Leeds. Senior staff members in the home had attended training on supervising staff and there were plans made to allocate a number of staff members to the senior staff for formal staff supervision. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 21 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) 38 and 40. Management at the home has been disrupted but is now addressed with the placement of a temporary manager. Members of staff have access to a range of policies and procedures to assist them in their work. EVIDENCE: Discussion with staff members and visitors clearly demonstrated that the home is being managed in an inclusive, open and positive manner. It would appear from observation and from comments made by visitors that staff members work well together to make sure residents are included and that their needs and wishes are met. Staff meetings are held and staff members have opportunity to discuss matters that relate to residents and the running of the home. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 22 Staff members have access to a range of policies and procedures, which are kept in the office that are accessible and readily available. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 23 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 x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x 3 x 3 x x Standard No 31 32 33 34 35 36 Score x 2 x x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Philips Close Score 3 3 3 2 Standard No 37 38 39 40 41 42 43 Score x 3 x 3 x x x J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 24 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 YA6 Regulation 17 Requirement The residents care plans must include all aspects of personal, social and healthcare needs and demonstrate how support and assistance is to be provided by staff. Any limitations placed on a service user must be made only in the person’s best interest and must be formally agreed and recorded with the service user, their representative and/or other professionals involved in their care. Risk to service users must be assessed and recorded and risk management strategies must be agreed with the service user and recorded in the care plan. Staff must be provided with training in regards to the change in needs and dealing with the ageing of residents. The registered provider must make sure that residents have access to staff that are permanent at the home. Staff must recieve formal supervision. Timescale for action 9TH Ocotber 2005. (previous 31st 3 05) 9TH Octobe 2005 (previous 31/03/05) 2. YA7 13 3. )YA9 13 9th Ocotber 2005 (preious 30/03/05) 15th November 2005 9th October 2005. 4. YA21 18 5. 32 18(1)(a) 6. YA 36 18 (2) 30th September 2005 Version 1.30 Page 25 St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc 7. YA37 8 The Registered Provider must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 9th Ocotober 2005 8. 9. 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. 3. Refer to Standard 22 Good Practice Recommendations residents should have access to the complaint procedure which is acessable and can be understood. St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP 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 St Philips Close J52 S1501 3 ST Philips V192412 190705 Stage 4.doc Version 1.30 Page 27 - 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!