Inspection on 25/07/06 for The Bungalow

This inspection was carried out on 25th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Bungalow 08/10/07

The Bungalow 06/03/06

The Bungalow 20/09/05

The Bungalow 09/03/05

The Bungalow 04/08/04

The Bungalow 20/02/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Bungalow Raby Hall Road Bromborough Wirral CH63 ONN Lead Inspector Lynn Sharples Unannounced Inspection 25th July 2006 09:30 The Bungalow DS0000019000.V296274.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 The Bungalow DS0000019000.V296274.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. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Bungalow Address Raby Hall Road Bromborough Wirral CH63 ONN 0151 334 7510 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) siobhan.wise@wirral.autistic.org Wirral Autistic Society Mr Michael James Hatton Mrs Siobhan Anne Wise Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: The Bungalow is set within the grounds of Raby Hall and provides accommodation and personal care to three adults who have a learning disability, specifically autism. The home is set within extensive, wellmaintained grounds. The home provides each service user with a single bedroom and all the facilities expected within a smaller home, designed to provide a homely environment. The fees at the home range from £878 - £905 per week. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home did not know about the visit and took three hours. The inspector spoke with the manager and staff about the home and spent time with the service users. Files and other documents relating to the home were read. The inspector looked round the home. What the service does well: What has improved since the last inspection? Regularly reviews of the care plans and risk assessments of the service users, takes place. A record of staff attendance at fire drills is kept. The health needs of the service users are met. The toenails are now cut by appropriately trained staff. The manager is now registered with the CSCI. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 6 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 Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Service User Guide are good providing service users and prospective service users with details of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: The Statement of Purpose and Service User Guide are well written documents. No new service users have been admitted to the home for several years and there are no changes planned for the home. Full assessments have been undertaken on all service users by specially trained staff. Service users, their families and other care professionals are involved with these assessments. Prospective service users and their relatives would visit the home and have a gradual introduction to the home. Each service user has a contract statement in their files. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The care planning provides staff with the information they need to meet service users needs. Service users have limited involvement in making decisions, choices and are not consulted in the running of the home. This leaves service users without the information, assistance and communication support they need to make decisions about their own lives. EVIDENCE: The care plans include details of the clients communication, daily routines, activities undertaken in the house, health and wellbeing, healthy eating plans, risk assessments and reactive plans. The care plans are reviewed annually and the risk assessments every six months. The service users would benefit from having an Essential Lifestyle Plan, so that they are in control of the care planning system. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 10 In each file there was a “Decision Making Consent Form” these were not filled in. These are a good starting point to discuss decision making and should be filled in and expanded upon. There is limited evidence of the service users making decisions. The lack of communication aids such as storyboards and pictorial information leaves the service users without adequate information to make choices and make decisions about their own lives. The home does not use an independent advocacy service this could also help with informed decision making. The home does not have residents meetings or consult with service users in changes to the statement of purpose, or involve them in staff meetings. The manager does hold occasional meetings with service users the last one was in January when a member of staff left. Policies and procedures are not presented in a suitable format for service users. This means that service users are denied opportunities to make major life decisions as well as everyday choices. The home does not use physical intervention with the service users; this is documented in their care files. The risk assessments are extensive and are reviewed. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15,16,17 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The daily routines ensure that the preferences of service users are provided for. Dietary needs of service users are well catered for with a balanced and varied selection of food available according to their assessed requirement. However, service users have limited choice over what they eat. EVIDENCE: The service users attend day services that include education, training, life skills and domestic skills. The services are age appropriate and may include horticulture, furniture restoration and music. In house activities also take place and this includes art and craft. The service users are involved in the local community as much as possible. They use local shops, services and leisure services as much as possible. The service users assist the staff to do the shopping at the local supermarket and other local