CARE HOME ADULTS 18-65
The Boundary 418 Parrswood Road East Didsbury Manchester M20 9GP Lead Inspector
Steve OConnor Unannounced 9 August 2005
th 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. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Boundary Address 418 Parrswood Road East Didsbury Manchester M20 9GP 0161 445 0422 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) Mrs Teresa Williams Mrs Joan Elizabeth Ford Care home only (PC) 12 Category(ies) of Learning disability (LD) (12) registration, with number of places The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: One named service user is aged 65 years or over. Should this service user leave the home the place will revert to the service user category Learning disability (LD) Date of last inspection 01 February 2005 Brief Description of the Service: The Boundary is a home providing accommodation and personal care for 12 adults with a learning disability. It is made up of two semi-detached houses converted into one to form a detached property. The home has a paved area at the front with parking for approximately three cars. The home also has a conservatory and a large rear garden with seating and shaded areas. The garage situated at the rear of the property is used for storage. Accommodation at The Boundary consists of eight single and two double rooms, two adjoining lounge areas, a kitchen and a large conservatory, which is used as a dining area and for activities. The home is situated in a residential area of Didsbury, close to public transport routes into the city centre and surrounding areas. A railway station is less than five minutes walk from the home.The area has a good range of all the usual services, including shops, a post office and public houses etc. A large Tesco supermarket is situated less than five minutes walk from the home and there is a corner shop nearby, which is convenient for service users. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 8th August 2005. During the inspection time was spent sitting and talking with the people who lived at the home, with staff on duty and the deputy manager. In addition people’s files, records and other relevant documentation were examined. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. At the last inspection the home needed to work on several areas to make sure it met the required National Minimum Standards (NMS). The majority of these had been looked at by the home and the required changes made. There were still some issues outstanding, but at the time of the inspection the registered manager was not working and so some documentation was not available for inspection. The Commission for Social Care Inspection (CSCI) had not received any complaints about the home since the last inspection. What the service does well:
Even though people may need support and encouragement in their day to day lives, it is very important that they are able to contribute to how the home is run, be able to talk or show their concerns and worries and be able to make choices that effect them. From talking to people and to staff the home showed that they encourage people to be as involved as possible in areas such as keeping their home and personal space a clean and homely place. Each person has his or her own responsibility (to the best of their abilities) for domestic duties. People are encouraged to make their own decisions and choices about holidays, social and leisure events and an example was seen where a person wanted a change to their domestic responsibilities and this was discussed between the group and they decided to make some changes. The chance for people to get together and talk about things that are important to them was also supported by the home. One of the group took the notes of these meetings and issues such as advocacy, staff changes and holidays were discussed. Having access to good medical and health treatment is important for everyone. The home helps people maintain their health and wellbeing through supporting them to regularly visit their G.P, dentist, chiropodist, optician and specialist
The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 6 health providers. The home has a lot of knowledge and understanding of people’s specific individual health needs and works closely with other healthcare services to monitor and respond to any changes. An example of this was shown when the home noticed a change in a person’s health and quickly got medical help to find out what was going on. They then changed the level of support to lessen the impact of this change on the person’s day-to-day life. 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.
The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 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 The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 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 People’s needs had been identified through the Care Management assessment process. EVIDENCE: Each person had a Care Management assessment document. As there had been no change of the people living at the home the standard continued to be met. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 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 The home had not shown that it had reflected fully people’s current and changing needs and goals. EVIDENCE: Each person had a ‘Daily Care Plan/Activities Guide’. This set out the daily routine and basic support needs (such as personal care, transport and meal times) of each person. The care plan included information such as times the person wants/needs to get up and when they like to go to bed. The actual activities the person takes part in are reviewed every September to coincide with the start of new courses at local adult education colleges. The care plans seen did not accurately reflect people’s full holistic needs and goals nor the actual support that the home provides to meet those goals. There was no recent evidence of either formal care management or in-house reviews. The home must ensure that people’s care plans identify fully people’s goals and needs and accurately reflects the support provided to meet those goals. A
The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 10 person’s goals and the support must be reviewed and evidenced at least every six months. The reviewing aspect of this requirement was identified at the previous inspection in February 2005. The issue of introducing a ‘Person Centred Planning’ care planning process based on the Governments White Paper’ Valuing People’ was again discussed with the home. This issue was recommended at the previous inspection and was reiterated. People were encouraged and supported to express their views and opinions about the home. People have the opportunity to meet together to discuss issues such as domestic arrangements, meals, social activities and holidays. Restrictions of choice were only applied as a result of a risk assessment and involvement of the person and other relevant people. One of the group takes the minutes of the meetings and it was recommended that the original notes be kept as they provide good evidence of how people are involved in their own decision making. The collection of people’s benefits had been arranged so that an appointee was no longer required. People were still supported to manage their benefits and personal finances but this was not recorded within the individual care plans. The issue of recording fully people’s needs and support was highlighted above. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 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) 12, 13, 15 and 16. People are supported and encouraged to participate in a range of specialist and community based social, leisure and educational activities. The home actively encourages and supports people to maintain relationships with their families and friends and the routines of the home are based of people’s individual needs. EVIDENCE: The majority of daily activities people participated involve attending specialist services for learning disabled people. This included day services, drop-ins and specialist local college courses. During the summer month’s people discuss and decide what social activities they wish to try. These include visits to the cinema, bowling, eating out and day trips to local attractions. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 12 People are encouraged and supported to maintain and develop their independence skills through allocated domestic tasks within the home and through maintaining their own bedrooms. People can access local colleges for courses that develop new skills and education and people also access work placements. Several people are able to travel into the community independently to use local shops, facilities and to visit family and friends. Those people that need it are supported to attend the local churches and local amenities such as shops, cafes and libraries. A variety of transport is used including Ring and Ride, public transport, staff cars and taxis. The home discusses with people what holidays they want to take and have supported them to a variety of locations both in the United Kingdom and in Europe. Several people regularly go and stay with their family and families and friends are encouraged to take an active part in people’s lives. People’s daily routine is based on their individual needs such as attending day activities. Meals are usually taken together in the dining room. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The home supported people to maintain their personal and healthcare needs and they had the policies and procedures in place for the medication administration system to keep people safe and well. EVIDENCE: People were encouraged and supported to maintain their personal care skills. Those people who require support is clearly recorded in the person’s care plan. Where required the home has sought the advice and support from specialist services such as occupational therapists to meet people’s changing personal care and mobility needs. The building has had additional rails and aids installed to help people remain as independent as possible. The home supported people to access general health services on a regular basis to maintain their health and wellbeing. Support was also provided via the local G.P and specialist healthcare professionals such as psychiatry. At the previous inspection a number of issues relating to the home’s medication administration system were raised. All these issues had been addressed and MAR sheets showed that medication was being administered at the required times. Only those staff who have attended specific medication training administer any drugs.
