Inspection on 11/01/06 for Stables, The

This inspection was carried out on 11th January 2006.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stables, The 28/09/07

Stables, The 01/06/06

Stables, The 19/09/05

Stables, The 22/03/05

Stables, The 18/01/05

Stables, The 25/02/04

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Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Cuerden Grange Rest Home

Springfield Cottage

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Park Lodge

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

CARE HOME ADULTS 18-65 Stables, The 4 Stables The Crosby Liverpool Merseyside L23 9YT Lead Inspector Ms Lorraine Farrar Unannounced Inspection 11th January 2006 12.00 Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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 Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Stables, The Address 4 Stables The Crosby Liverpool Merseyside L23 9YT 0151 931 5787 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.mencap.org.uk Royal Mencap Society Mr Richard Gary North Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 4 LD and up to 4 PD. Two staff on duty at all times. One staff to be alone with service users only in the event that all the guidelines and risk assessments agreed by the NCSC are adhered to. Night staffing conditions of two sleep in staff to remain as previously agreed. Manager to obtain NVQ Level IV in Care or equivalent by 2005. Manager to obtain NVQ Level IV in Management or equivalent by 2005. 3. 4. Date of last inspection 19th September 2006 Brief Description of the Service: The Stables is registered to provide support and accommodation for four adults who have a learning disability. It is owned and run by Mencap a national organisation who provide a variety of support services to people who have a learning disability. The home is in a cul-de-sac in a quiet residential area of Crosby and fits in well with surrounding houses. It is a detached bungalow with fenced back garden and has a detached garage, which is used, as a laundry and for storage. Inside a small entrance leads to a single toilet and through to a large living / dining room. The kitchen is off the lounge and is large enough for people using wheelchairs to access. Bedrooms and the office lead off a hallway at the back of the lounge, which also provides access to the two bathrooms. All of the bedrooms are single and the bathrooms are adapted for use by people who have a physical disability. There are a number of other aids fitted in the home including ceiling tracking, hoists and grab rails. The home and organisation aim to providing ordinary lifestyles for the people living there and the home is furnished and decorated to a high standard and does not look or feel like a care home. There are always two staff on duty, at night these staff sleep-in and during the day there is sometimes one staff in the house while another member of staff is out with one of the people living there. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was last inspected in September 2005. Information about identified standards that were not looked at during this inspection can be found in the report from that inspection. During this inspection tenants were met with, records, files and care plans were examined, parts of the building were looked at and discussion took place with three members of staff. What the service does well: Staff have a good understanding of clients, their personalities, choices and support needs and have the skills to understand and communicate with them both verbally and non-verbally. Care plans in the home are detailed and provide good information on the person, their preferences and how staff should support them effectively in all areas of their lives. Support is provided to clients to get out and about either on a 1-1 basis with staff or in small groups and the home have supported clients to get mini buses adapted for their needs. Personal care and routines are on an individual basis and staff take time to support clients with their appearance as well as with their care needs. The home looks and feels like an ordinary domestic home and is decorated and furnished in keeping with this, bedrooms are individual to the person and meet both their needs and choices. Aids and adaptations are provided to support clients with their mobility needs with bathrooms providing space and adapted facilities. There is a good induction programme in place for new staff which covers care practices and working with adults with learning disabilities. The home provides a high level of support to tenants who are terminally ill and supports staff and tenants through the bereavement process. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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 Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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 Staff are aware of the process to follow when a new tenant if referred. There is no policy or assessment tool available, which staff can use to make sure they have all the information needed to ensure the home, can support the person successfully. EVIDENCE: All of the people living at The Stables have lived there for a long tine so it was not possible to practically assess the support offered to anyone considering moving in. The homes policy file was looked at and although the contents file listed a policy for ‘needs assessment’ this was not available. A member of staff spoken with was able to explain that anyone new would be referred and an assessment obtained. The home would then meet with them several times, carry out an assessment and invite them for several visits and short stays to make sure that they could meet the persons needs and give them the opportunity to trial the home. The home needs to obtain a copy of Mencap’s policy for introducing new tenants and their ‘needs assessment’ documents. This will help staff to make sure that they have all the information available when offering a place to a prospective tenant. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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 Each Tenant has a clear care plan in place, which is reviewed regularly and provides the detailed information needed to communicate with and support the person successfully. EVIDENCE: Each tenant has their own care plan in place and two of these were read during the inspection. Plans are very detailed and contain clear, information about the person and what is needed to support them successfully. This includes information about their health and personal care needs and how the person likes to be supported with these. Detailed information is recorded about the person’s likes and dislikes and how they communicate. Plans are reviewed and updated regularly and the tenant and family involved and much as possible. Tenants have an identified keyworker who helps them with their finances, activities and care plan. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 10 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): 12,14,15,16 The home provides support to tenants to get out and about on an individual basis, this includes attending a resource centre, using community facilities and accessing leisure opportunities. Staff support tenants to maintain contact with their family and are actively looking at ways in which they can support tenants to become part of the local community. Daily routines in the home are based upon each persons arranged activities and preferences. EVIDENCE: The home supports tenants to go out either individually or in small groups and has supported them to get vehicles that are adapted to meet their needs. One of the people living in the home goes to a Resource Centre several times a week and staff from the home provide the transport for her. Activities were looked at for two people from 1st January and included, shopping, theatre, swimming, local bird sanctuary, eating out and going for a walk. Activities within the home include, TV, videos and music with tenants bedrooms equipped with some of the activities they enjoy including different light effects and equipment. Staff support tenants to go on an annual holiday in small groups either within Britain or abroad as they choose. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 11 The home has a policy, which provides advice on supporting tenants with personal, social and sexual relationships. This policy is in depth and provides information about supporting the person’s rights to both relationships and protection. Staff provide support to tenant’s to maintain family links including sending cards and welcoming visitors. Tenants are able to meet people without disabilities though their use of community facilities. The manager explained that they were going to a local ‘men only’ swimming session as they hoped the tenant would enjoy this and would begin to get to know people from the local area. Tenants daily routines are detailed in their care plan and include information about the times they like to get up / go to bed, what their preferred routine is and how they communicate this. Two of these were read and both gave information, which differed for each person based on their choices. Two members of staff explained tenants daily routines and were able to give clear examples of how this differed for each person and how the person communicated what they wanted. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 12 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 The home has a good system in place for dispensing medication and this is followed. However the medication cabinet is untidy and is not checked regularly for unused medications, which could lead to errors being made. The home provides an excellent service to tenants who are seriously or terminally ill. EVIDENCE: It was identified at the last inspection that the medication cupboard was untidy and a system needed to be set up to make sure it was checked and cleaned regularly. At this inspection the medication cupboard contained medication that was not longer prescribed and should have been returned to the chemist. There was also a lot of paperwork stored in one side of the cupboard. The home must make sure that they set up a system for regularly checking that old medication is returned and that the cupboard is cleaned regularly, this will help to make sure that mistakes are not made when medication is given out. The home uses a blister system for medication, this is out together by the pharmacist and records showed that staff in the home record and dispense it correctly. At present the home take the prescriptions to the GP and the Chemist collects them, staff should make sure they see the GP prescription so they can check it is correct before the pharmacist dispense it. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 13 The home has recently supported a tenant who was terminally ill. Staff worked well together to provide individual care, support other tenants and each other and make sure that the person’s needs were met. They worked with other professionals to make sure equipment was provided and medication and healthcare available. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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&23 The home has a suitable complaints procedure in place and provides and easy to access version for tenants. Staff receive training in protecting people from abuse and there are suitable polices available in the home. The home had failed to protect tenants from identified financial mismanagement. EVIDENCE: No complaints about the home have been received either by the organisation or the Commission for Social Care Inspection. There is a complaint procedure in the home which provides clear information about who the person can complain to, how it will be investigated and the time this will take. An easy to understand version is also available for tenants. It was identified at the last inspection that the home had a system in place whereby one tenant paid for Sky TV via their bank account and that this was then reimbursed by the organisation. However there was no record of this monthly payment being reimbursed since June 2005. The home were required to audit their records and ensure that outstanding monies were paid and to review the system to ensure that the money is paid to the client either prior to or on the day that it is taken from their account. At this inspection the persons keyworker and the manager advised that they had arranged for the payment to be made directly by the house and not via the persons account. However the outstanding monies had not all been paid back to the person. An immediate requirement was given to the home that they audit the account from the time the Sky payments began and paid all outstanding monies within 2 weeks - by the 24/1/06. A letter has since been received from Mencap stating that the direct debit had been cancelled, an audit has taken place and arrangements made to repay the outstanding balance of £344. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 15 The home have copies of the local authorities and Mencap’s adult protection polices available and staff receive training in their induction and through courses on protecting people from abuse. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 The home is nicely decorated and furnished and presents as a domestic home environment, however there are areas of risk to tenants which have not been dealt with. Procedures, practice and equipment are in place within the home to prevent the spread of infection. EVIDENCE: The Stables is a bungalow located in a residential area of Crosby and fits in well with other houses in the area. The home is nicely decorated and furnished with equipment provided where needed. Décor and furnishings are homely in appearance and there is a comfortable atmosphere with tenants making use of communal areas. Access throughout the home is level with sufficient space and equipment for people using a wheelchair to get about. It was identified at the last two inspections that the flagged drive has loose flags, which could cause an accident and a requirement was given that a risk assessment must be carried out and work identified should be undertaken. At this inspection the manager stated that the loose flags had been refitted and that a quote had been obtained and work would go ahead to re-flag this area. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 17 It was also identified that the back garden was unsafe for tenants to use as flags were uneven and a risk assessment should be carried out with identified work undertaken. The manager stated that some work was planned but no risk assessment had been carried out and there were no dates for this work available. The garden area still appears unsafe for tenants to use and the home must carry out a risk assessment to ensure tenants safety. It was also identified at the last two inspections that the home must carry out a risk assessment of one tenants bedroom. At this inspection no assessment had been documented however staff had re-arranged the room to present less of a risk and the manager advised they were in the process of obtaining a quote to extend the room. The homes laundry equipment is located in an outside garage and provides both a washer and dryer. Protective equipment including gloves, aprons and disposable bags is available for ensuring infection control. The home was clean, hygienically maintained and free from odours. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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&35 Staff working n the home have a good understanding of tenants needs and choices and work well to meet these. The home are not meeting national standards for ensuring 50 of care staff hold a care qualification. Other training is provided to staff in areas of care however staff are not up to date with training in moving and handling people. EVIDENCE: Staff spoken with had an in-depth understanding of tenants and were able to give detailed information about the support each person needs, how they communicate and what they do and do not like. Staff were seen to spend time talking with tenants and to communicate effectively with them. The home has a staff team of 8 staff, of these 2 are working towards a level 3 care qualification (NVQ), other staff have stated they would like to obtain this and are waiting for it to be offered by the organisation. National standards state that a home should make sure at least 50 of staff have a qualification in care, the Stables is not currently meeting this target and must make sure they offer this qualification. There is a good induction programme in place, which newer staff are following. This is based on national inductions to care and working with people with a learning disability. Three staff files were looked at and these contained evidence that staff had received training in fire, first aid and medication. Staff had not received training recently in moving and handling, it is important that staff are up to date with this training so they can make sure they and the tenants are as safe as possible when supporting them with their mobility. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 The home manager is experienced in working with adults who have a learning disability and in managing within care services. He does not currently hold a management qualification. EVIDENCE: Mr Ray Hanna has been appointed by the organisation to manage the home. He has worked for the organisation since 1989 and has several years experience of management within care services for people who have a learning disability. He does not currently hold a management qualification but stated that he intends to work toward obtaining the registered managers award. It is a requirement of this report that the registered manager obtains this qualification. Mr Hanna has applied to the Commission for Social Care Inspection to be registered with them as manager of The Stables. It was identified at the last inspection that the home must provide running hot water to the washbasin in the small toilet. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 20 At this inspection there was still no hot water available, the manager advised that a plumber had visited the previous day and was unsure as to why the water was not working but intended to rectify this. This requirement is repeated at this inspection, the lack of warm water in a toilet area could contribute to spread of infection and could be uncomfortable for tenants, staff and visitors. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 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 2 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 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 4 2 X X X X X X Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 22 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 YA20 Regulation 13(2) Requirement The home must set up a system for auditing and cleaning the medication storage cupboard. This is a previous inspection requirement 2 YA24 13(4)(a) (c) The home must carry out a documented risk assessment of the back garden and take action to prevent any risks identified. This is a previous inspection requirement 3 YA42 13(3) The home must provide running hot water in the washbasin in the small toilet. This is a previous inspection requirement. 4 YA2 14(2) The home must obtain copies of the organisation assessment information and policy for introducing new tenants. The home must ensure at least 50 of staff hold a care qualification (NVQ) DS0000005386.V277358.R01.S.doc Timescale for action 28/02/06 30/04/06 10/03/06 10/03/06 5 YA32 18(1)(a) 31/01/07 Stables, The Version 5.1 Page 23 6 YA35 13(5) The home must ensure all staff have up to date training in moving and handling people The manager must obtain a management and care qualification. 07/04/06 7 YA37 10(3) 31/01/07 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 YA20 Good Practice Recommendations The home should have sight of prescriptions once the GP has signed them. Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Stables, The DS0000005386.V277358.R01.S.doc Version 5.1 Page 25 - 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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