shops. The service users do not shop for toiletries as these are bought in bulk by the home; this limits the experience of service users living The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 12 an ordinary life. The geographical location of the home limits the community presence of service users and the experience of living in the local community. The service users have strong family links. The families visit the home and two service users visit their families on a regular basis. These visits are planned in advance and agreed with the service users. The daily routines and house rules are discussed with service users at their regular reviews and the outcomes recorded in their care plans. These are also discussed by staff at house meetings to ensure that all staff have a consistent approach to care. The home uses a pictorial chart to assist service users to undertake domestic chores. Meals are taken in the kitchen/dining room. The record of meals taken by the service users provides evidence that a nutritious, varied and balanced diet is taken. During the week, breakfast is taken at 8:00 am with lunch at 12:30 at day services. The evening meal is served between 5:30 and 6:00 pm with supper at a time of the service users choosing. Meals at the weekend tend to be more flexible to fit in with the leisure activities enjoyed by the service users. The service users go out for meals as well. The service users would benefit from having the meals photographed and then they can choose what to have each day and this would increase the choices that they can make. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 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): 18,19,20 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of the service users’ support needs. This is evident from the positive relationships, which have been formed between the staff and service users. The care plans include details of service users’ physical and emotional health needs. This provides care staff with the information they need to meet the service users care needs. The systems for the administration of medication clear and arrangements are in place to ensure service users medication needs are met. EVIDENCE: Service users are each accommodated in single bedrooms that have been personalised to reflect their individuality. The staff assist service users to personalise their rooms where necessary. Personal care is given to service users in their bedroom or in the bathroom as necessary. Privacy and dignity were seen to be respected at all times. The staff were seen to interact positively with the service users. The three staff at the home each has prior responsibility for one service user as key worker. It is evident that the staff have a clear understanding of the service user they have responsibility for. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 14 In the care files there were details of the visits to the doctor, dentist and opticians. A service user had been unwell and in their care file there was documentation to demonstrate that the staff had monitored their condition and had ensure that sufficient fluids had been taken by the service users. None of the service users administers their own medications. All medications are securely held. Records are held of all medications administered to service users and these were found to be well maintained and up to date. The staff have received training in medication. The Bungalow DS0000019000.V296274.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 is good. This judgement has been made using available evidence including a visit to this service. The home has a documented complaints procedure to ensure service users’ views are listened to and acted upon. Systems are in place to ensure service users are safeguarded from abuse and harm. EVIDENCE: Wirral Autistic Society has a complaints policy and procedure to be followed. A copy of the procedure is held in the home and is also detailed in the Statement of Purpose. No complaints have been received by the home or by CSCI. It would be beneficial if the home kept a copy of the complaints procedure in a pictorial form that service users could understand. The staff team spoken with were able to demonstrate a clear understanding of their role as alerter to incidents or allegations of abuse. The staff have been given training on abuse and of the action to be taken in the event of it being suspected. The home holds the policy and procedure on this. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. There has been some change to the décor or furnishings since the last visit and some issues may cause a risk to service users. EVIDENCE: The home was found to be maintained in a very good condition. The home comprises three bedrooms, a lounge, kitchen dining area, washing and bathing facilities and a staff office/sleep in room. The lounge provides a pleasant environment for the service users. The lounge furniture is comfortable. The kitchen does need some attention, there were chipped worktops and a cupboard was broken, this falls off and could be a risk to service user. Blinds have been fitted to the home at the front of the building and provide a good level of privacy for service users. Radiator protectors have been fitted to further ensure the safety of service users. Bedrooms are attractively decorated and it is evident that the staff have taken service users preferences into consideration when personalising the rooms. One bedroom carpet has been replaced and one carpet was threadbare in The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 17 places and this could pose a risk to the service user and should be addressed as a matter of urgency. There are two separate toilets and a bathroom, the flooring in the bathroom is lifting at the door and posing a risk to service users. The home was found to be clean and hygienic throughout. Laundry is dealt with by the staff and service users personal clothes were seen to have been carefully laundered. The Bungalow DS0000019000.V296274.