The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 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 standard(s) 22 and 23 The home showed that they encouraged people to express their views and concerns. However, the home does not have the systems, policies and procedures in place to fully show that people are protected from potential abuse. EVIDENCE: There had been no formal complaints since the previous inspection. People spoken were aware that they could raise their concerns with the staff and through the meetings. People’s benefit entitlement was now paid directly into their own bank accounts and money was withdrawn using personal debit cards. The registered provider kept these cards in her own home, with the PIN numbers. She stated that she went with each person to withdraw the money they require. However, there was no clear written policy and procedure covering the safe use and storage of the cards and PIN numbers. The registered provider must develop such a policy and procedure and provide the CSCI with a copy within the timescale stated. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 15 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 The home must rectify the faults identified to ensure that people live in a fully comfortable and safe environment. EVIDENCE: The premises were generally clean and tidy and most areas were well maintained. The décor and furnishings were homely in nature. Since the last inspection all of the bedrooms had been repainted and worn and damaged furniture replaced. New curtains were being fitted and some carpets had been replaced. There were plans to redecorate the lounge areas as the decoration was starting to look worn. Any maintenance issues were recorded and past onto the registered provider to resolve. During a tour of the building several areas of concern were noted. 1. The kitchen door was in a poor state of repair and needs replacing. 2. A window in the kitchen was cracked and needs replacing. 3. In the upstairs landing there is a large crack that travels through the ceiling and part way down one wall. This needs investigating and appropriate repair. 4. A damaged white car had been parked in the front garden of the house for several months that must be removed.
The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 16 The laundry facilities were sufficient to meet people’s needs. There was no requirement to handle and dispose of clinical waste. Staff wore plastic aprons and gloves for cleaning and when personal care was required. Cleaning materials were not kept locked in storage. The registered provider stated that this would be resolved the next day. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this inspection. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 18 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) 42 The home did not fully have the facilities or systems in place to ensure people’s safety. EVIDENCE: The home was maintaining an accurate fire log with the required checks and fire drills. Equipment was being serviced on a yearly basis. A new fire alarm and smoke detectors had been installed recently. The home would check the temperatures of hot water when supporting people to take baths but did not maintain a regular, ongoing record of all the hot water sources in the house. It was found that some of the fire doors did not fit correctly into the doorframes. In addition several fire doors were wedged open with a doorstop. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 19 All fire doors must be checked and repairs made as required. Fire doors must not be propped open. Guidance should be sought from the relevant fire authority regarding the number and type of fire doors required in the home. The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 20 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 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Boundary Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 21 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 6 Regulation 15 Requirement The home must ensure that people’s care plans identify fully people’s goals and needs and accurately reflects the support provided to meet those goals. A person’s goals and the support must be reviewed and evidenced at least every six months. The registered provider must develop a policy and procedure for the use and security of peoples debit cards and PIN numbers and provide the CSCI with a copy within the timescale stated. The repairs identified in the report must be carried out. (a) All fire doors must be checked and repairs made as required. (b) Fire doors must not be propped open. Guidance should be sought from the relevant fire authority regarding the number and type of fire doors required in the home. Evidence of the repairs and advise given regarding the fire doors must be provided to the CSCI.
F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Timescale for action 1st November 2005 2. 23 13 1st October 2005 3. 4. 24 42 23 13 1st November 2005 30th September 2005 The Boundary Version 1.40 Page 22 5. 42 13 The temperature of hot water sources must be monitored and recorded on a week weekly basis. 1st September 2005 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 6 Good Practice Recommendations It is recommended that the home look at the introduction of a Person Centred Planning focused system for care planning and review that would place the person at the centre of the process. It is recommended that the original notes of the group meetings, written by one the group, be kept as they provide good evidence of how people are involved in their own decision making. 2. 7 The Boundary F55 F05 s21605 The Boundary V236233 D010705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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