Inspection on 23/11/05 for St Philips Close

This inspection was carried out on 23rd November 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 no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Philips Close 03/10/07

St Philips Close 14/11/06

St Philips Close 23/05/06

St Philips Close 04/05/05

St Philips Close 02/11/04

St Philips Close 18/05/04

St Philips Close 25/11/03

St Philips Close 19/08/03

St Philips Close 09/10/02

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

CARE HOME ADULTS 18-65 St Philips Close 1 St Philips Close Middleton Leeds West Yorkshire LS10 3TR Lead Inspector Valerie Francis Unannounced Inspection 23rd November 2005 09:30 St Philips Close DS0000001500.V266627.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 Philips Close DS0000001500.V266627.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 Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Philips Close Address 1 St Philips Close Middleton Leeds West Yorkshire LS10 3TR 0113 277 8069 0113 2778069 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) Milbury Care Services Limited Mr John Irving Care Home 4 Category(ies) of Learning disability (4) registration, with number of places St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2005 Brief Description of the Service: 1 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 communal lounge/dining room, a communal bathroom and toilet, a domestic style kitchen and separate laundry room. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection between 9.15am and 3.30pm. The purpose of the inspection was to ensure the home was operating and being managed to a satisfactory standard. The inspector looked around the home, observed practices and spoke to the two staff on duty and another member of staff from the home next door. Feedback of the finding was made to the temporary manager on the 29th November. Most of the residents living at the home have complex needs, and discussions with them were limited. Records were inspected including residents care files, risk assessments, daily records and staff training records. A pre-inspection questionnaire was sent into the Commission after the inspection. What the service does well: What has improved since the last inspection? Since the last inspection redecoration and replacement of furniture in communal rooms have taken place. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 6 An area has been found in the home for the storage of office equipment. However, the fax machine and some files are still in the dining room used by residents. The installation of the High-Low bath has been carried out. Water temperatures of the water from the hot taps are now recorded. 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 Philips Close DS0000001500.V266627.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 Philips Close DS0000001500.V266627.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): 2 The home has failed to provide a record of care assessment carried out. This prevents service users having a plan of care drawn up that is specific to their needs, and how they would be met. EVIDENCE: Although the member of staff in charge had indicated that a pre assessment had been carried out for the new resident, this was not on file, therefore no judgement could be made if the home were meeting the identified needs of the resident. There was also no assessment from the placing agency. Though there was, however, information from the previous home, and information put together by the staff at 1 St Phillips Close gave some guidelines how to meet the obvious needs of the individual. This was discussed with the temporary manager who said an assessment had been carried out during several visits made to see the person at the previous home. St Philips Close DS0000001500.V266627.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): 6,7,8,9 & 10. Although the manager said staff had had training on care planning, the breach of the requirements made from the last inspection remains the same. It is important to make sure that resident’s needs are recorded in a plan of care. Risk assessments are not carried for any identified needs. EVIDENCE: There were no real written plans of care for residents that would provide staff with clear information how assessed needs are to be met and action to be taken to address any risks identified. It was evident from the information and observation that time is taken to involve residents in the day to day running of the home, and with matters that concern them personally. Staff also sit and talk to people. Although it was evident from discussion with staff that there is some identified risk for residents during their daily life regarding moving and handling, St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 10 however, there was no record of risk assessments. During discussion with staff they indicated that they were not trained on risk assessment. The manager and senior line management to the home visiting at the time of the inspection, said arrangement would be made for all staff to attend a refresher course on care planning and risk assessment. Staff said they were aware of confidentiality and data protection in relation to resident information and their role to maintain these records are stored in a locked cupboard. St Philips Close DS0000001500.V266627.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): 15,16 & 17. Residents receive an individual care service, which consists of varied and regular activities. Staff encourage and support residents to maintain relationship with their families. EVIDENCE: Residents are supported to see their families. In some case staff take them out to visit their families or friends. The care officer said one resident has developed a friendship with the people at the local shop. It was also indicated that encouragement is given for residents to develop friendship with people out of the home, all of which would be risk assessed to ensure that residents are not at risk. Staff talked about the recreation that residents enjoy; outings are very popular. Some in house activities are provided. Daily records confirmed that regular outings and activities are arranged. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 12 During the course of the inspection it was noted that residents were assisted with the making of their beds and the laundry of their personal items, staff discuss with individual residents the social plan for the day. It was noted that staff were friendly with residents engaging them in conversation and giving them time to interact in conversations. Residents have a key worker who assists them with their daily living activities. The temporary manager said staff are encouraged to take a resident along with them to carry out the food at the supermarket, thus giving them the opportunity to exercise their choice of food. During the inspection of the records of food served to residents it was noted that convenience food was mainly served and that there was no real evidence that residents were served a healthy balanced diet. It was noted that over a period of two months vegetables were served only three times. There was also no indication that fresh fruit or fresh vegetable were provided. There were no records on any file that nutritional risk assessments had been carried out, to make sure that none of the residents were at risk. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 13 St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 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 the following standard(s): 20 &21 None of the staff have received certificated training in the handling, recording, storage, administration and disposal of medication. Training relating to death and dying and the aging process is needed to make sure that residents aging and illness are handled with respect and as the individual would like. EVIDENCE: The home uses “Boots” pre-dispensed medicine system, it was assessed that none of the residents had the capacity to be able to self medicate. Staff administering medicine had had one day training on handling medicine. There is a policy procedure in place for safe handling of medicine however the information in the policy/procedure needs to lay down clear instructions of the procedure for staff to follow when ordering medicines, and that the it is line with the Royal Pharmaceutical Guidelines for residential homes. The inspector was told that the staff had good working relationship with GP’s and health care professionals and can contact the for support and guidance. Although it is acknowledged that the home is for younger adults who are not receiving terminal care, there were no plans of care for resident’s last wishes. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 15 Staff had not received any training on the aging process or illness, dying and death, that would able them to meet the changing needs of residents and to support them in their last days. However some staff have had training on bereavement. The manager said she was aware of these shortfalls and was putting a training programme in place to resolve this matter. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 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 the following standard(s): 22 & 23. Most residents in general do not have the capacity or able to say how they are feeling. However staff work closely with them through other methods to try and interpret their wishes. There systems in place to make sure residents are safeguarded from any abuse. EVIDENCE: Not all residents are able to verbally say if they were not satisfied with the service. Although there is a complaint procedure which meets the regulations, the format do not allow residents to have some autonomy when making a complaint. Staff spoken with said they were aware of residents needs and they use their knowledge and experience to identify when residents are unhappy. There was no records or information in resident’s files, which indicated when someone is sad or happy. No complaints have been received during the past twelve months. The home has a complaints procedure, which is displayed in the entrance. The home has adult protection policies and procedures. The manager had a clear understanding of the procedures and responsibilities for reporting allegations. Staff were also aware of the procedures, and how to safe guard adults from abuse. The manager has attended Protection of Vulnerable Adults training and all staff have had adult protection training. New staff is only employed following a satisfactory CRB check. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 17 St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,2,6,27,28,29 & 30. 1 St Phillips Close is homely, and nicely decorated and furnished. It is clean and well organised. Resident’s bedrooms are personalised and furnished to the individual choice. Specialist equipment is obtained to meet individual needs. EVIDENCE: Since the last inspection the communal sitting areas have been redecorated and new furnishing bought, all of which is suitable for the resident group. The floor covering had also been replaced with a laminate floor covering in the dining room, and furnished for residents needs. Although there were still some elements of an office it was apparent that staff had worked hard to make sure that residents dining space is not compromised. One residents bedroom had recently been redecorated, it was clear that the each room reflected the occupants’ interests; although all bedrooms were lockable none was locked. An assessment had been carried out and no one had the capacity to have a key and keep their bedrooms locked. At the last and previous inspections there were some concerns about a new bath that should have been fitted to meet the needs of the resident group and that of moving and handling for staff. However, the installation of a hoist was needed so that the work could be completed and the health and safety of St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 19 residents and staff are not compromised during the process of helping residents into the bath. This was discussed with senior line management for the home, who was visiting at the time of the inspection All staff had received training on infection control, residents washing is carried out individually the washing machine has a sluice cycle and staff are provided with protective clothing. During the course of the inspection of the premises it was noted that washing tablets were stored in a basket on a shelve, however it was felt because of the packaging of the individual washing tablets they could be easily mistaken as sweets and an appropriate storage place must be found in line with COSHH regulations. In general the home was found to be clean and tidy. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 20 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): 31,32,33,34,35 & 36. Although staff appeared to have a good understanding of the needs of resident group and there is some elements teamwork, staff would benefit from regular staff meetings, supervision and training courses that would enable them to work tighter as a team to ensure residents receive the care they needed. EVIDENCE: The two staff who were on duty at the time of the inspection were agency staff who regularly covered some of the vacant hours. It appeared that they both work well together to meet the needs of the residents In their care. Although it was said that the team worked well together, it was felt that there was some improvements was needed with communication so that there is continuity with the service delivery to resident. The inspector was told that an implementation of a handover book, which was due to be started, should resolve this matter The low turnover of staff has provided consistency and continuity. Staff had a good understanding of service user’s needs and keyworker responsibilities. The home has a minimum of two members of staff on duty for each day shift and one waking night staff, often three staff are on duty during the day which included the manager. One staff file seen contained an application form, interview notes, two references POVA check CRB checks and terms a condition of employment. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 21 From discussion with staff during the inspection it was indicated that further training was needed for risk assessments and care planning. The person in charge said that four of the staff have an National Vocational Qualification (NVQ) and two staff were undertaking level 3. A training matrix was in place for staff training, some of which are training on specialist care. Individual training needs are identified at one to one supervision, which is held every four to six weeks as required. Annual appraisals are also carried out. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 22 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): 37,38,39,40,41,42 & 43. A temporary manager is in place to provide staff and residents with clear leadership in the home. Recording systems are good despite no plan of care in place. The health and safety of service users and staff are protected. EVIDENCE: At the time of the inspection the registered manager had been absent from the home for some time and a temporary manager has been put in place to provide staff with clear leadership whilst the management arrangement is sorted out. It was apparent that staff make sure that residents welfare and wellbeing are protected. There are systems in place for the views of resident’s families regarding the service provided at the home. Staff have access to a range of polices and procedure which are regularly reviewed. All staff have had training in moving and handling and health and safety. All health and safety checks are carried out with records kept. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 23 St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 24 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 1 X X X Standard No 22 23 Score 3 3 ENVIRONMENT Standard No 24 25 26 27 28 29 30 STAFFING Score INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 3 3 3 3 3 3 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 2 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Philips Close Score X X 2 2 Standard No 37 38 39 40 41 42 43 Score 2 2 3 3 2 3 3 DS0000001500.V266627.R01.S.doc Version 5.0 Page 25 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. 2. 3. Standard YA22 YA2 YA6 Regulation 14 4 (c) 15 Requirement An assessment of need must be carried of prospective residents before admission. All identified risk must be assessed with an action plan in place to minimise the risk. Each resident must have a clear care plan, which identified all their needs and how they would be met. Nutritional risk assessment must be carried out for all residents. Residents must be served a healthy balanced diet. Staff must have certified training on the safe handling of medicine. Staff must Receive training in relation to ageing and associated illness and death. The hoist for the “high-Low” bath must be fitted There must be on going review of staffing level to make sure there is enough staff over 24 hours to meet the needs of residents. The issue of the availability of the registered manager must be resolved. Timescale for action 28/01/06 15/02/06 15/02/06 4 5. 6 7. 8. 9. YA15 YA15 YA20 YA21 YA29 YA33 13 16 13 18 (c) (i) 23(2) (n) 18 15/02/06 15/02/06 15/02/06 15/02/06 15/02/06 15/02/06 10. YA31 8 15/02/06 St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 26 11. 12. YA33 YA35 18 (a) 18 Staff vacancies must be filled. Staff must have training in specialist areas to ensure they can meet the changing needs of residents, infection control and health and safety. 15/02/06 15/02/06 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 4. 5. 6. 7. Refer to Standard YA5 YA5 YA20 YA31 YA21 YA24 YA22 Good Practice Recommendations Contract of terms and condition should be signed when by relatives or advocate. Some consideration should be given to provide residents terms and condition in format that they would be able to recognise. Consideration must be given to provide staff with medicine policy procedure, which is in line with the (RPS) Royal Pharmaceutical Guidelines. The arrangement of the person in charge covering both houses whilst included in the number of staff available should be address A plan of care with information how the last wishes of residents would be meet. Risk assessment should be carried out for residents and the reason for room keys are not given. Some consideration should be given to provide a complaint procedure which resdent can have some autonomy when making a complaint. St Philips Close DS0000001500.V266627.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Aire House Town Street Rodley Leeds 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 DS0000001500.V266627.R01.S.doc Version 5.0 Page 28 - 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. 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