CARE HOME ADULTS 18-65
The Boundary 418 Parrswood Road East Didsbury Manchester M20 9GP Lead Inspector
Steve O`Connor Unannounced Inspection 9th February 2006 01:30 The Boundary DS0000021605.V283393.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 The Boundary DS0000021605.V283393.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. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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 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) Mrs Teresa Williams Mrs Joan Elizabeth Ford Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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). 9th August 2005 Date of last inspection 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 the people who live there. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 9th February 2006. During the inspection time was spent sitting and talking with staff on duty and the manager. In addition people’s files, records and other relevant documentation were examined. 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 not been looked at by the home. In addition a number of additional requirements were made including an immediate requirement to repair unsafe fire doors. 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. The Commission for Social Care Inspection (CSCI) had not received any complaints about the home since the last inspection. What the service does well: What has improved since the last inspection?
The home supports people with a variety of personal, health, social and emotional needs. To show that they have recognised and are supporting those needs each person should have a detailed care plan setting out their individual needs and how the home will support them. This issue has been raised with the home at previous inspections and they have worked on developing a new care planning system that describes the person in a much more informative and personal way. They have started to identify all the needs and support a person requires and to look beyond just their personal care needs to all aspects of a person’s life. This is a marked improvement and the work needs to continue. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 6 What they could do better:
To be able to offer people the support they need to help them lead a full and meaningful life requires the right level of support and enough staff hours. When the local authority was responsible for inspecting care homes they set the minimum number of support hours that care home must provide at 210 hours a week. The home’s staff rota showed that, excluding the manager’s hours, the home provided just 176 hours of support. It was also seen that the manager spent the majority of her time providing people with support and not carrying out her managerial duties or the work required to meet the requirements and National Minimum Standards. Although they were given a day a week to do this, the report shows that previous requirements remained outstanding and a number of standards inspected were not being met. This lack of time has resulted in the need to improve staff records, training plans, supervision, risk assessments, care plan reviews and develop a way of finding out how well the home is doing in supporting people. The registered provider has been required to provide an action plan on how, and when, this work will be carried out. At the previous inspection the home was required to check all the fire doors and make the necessary repairs. Repairs to the seals of the doors had not been made making the fire doors unsafe. A letter of serious concern was sent to the registered provider to put this right immediately. There were a number of repairs to the kitchen door and window that were identified at the last inspection. These had not been completed although the manager stated the work was being planned. The registered provider was required in the previous report to provide the CSCI with a clear policy and procedure on the use and security of people’s bankcards and PIN numbers. She has failed to provide the CSCI with the required information. The home must record people’s meals and choices on a daily basis so that it can be seen whether they are receiving a varied and nutritiously balanced diet. Medication Administration Record sheets must be signed at the point of administering at all times, in accordance with the Royal Pharmaceutical Society guidance, to ensure that people are safe. The home must provide the CSCI with an action plan setting out how they are going to meet the targets for achieving 50 of staff obtaining NVQ level 2. The home’s induction programme must be reviewed and updated, were required, to meet the requirements of the new Skills for Care Induction
The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 7 programme that will be compulsory for all care workers by September 2006. Evidence of the new induction programme must be submitted to the CSCI within the timescale set. 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 DS0000021605.V283393.R01.S.doc Version 5.1 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 The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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): No judgement was made at this inspection. EVIDENCE: The key standard was assessed during the previous inspection. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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): 9 The home did not have the full systems and procedures in place to respond to new situations and changes of needs that may present people with new risks and hazards. EVIDENCE: A requirement around the issue of care planning had been raised at the previous inspection. The manager had developed a new care-planning format that included a care plan/assessment tool that identified people’s primary needs. A more in-depth support plan of the actions required to meet those needs and a personal history that would go into greater detail about the main aspects of a persons life and set out clear goals that they wanted to achieve. This process had been completed with one person and the manager would now start to develop the care plans with the rest of the people who live at the home. It was recommended that the whole staff team become more fully engaged in the care planning process and to find ways to make the process more person centred and allow people to make a full contribution to their own care plan.
