CARE HOME ADULTS 18-65
Stakesby Road (89) 89 Stakesby Road Whitby North Yorkshire YO21 1JF Lead Inspector
David Blackburn Unannounced 24 May 2005 9:00. 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. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Stakesby Road (89) Address 89 Stakesby Road Whitby North Yorkshire YO21 1JF 01947 602452 01947 602452 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) The Wilf Ward Family Trust Kathryn Mansfield Care home only 3 Category(ies) of LD Learning Disability (3) registration, with number of places Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 21/09/2004. Brief Description of the Service: 89 Stakesby Road is a dormer style bungalow situated in a private residential area of Whitby. A former private dwelling, it now provides suitable accommodation for the three residents. There are gardens to the front and rear of the building accessible to the residents. There are three bedrooms offering residents single room accommodation. A communal lounge is provided with a television, video and music stereo systems. There is a dining room, a domestic style kitchen, bathroom and toilet facilities. Stakesby Road provides accommodation for residents who have severe learning and physical disabilities. Appropriate aids and equipment are provided to assist service users. The staff seek to provide a holistic care regime, offering personal care, help, advice and guidance with daily living skills and activities, a catering service, a laundry service and domestic services. Social activities are arranged by the staff in-house and at external locations. Some residents attend day care placements. All residents are registered with a local general medical practice in the town. Their doctors arrange access to the more specialised health services. The staff team has developed very good relationships with the Community Learning Disability Team (CLDT) and Consultant Psychiatrists who provide a valuable resource and input into the home. Stakesby Road is owned by the local health authority. The care input is provided by the Wilf Ward Family Trust, a registered charity.
Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection on which this report is based was the first to be carried out in the inspection year April 2005 to March 2006. It was undertaken over 5.5 hours including preparation time. The focus was on a number of key standards together with any subject to requirements and recommendations at the last inspection. An inspection of some parts of the premises including bedrooms was carried out. A number of policies, procedures and records were examined. Discussions were held with the registered manager, the two staff on duty, two visiting professionals, and the three residents. The residents were unable to enter into any meaningful discussion and generally gave one-word answers or gestures. A survey in the form of a questionnaire had been sent to family, visiting professionals and other people with an interest in the care of the residents. The results of that survey formed part of the evidence used in this report. What the service does well:
Good assessment procedures were available should a vacancy arise in the home. These procedures would ensure any person admitted would have their personal needs, hopes and aspirations fully identified, understood and met. A well-defined care planning system was in operation that was easy to follow and understand. The wealth of information on each resident clearly showed in great detail their needs and how they would be met. Care plans were subject to regular review and updates. A visiting professional said the staff achieved “the correct intervention at the correct time.” Although residents were unable to verbalise their wishes, choices and preferences, great attention had been paid to the different forms of communication used by residents including gestures, facial expressions and sounds other than words. This had meant that some feedback was gained from residents and their agreement or otherwise given to any planned course of action. A relative said “ the care C (resident) receives is excellent. I could not ask for anything better for her.” Another made the comment “it’s the additional touches that are nice. Attention is given to the little things like nail varnish and make up for the female residents. It does make a difference.” Residents were encouraged to make full use of the local community and the minibus facilitated easy access to facilities and amenities. Residents continued to enjoy contact with family and friends. Proper medication procedures were in place. The premises were clean, warm, and free from offensive odours. Proper attention was given to the maintenance of hygiene. Staff were a stable group with good morale who had received the relevant training. Relatives said “they are a good group of staff very committed to the people in their care” and “the staff do a brilliant job.” The home was well managed. Appropriate attention had been given to matters of health and safety to ensure the home was a safe place in which to
Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 6 live and work. A relative said “I always visit unannounced. The home is always clean and tidy.” 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. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 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 standard(s) 2. Residents were assured their needs and choices would be properly assessed and met. EVIDENCE: All the present residents were admitted from a local hospital over 10 years ago. They had assessments undertaken and completed as part of their admission process. The criteria for admission were shown in the Statement of Purpose and within the policies and procedures of the registered provider. The expectation was that the funding authority would carry out the assessment process and produce the initial care plan using their selection criteria. The registered provider expected those carrying out this assessment would make full use of and take into account the views of existing residents, family and advocates, visiting professionals and those giving either a social care or health care input to the home. The registered provider had produced an Individual Needs Assessment proforma that the registered manager said would be used alongside the funding authority’s assessment. This covered a large number of the activities of daily living. The registered manager said this form was being revised. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 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 standard(s) 6 and 7. Residents’ needs, choices and preferences were well recorded ensuring they were properly understood and met. EVIDENCE: The case file of each resident was examined. They were indexed and the sections numbered. The information was detailed, comprehensive and informative recording accurately each resident’s strengths and needs. A personal support plan had been devised showing an activity, the objectives to be achieved and the support needed to reach that goal. A Health Action Plan was on one file as part of the Government’s initiative “Valuing People.” Plans were being set up for the other residents. A clear indication was given of the specialist equipment needed and how it was to be used. Good use had been made of colour photographs and diagrams to illustrate such use. The care plans fully recorded the involvement of outside agencies. Risk assessments for particular activities of daily living were on each file. Care plans had not been signed by residents as they were unable to understand the concept. All care plans had been reviewed in conjunction with the funding authority in April this year. The plans were subject to on-going review at all times. A daily diary was maintained for each resident that showed the events and occurrences as they affected the particular person.
Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 10 The care plans fully recorded each resident’s likes, dislikes, choices and preferences around the many activities of daily living. Details of any limitations or restrictions were recorded. The profound nature of each resident’s disabilities severely affected their ability to make day-to-day choices. Staff’s attention to detail and vigilance in observation had led to a realistic assessment of each resident’s needs. Staff were heard and observed throughout the inspection to ask residents about their preferences for drinks, snacks, meals and activities. Some activities were observed, for example baking in which a particular resident was fully involved. Staff responses were timely, appropriate and in keeping with residents’ wishes. Staff were well able to understand the meaning and significance of each movement, gesture, noise or change of demeanour made by individual residents. The registered manager handled each resident’s personal monies. The records were seen and reconciled with the money held. There were no discrepancies. Visiting professionals and relatives were very complimentary of the way care was given. “Staff are able to understand and respond to gestures, facial expressions and sounds in the absence of speech.” “The care provided for my relative is exemplary.” “They give the best in care. This is due to their knowing what is needed and when.” “I have every confidence that residents’ needs are known, acknowledged and met.” “The care is excellent. I could not wish for better for her.” Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 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 standard(s) 13 and 15. Residents use of local facilities and amenities and regular contact with family are promoted and maintained enabling them to have a number of different life experiences. EVIDENCE: Residents were encouraged to make full use of the facilities and amenities in the local community. Staff said their disabilities were seen as no bar to any activity they might wish to choose. One comment from the questionnaires said staff might be “unrealistic in their expectations of residents’ abilities”. Staff felt it better to try and perhaps fail than never to try. They were able to relate events to which residents had been invited and had attended including use of a hydrotherapy pool, music sessions and meals at restaurants and public houses. Some residents had day care placements on a number of days each week. Family contact had been promoted and maintained. Two residents received regular visitors and one went home every Sunday. The third resident had a sister with a similar disability who attended the same day care placement. She was invited to birthday parties at the home. The staff were unsure whether she or her brother were aware of the relationship. This particular resident had an advocate.
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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) 20. Residents’ medication was properly administered ensuring maintenance of their general health. EVIDENCE: A medication policy and procedure was seen. Proper procedures were being followed for the receipt, storage, administration and recording of medication. None of the residents could self-administer. Medication supplies were kept in a locked cabinet in a locked storeroom. A monitored dosage system was used though a small number of medicines were administered directly from the original packaging or bottle because they could not be stored in blister packs. Any special instructions were recorded in the medication file. A good method of stock control had been introduced. The records were seen. The medication administration record sheets were scrutinised. They had been completed correctly. Reconciliation between medicines and records showed no discrepancies. All staff had undertaken a medication course set by the registered provider. Those with particular responsibility for medicine administration in the home had completed external accredited training. This was confirmed by the staff on duty. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 13 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. Residents had the confidence their concerns and worries would be listened to and acted upon. EVIDENCE: A complaints policy and procedure was seen. Leaflets were available “How to Make a Complaint” and had been produced in pictorial form. Copies were displayed in the home. The procedure showed how to complain, to whom and gave timescales for a response. The leaflets showed the name and address of the previous regulatory authority. They must be reprinted with the name and address of the current regulatory authority clearly shown. The registered manager felt that as two residents had regular visitors and one had an advocate if there were concerns about their care these would be raised without delay. Relatives and visitors were aware of the complaints procedure and the location of the registered provider’s headquarters. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 14 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 were provided with a homely, comfortable and safe place in which to live. EVIDENCE: Stakesby Road is a large bungalow situated in a residential area of the town. There was no indication that it was a care home. Its’ location made it convenient for access to local amenities and facilities. The building appeared to be well maintained internally and externally. The premises had been adapted to provide accommodation for three residents in single rooms. Adaptations had included the widening of doors to facilitate wheelchair access. Level access was afforded to all exit doors. Ramps gave safe access to the garden. There was adequate communal space. Specialised bathing facilities had been provided. The home was safe, comfortable, bright, clean and free from offensive odour. There was sufficient natural light, ventilation and heat. Furnishing, fittings and fixtures were domestic in nature, of a good quality and in a serviceable condition. Some re-decoration had been undertaken. Relatives said “it feels like home-from-home not a building with people in it.” The laundry was in a utility room accessed through the kitchen. Suitable procedures were in place for the proper transportation of laundry. The necessary bags and baskets had been provided.
