CARE HOME ADULTS 18-65
Mr David Chadwick 54 Strawberry Fields Meriden Coventry West Midlands CV7 7SA Lead Inspector
Jennifer Beddows Key Unannounced Inspection 5th October 2006 1:00pm Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mr David Chadwick Address 54 Strawberry Fields Meriden Coventry West Midlands CV7 7SA 01676 523 887 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) Mr David Chadwick Mr David Chadwick Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd March 2006 Brief Description of the Service: Strawberry Fields is a small care home registered with the Commission for Social Care Inspection to provide care for up to 3 residents who have learning difficulties. The registered person lives on the premises. The home runs very much as an Adult Placement Home although it cannot be registered as this as there is no Adult Placement scheme in the area. The situation remains the same as the last inspection as the home has two vacancies and there is currently one service user residing in the home. The home has three single bedrooms, one bathroom and two WCs for the use of residents. There is a lounge and a separate dining room. The garage has been converted into a second lounge, which has become the designated smoking room. The current resident has almost exclusive use of this room with equipment to make himself a hot drink. The home is located close to the amenities in the village of Meriden. That includes shops, public house and place of worship. The resident travels independently using the local bus service. Coventry, Birmingham and Solihull can be reached using the bus services. The current resident is independent in a majority of aspects of daily living but has encouragement, support and guidance from the registered manager regarding matters of travel, food preparation and time keeping. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The fieldwork was carried out over the afternoon of one day. The inspector collected information to form the basis of judgements in this report in a number of ways: she spent time with the resident and the manager individually and together. The resident had also completed a pre-inspection questionnaire assisted by his friend who is also his advocate. The registered provider continues to explore the possibility of moving over to an Adult Placement Scheme but as Solihull borough does not run one he intends approaching the borough of Coventry instead. He feels these options may be more appropriate to the current registration as a care home. The service aims to provide long-term support to the person accommodated subject to regular review and being able to meet any changing needs. The inspector would like to thank everyone who assisted with the inspection process. What the service does well:
The resident expressed satisfaction with his placement at Strawberry Fields and said that he was very happy to continue living there. The language he used further emphasised his wish to remain. From discussions with him it was clear he enjoyed a full life with the support of the volunteers and professionals around him, who he referred to as his friends. The rapport he had when he engaged with the manager was relaxed and comfortable which demonstrated an underlying trust and mutual regard for one another. It is evident the manager has worked pro-actively, consistently and constructively with the resident to ensure the placement is a success. This placement has been able to provide him with much needed security and stability over the years. The resident continues to benefit from a single bedroom and sole use of the bathroom. He also has a separate lounge diner to smoke in which is comfortably furnished and has a kitchenette where he can make his own drinks and watch TV. This room also has a video player, smoke alarm and extractor fan. This room has separate access to the rear garden and the resident is encouraged to invite his friends to visit him at home. The resident appeared to be comfortable in other parts of the home, which weren’t specifically designated for his sole use and seemed very relaxed. He
Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 6 was unaware that the inspection was planned for that day and seemed very much at home. The resident enjoys being independent and participates in community life. He is very fond of attending the day centre, helping his friend and advocate on occasions in the charity shop, and catching the bus to get around the local area. He enjoys meeting his friends in Solihull every Saturday, and spoke of having a girlfriend. The resident appeared to be confident, relaxed and at home. He spoke of going on day trips to the seaside with the day centre, which he said he enjoyed very much. What has improved since the last inspection?