The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 11 The other part of the requirement was to ensure that the care plans were reviewed and clearly evidenced every six months. The home had not yet put a new review system into effect and so the requirement was reiterated. A recommendation from the previous inspection was that the original notes taken at house meeting were kept. It was seen that the last two meetings minutes were taken by people themselves and not staff. This action met the recommendation. The homes risk assessment process includes a general assessment in areas such as medication, mobility and communication. This gives an overall guide to whether further more in-depth assessments were required. There were some examples of these fuller assessments. However, it was found that where there had been changes in people’s circumstances, such as health, a new risk assessment had not been made to reflect the new risks and hazards faced by the person. The home must ensure that it develops a system of risk assessment and review that responds to new situations and changes in people’s support needs. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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): 16 and 17 People’s routines and involvement in the day-to-day running of the home was based on individuals needs. The home could not fully show that it was providing a nutritious and balanced range of meals. EVIDENCE: Each person has their own daily and weekly routine based on their own needs and the activities that they participate in. The home have developed a routine guide that shows information about each person’s routine and include details such as when they like to get up/go to bed. Information about what people like and don’t like to eat was well known by the staff and this information was used to develop the weekly menus. The main meal included both a hot and cold choice and individual preferences were accommodated where possible. There was a good stock of fresh and frozen foods. As the home did not record what people actually had for their meals it was not possible to assess whether they were eating a nutritious and balanced diet. The home must record people’s meals and choices on a daily basis. The remaining standards were assessed during the previous inspection.
The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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 the following standard(s): 20 The home did not have all the systems in place to ensure that medication was administered safely. EVIDENCE: The staff team were undertaking a distance learning medication course to raise their skills and awareness of medication administration. The MAR sheets were seen and found that occasionally the staff member who administered medication had not signed the MAR sheet. MAR sheets must be signed at the point of administration at all times. It was found that some of the signatures on the MAR sheets were just single letters and could not be readily identified to a single member of staff. It was recommended that a signature sheet be produced that clearly identifies each member of staff’s signature. The remaining standards were assessed at the previous inspection. The Boundary DS0000021605.V283393.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): No judgement was made at this inspection. EVIDENCE: At the previous inspection it was found that people’s benefit entitlement was 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 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 was required to develop such a policy and procedure and provide the CSCI with a copy within the timescale stated. This has not been actioned and the requirement was reiterated. There had been no formal complaints made against the home. These standards were assessed at the previous inspection. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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 the following standard(s): No judgement was made at this inspection. EVIDENCE: The previous inspection report highlighted a number of repairs that were required. The following had not been actioned. 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. The requirement was reiterated with set timescales for action. The remaining standards had been assessed during the previous inspection. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 16 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, 33, 34, 35 and 36 The home does not have the required levels of staff support nor the training systems in place to show that people are being supported by competent and qualified staff. EVIDENCE: Of the current six staff members two are undertaking the NVQ award. This is below the targets set in the National Minimum Standards. The home must provide the CSCI with an action plan setting out how they are going to meet the standards within the timeframe set. The staff rota showed that, excluding the managers hours, the home are providing 176 hours of support a week. This is below the minimum levels set by the previous inspection authority. The registered provider must provide the minimum staffing levels of 210 hours per week as set out by the previous inspection authority. Evidence of the increase in staff hours must be provided to the CSCI within the timescale set. Staff files did not contain the required documentation. The home could not provide details that Criminal Record Bureau (CRB) disclosure and POVA checks had been made on all the staff team. The registered provider must ensure that staff files contain all the documentation required as set out in Schedule 2 of the Care Homes Regulations 2001 and that up-to-date CRB/POVA checks