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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 and 35. The residents were given good and consistent care by a well-motivated and competent staff team who had received the required training. EVIDENCE: There had been no changes to the staff team since the last inspection. An extra 33 staff hours had been agreed. This would lead to the availability of more one-to-one activities for residents. Staff were seen as well motivated, with good morale and an ability to work well together. The registered manager said they were mutually supportive and always focused on the task in hand. Of the 10 support workers three had achieved a National Vocational Qualification in care to at least level 2. Others were working towards this award. Staff were observed throughout the inspection to respond to residents in a warm, friendly and non-demeaning manner. Residents responded positively to the attention given. Staff confirmed they undertook induction and foundation training to TOPSS and LDAF standards. Further training was identified through supervision. A variety of courses were on offer from the registered provider. Training needs were recorded by the registered manager on her monthly report to the registered provider. The registered manager also made good use of local resources for example district nurses and occupational therapist. During the inspection staff were being instructed in the use of lifting equipment and techniques by a physiotherapist. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 16 Relatives and visiting professionals were very complimentary about the staff team. “All staff strike me as caring and dedicated.” “The staff do a brilliant job.” “The professionalism and dedication is clear to see.” “It’s a very good staff team with a sense of purpose and focus.” “When my brother was ill, the dedication of the staff was extraordinary in its commitment.” Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 17 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) 37, 39 41 and 42. Residents were able to live in well-managed, safe and secure environment. EVIDENCE: The registered manager was a Registered Nurse of the Mentally Handicapped (RNMH) and held a current Nursing and Midwifery Council registration. She held a D32/33 National Vocational Qualification Assessor award. She had recently completed the Registered Managers (Adults) NVQ 4 award. The certificate was seen. During discussion and observation she demonstrated a good understanding of the issues and needs relevant to the good management of a care home. A recent survey carried out among visiting professionals and other stakeholders had elicited a very good response. The feedback had been positive and supportive of the staff and care being provided in the home. A number of records were seen. All were being maintained in a proper manner. It was noted that no staff records as required by Regulations were available in the home. These were held centrally at the registered provider’s
Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 18 headquarters. An inspection of these records had been carried out at this location last year. It was proposed that these records would be inspected again during the current year. The registered manager said that all records relating to staff were seen at interview. Policies and procedures were seen on the promotion and maintenance of health and safety. Proper attention was given to the storage of hazardous substances. Staff confirmed attendance on courses such as moving and handling, fire safety and food hygiene. A first aid update was planned for later in the month. Hot water temperatures were checked and found to be within the required range. A number of satisfactory safety reports and certificates related to the premises, equipment and mini-bus were seen. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 1 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 4 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 3 x x 3 x x Standard No 31 32 33 34 35 36 Score x 2 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Stakesby Road (89) Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 1 3 x J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 20 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 22 Regulation 22(7) Requirement Timescale for action 30/07/05 2. 41 17(2) Schedule 4.6 The complaints procedure must show the name, address and telephone number of the current regulatory authority. Staff records to be kept in the 30/07/05 home must contain the information required by Schedule 4.6 to the Care Homes Regulations 2001. (Previous timescale of 31/03/04 not met) 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 32 Good Practice Recommendations The registered provider is reminded of the need for at least 50 of the care staff to have achieved a National Vocational Qualification in care to level 2 by 2005. Stakesby Road (89) J53-J04 S7841 Stakesby Road (89) V229200 240505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross YORK YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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