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): 32,33,34,35,36 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. There is an enthusiastic workforce that works positively with service users to improve their whole quality of life. The recruitment practices are good and appropriate checks are carried out. This ensures that the resident is not put at risk. The lack of supervision leaves the staff without appropriate direction. EVIDENCE: The home provides one member of staff on duty at all times when the service users are in the home. Additional staff are provided by the day services to provide education, training and life skills. One member of staff holds NVQ at level 3 and one holds NVQ at level 2 and the other new member of staff will be starting their NVQ award. The staff spoken with were able to demonstrate a good understanding of autistic spectrum disorder. The rotas indicated that there were sufficient staff team to support service users needs. The staff commented that it would be good to have more staff on to go out on an individual basis with service users. The home has regular staff meetings that are recorded. A relative comment card stated that the staff were “caring, friendly and helpful.” The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 19 The training that staff have undertaken includes medications, first aid, food hygiene, fire safety, equal opportunities, communications, deaf awareness, moving and handling and autism specific training. Details of forthcoming training events are displayed on the board in the office/staff sleeping in room. A staff member spoke about their induction and provided documentation that specific courses have been attended. It was difficult to obtain the service users views about the staff due to the nature of their learning disability; communication aids would greatly improve this. An examination of a sample of staff records indicated that all staff had two references, enhanced CRB checks, statements of terms and conditions on their personnel file. The supervision records of some staff members is poor. The manager said that they found it very difficult to supervise staff at least six times a year. The manager should raise this issue with the responsible person to ensure that the staff team are appropriately formally supervised, to ensure that they can monitor the work of staff with individual service users and provide support and professional guidance. The Bungalow DS0000019000.V296274.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): 37,39,42 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The record of self-review by the registered provider is good and provides the home with adequate quality assurance. EVIDENCE: The manager of the home is now registered with CSCI; they are completing the NVQ level 4. The registered provider visits on a monthly basis and produces a report. The Society holds Investors in People and is accredited by the National Autistic Society. It would be useful if the home completed a survey using advocates with the service users to gain their opinion of the home. The staff said that the manager was supportive. The home was able to provide evidence that the health and safety of the staff and service users is assured. The home now keeps a record of staff attendance at fire drills. Risk assessments were seen to be in place including a lone worker assessment. A walkie-talkie telephone has been provided for the staff to The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 21 enable them to call for assistance without having to use the homes’ main telephone. The staff are required to carry this with them at all times. A sample of safety check records were examined for the gas, electricity and fire drills and detection systems and were found to be in order. The Bungalow DS0000019000.V296274.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 CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 23 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 YA7 Regulation 12 Requirement The registered person must ensure that records are kept indicating service users make decisions with assistance. The registered person must ensure that communication aids are made available to service users to assist with the decision making process. The registered person must ensure that service users are consulted about the running of the home and have opportunities to make major life decisions as well as everyday choices. The registered person must ensure that the cupboards in the kitchen are safe for service users to use and if they are not replaced provide a risk assessment. The registered person must ensure that the carpet in one service users bedroom is replaced. It is threadbare and the service user is at risk of injury. The registered person must ensure that the flooring in DS0000019000.V296274.R01.S.doc Timescale for action 21/08/06 2 YA7 12 21/08/06 3 YA8 12 21/08/06 4 YA24 23 21/08/06 5 YA25 23 21/08/06 6 YA27 23 21/08/06 The Bungalow Version 5.2 Page 24 7 YA36 18 bathroom is repaired as it currently poses a risk of injury to the service users. The registered person must ensure that staff are formally supervised on a regular basis. (This requirement remains outstanding 06/03/06). 21/08/06 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 2 Refer to Standard YA7 YA7 Good Practice Recommendations Records should indicate the choices made by each service users. It is recommended that service users have access to an independent advocacy service. The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 The Bungalow DS0000019000.V296274.R01.S.doc Version 5.2 Page 26 - 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!