The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 17 have been made on all the staff team. Evidence that these documents have been sought must be provided to the CSCI within the timescale set. The home provides an induction and core-training programme based on the Learning Disability Award Framework. This core programme consists of Moving and Handling, First Aid, Food Hygiene and Health and Safety. The training records and log were not kept up-to-date and staff did not have an individual staff training plan. Each member of the staff team must have a training plan and log that sets out the training they have achieved and are required to undertake. Evidence of the staff training plans must be submitted to the CSCI within the timescale set. In September 2006 the Skills for Care Induction modules becomes a compulsory induction programme for all social care staff. The home’s induction programme must be reviewed and updated, were required, to meet the requirements of the Skills for Care Induction. Evidence of the new induction programme must be submitted to the CSCI within the timescale set. Some of the staff team had received formal recorded supervision. However, a number had not had regular supervision. Staff must receive formal supervision at the frequency set in the National Minimum Standards. Whilst staff may have undertaken the home’s induction and core training programme the home has no system to evidence that staff are competent in the core skills required to support people. It is recommended that the home introduces a system of evidencing staff competence in the implementation of the core skills developed through the home’s training programme. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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 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 and 39 The home does not have a system in place that seeks people’s views as part of a quality assurance programme. The manager does not have the time available to undertake their managerial responsibilities. EVIDENCE: At the time of the inspection the majority of the manager’s hours were spent providing people with support. The registered provider had allocated one day a week for the manager to spend covering her managerial responsibilities and undertaking the work required to address the requirements made from previous inspections. The manager has made some progress in actioning the requirements, however, as this report shows there are several areas of work that require attention and the manager does not have to time to undertake the actions required. A deputy manager is being trained to take on some of the manager’s responsibilities but she has not yet been able to delegate any of these tasks. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 19 The manager must be given the time and resources to carry out her managerial role and responsibilities and action the requirements for the home to meet the National Minimum Standards. The registered provider must provide the CSCI with written evidence that this has been actioned. The home has no informal or formal systems for quality assurance. People do have house meetings every three to four months where they discuss issues such as social and leisure activities. A system of quality assurance must be implemented that seeks people’s (and other relevant people) views on the quality of the service they receive. The outcome of such an exercise must produce an action plan and be submitted to the CSCI within the timescale set. The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 2 X 2 X X X X The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation 15 Requirement Peoples care plans, goals and the support they receive must be reviewed and evidenced at least every six months. (Previous timescale of 01/11/05 was not met) The home must ensure that it develops a system of risk assessment and review that responds to new situations and changes in people’s support needs. The home must record people’s meals and choices on a daily basis. MAR sheets must be signed at the point of administration at all times. 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. (Previous timescale of 1/10/05 was not met). Timescale for action 01/04/06 2 YA9 12 01/04/06 3 4 5. YA17 YA20 YA23 16 13 13 01/03/06 01/03/06 01/04/06 The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 22 6. YA24 23 7 YA32 19 8 YA33 18 The repairs identified in the 01/04/06 report must be carried out. (The previous timescale of 01/11/05 had not been met) The home must provide the CSCI 01/04/06 with an action plan setting out how they are going to meet the targets for achieving 50 of staff obtaining NVQ level 2 within the timeframe set. The registered provider must 01/03/06 provide the minimum staffing levels of 210 hours per week as set out by the previous inspection authority. Evidence of the increase in staff hours must be provided to the CSCI within the timescale set. The registered provider must ensure that staff files contain all the documentation required as set out in Schedule 2 of the Care Homes Regulations 2001 and that up-to-date CRB/POVA checks have been made on all the staff team. Evidence that these documents have been sought must be provided to the CSCI within the timescale set. Each member of the staff team must have a training plan and log that sets out the training they have achieved and are required to undertake. Evidence of the staff training plans must be submitted to the CSCI within the timescale set. The home’s induction programme must be reviewed and updated, were required, to meet the requirements of the Skills for Care Induction. Evidence of the new induction programme must be submitted to the CSCI within the timescale set.
DS0000021605.V283393.R01.S.doc 9 YA34 17 01/04/06 10 YA35 19 01/04/06 11 YA35 19 01/09/06 The Boundary Version 5.1 Page 23 12 YA36 19 Staff must receive formal supervision at the frequency set in the National Minimum Standards. The manager must be given the time and resources to carry out her managerial role and responsibilities and action the requirements for the home to meet the National Minimum Standards. The registered provider must provide the CSCI with written evidence that this has been actioned. A system of quality assurance must be implemented that seeks people’s (and other relevant people) views on the quality of the service they receive. The outcome of such an exercise must produce an action plan and be submitted to the CSCI within the timescale set. All fire doors must be checked and repairs made as required. Evidence of the repairs and advice given regarding the fire doors must be provided to the CSCI. (Previous timescale of 30/9/05 was not met). 01/04/06 13 YA37 19 01/03/06 14 YA39 24 01/06/06 15 YA42 13 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 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.
DS0000021605.V283393.R01.S.doc Version 5.1 Page 24 The Boundary 2 YA20 It was recommended that a signature sheet be produced that clearly identifies each member of staff’s signature who signs the MAR sheets. It is recommended that the home introduces a system of evidencing staff competence in the implementation of the core skills developed through the home’s training programme. 3 YA35 The Boundary DS0000021605.V283393.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection CSCI, Local office 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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