The manager has completed all but one of the requirements since the last inspection and all the recommendations. The manager has in consultation with the resident changed the fabric of the curtains in his bedroom to thicker ones so that light does not show through at daybreak. This has assisted the resident from rising so early in the morning and going out prematurely. The manager has also offered the resident alternative activities when he returns in the afternoon from the day centre, which has discouraged the resident from taking his usual afternoon nap before tea. This has enabled the resident to sleep longer in the mornings and to rise later in time for him to attend the day centre. As a consequence the time the resident spends alone waiting for the bus to attend the day centre has been reduced. The resident also carries an identity card at all times with a contact number advising reversed call charges in case of an emergency. The manager has raised issues identified at the last inspection with the reviewing officer at the residents day centre. A duty social worker will attend at the next review in November 2006. The manager has completed a written risk assessment regarding the resident travelling alone early in the morning. The manager has also explored opportunities for the resident to go on holiday but the resident has been unwilling to save towards this. The resident did not raise any issues regarding an annual holiday at this inspection but stated that he enjoyed participating in the day trips organised by the day centre. The manager has amended the Commissions contact number and address on the homes complaints policy document. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 7 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. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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 the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The resident can be confident that his needs and wishes can be met by this service. EVIDENCE: The resident had a full social work assessment prior to moving in and benefits from regular annual reviews at the day service that include all relevant parties. The manager is aware of the residents needs as there is only one resident living with him in the home, and there is a good rapport between them. Since the last inspection the risks regarding the resident rising very early in the morning have now been reduced as already stated. The resident is now in his seventies and as his health needs change he will continue to need regular reviews to ensure this placement continues to meet his needs. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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 the following standard(s): 6,7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident is supported to make decisions about his life with the assistance he requires and is consulted with and takes part in aspects of life within the home EVIDENCE: A personal planning book is in place for the one resident who lives in the home, which acts as his care plan. This was drawn up with the resident and uses symbols and photographs to help him understand the book. The manager now keeps an events diary where he records significant information. As this placement has been established for a number of years, the manager clearly knows the residents needs very well and is able to provide appropriate care for him on a daily basis. This happens on an informal basis, as the manager and the resident are the only people living in the home. This is further supported by the more formal involvement of an advocate and annual reviews. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 11 The resident clearly has lots of confidence in the manager and feels he can discuss any concerns with him. The resident also has a close and positive relationship with his friend and advocate and sees her on a regular basis. All information pertaining to the resident’s files and the running of the home are stored appropriately. At present the home well meets this residents needs. This will need to be kept under reviewed to identify and accommodate any changing needs. The manager had identified and discussed some possible options, which should be explored in a timely way to ensure the resident is prepared as far as possible to adjust to any necessary changes. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The resident is supported to engage in an active social life, which meets his needs. The resident takes part in appropriate peer group activities and participates in community activities. The resident enjoys a varied diet of his choice that generally reflects a well balanced diet. The residents rights and responsibilities are recognised and respected. EVIDENCE: The resident attends a local day centre five days a week, which he said he enjoys very much. He also meets his friends every Saturday in Solihull centre. He travels independently using public transport. He usually spends Sundays at home having a cooked Sunday roast and helps walk the dog. The resident has a very good appetite and said that he enjoys the cooked dinner and puddings provide by the day centre. He often has second helpings and so prefers not to have a full cooked meal during the week when he comes home.
Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 13 Owing to the nature of the placement the resident has a choice about all his meal times and enjoys discussing what he would like for his tea and then going out independently to the shop to buy this. He also likes the occasional take away, which he gets from the local fish and chip shop in the village. The manager has acted on the recommendations from the last inspection, and made enquiries about the resident having an annual holiday through various charities. Facilities are available within the home to put money away for savings. This ensures the resident has money to access more expensive trips offered at the day centre. The manager and resident have a clear idea of the food enjoyed and needed which is provided by the home. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The resident is offered access to regular health checks however the health needs of the resident remain largely un-assessed. EVIDENCE: The manager offers opportunity to access health appointments, but the resident largely declines these. It was positive to hear of a recent event where the resident was happy to see the GP and to receive treatment. The manager has recorded the resident’s refusal to see his dentist and GP and will raise this at the next review. The resident sees the optician every six months, and continues to have his annual flu vaccination. The manager continues to offer foot care himself, which is the residents’ preference. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The resident is able to raise concerns with a range of people who can support him so that complaints can be acted upon. A procedure is in place for reporting any suspicions of abuse so that they can be appropriately investigated. Additional training in this area would be beneficial to further increase and update the manager’s knowledge. EVIDENCE: The manager has updated the complaints policy in the home to reflect CSCI correct details. The resident was able to explain what makes him happy and whom he would speak to if he had any concerns or complaints. His friend and advocate who he sees on a regular basis is the first person he said he would approach. He also stated he felt able to discuss any concerns with the manager, who he sees as his friend. A list of telephone numbers is in place so that the manager can contact appropriate professionals if he had any concerns regarding abuse. The manager has a good knowledge of what he would do in the event of any concerns. The resident handles his finances and signs financial records every week to show he has received his personal allowance. The manager keeps a financial record of income, savings and expenditure of the residents’ monies.
Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 16 Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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 the following standard(s): 24,25,26, 27, 28 and 30. Quality in this outcome area is good. This judgment has been made using available evidence, including a visit to this service. The resident lives in a large, homely comfortable and safe environment. It is very well cared for, clean and hygienic. EVIDENCE: The service operates from the family home of the manager. This is a large detached new build property situated in a quite cul-de-sac. The property is very well decorated and very clean and tidy. The manager and resident report being well accepted by the neighbours and the local community. The resident benefits from pleasant gardens, which he enjoys using during the summer. He also has sole use of the bathroom facilities and has a second living area nicely furnished with his own TV, video recorder and kettle. He uses this room to smoke and relax in. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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): 32,34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The resident is supported by a manager, who is competent to meet his needs. The resident is supported and protected by the homes recruitment practices. EVIDENCE: The manager has undertaken a number of courses in recent years to support the resident with his needs; these include fire-training, administration of medication, first aid and food hygiene and are current. It is recommended the manager attend regular updates in these courses some of which can be provided through the adult education system at a minimum cost. As previously mentioned the manager has not yet completed Protection of Vulnerable Adults training for financial reasons. The manager will enquire at the residents day centre to see if he could be included in any staff training in this area. It would also be acceptable if the manager engaged in some selfdirected study if this is not possible. There is a written policy in place regarding the protection of vulnerable adults and the CSCI address has been corrected on this policy document. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 19 As the resident is now elderly, and his needs are likely to change, it is important the manager keeps the residents needs under constant review and attends other relevant training courses when appropriate. There are no other members of staff under employment currently. Arrangements are in place that the managers friend who has a current CRB check will provide support in his absence. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 20 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): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The resident benefits from a well run organised home, with a competent and accountable manager The resident can be confident that his views underpin all reviews and development by the manager The health, safety and welfare of the resident is adequately promoted and protected. EVIDENCE: The manager is clearly committed and very fond of the resident whose wishes and needs underpin the way the home is organised and managed around them. As the service is small the manager is able to provide a personal intimate service entirely focusing on the resident. This appears to suit the resident very well.
Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 21 Should the number of people living in the home increase; the manager would need to develop the basic procedures he has put in place. However as he has no plans to do this, they remain satisfactory. Owing to the size of the home there is no need to have a complicated quality assurance system. The manager continues to act on the advice of the last inspection and continues to support the resident to complete a yearly questionnaire about how he feels living in the home. The residents friend and advocate assists him with this. Basic health and safety measures are in place; the home is fitted with 3 smoke detectors, which are mains, operated. The manager also keeps a record of annual fire drills signed by the resident. The resident was able to tell me what was expected of him in the drill and what he would do in case of an emergency or if on his own in the house. It is recommended fire drills can be done on a risk assessment basis in conjunction with the West Midland Fire Service. The manager has a current Corgi gas certificate however there is no evidence of a current electrical certificate. The home is a new build property approximately 10 years old. It is a requirement that the manager obtains an NICEIC certificate for the electrical wiring. The water temperature is checked weekly and recorded and the thermostat fitted to the boiler remains functioning at 43 degrees centigrade. The fridge temperature is not being recorded on a weekly basis and no risk assessment has been completed on the resident using the electric kettle as previously recommended. This is because the manager states the resident does not boil the kettle but rather warms it up to make a hot drink. However this situation needs to be kept under review due to the resident’s age and changing needs. Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 22 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
CONCERNS AND COMPLAINTS CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score Standard No 22 23 Score 3 2 3 3 3 3 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 4 29 x 30 4 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42
DS0000004558.V312390.R01.S.doc LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20
Mr David Chadwick Score 3 2 2 3 x 3 x x 2
Version 5.2 Page 23 21 x 43 x Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 25 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 YA9 Regulation 13(4)(b) Requirement Timescale for action The registered manager must 20/11/06 complete a risk assessment so that a clear protocol/procedure is put in place to support the resident on the occasions when he is left at home on his own in the case of an emergency. The registered manager must continue to offer access to healthcare and to record any refusal to accept health services. The registered manager must update his knowledge on the Protection of Vulnerable Adults. 20/11/06 2. YA19 12 3. YA23 13(6)21 20/11/06 4. YA32 12(4)(b) The registered manager must 20/11/06 ensure he updates his knowledge base in courses on a regular basis, like food hygiene, first aid, fire, H & S and COSHH. There is also the need to attend any specialist courses to support the service users when and if his needs change. The registered manager must keep an ongoing record of fridge temperatures within the home. 20/11/06 5. YA42 23(2)(p) Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 26 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 YA42 Good Practice Recommendations It is recommended that fire drills can be done on a risk assessment basis in conjunction with West Midland Fire Service. The registered manager needs to consistently review the residents ability to safely use the electric kettle when making hot drinks. 2 YA42 Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Mr David Chadwick DS0000004558.V312390.R01.S.doc Version 5.2 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. 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!
