Inspection on 06/10/05 for The Green

This inspection was carried out on 6th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

The Green 15/09/08

The Green 17/10/06

The Green 21/01/06

The Green 10/03/05

The Green 23/08/04

The Green 01/03/04

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 Green Bromborough Pool Bromborough Wirral CH62 4TT Lead Inspector Beate Roth Unannounced Inspection 04:15 6 October and 13 October 2005 th th The Green DS0000019008.V257091.R01.S.doc Version 5.0 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 Green DS0000019008.V257091.R01.S.doc Version 5.0 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 Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Green Address Bromborough Pool Bromborough Wirral CH62 4TT 0151 643 8567 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) Wirral Autistic Society Patricia Sarah Anne Hood Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th March 2005 Brief Description of the Service: The Green is registered to provide personal care for 10 adults of either sex with a learning disability. The home consists of four flats that are accessible to one another and share the same main entrance. Two of the flats provide accommodation for two service users, and the other two flats provide accommodation for three service users. The home offers single occupancy bedrooms. Each flat has a kitchen with a dining area and either a through or separate lounge. There is a patio and a garden to the rear of the home. The home is close to local shops and to public transport services. Parking is available on the main road. The home is run by Wirral Autistic Society who have several care homes for adults with a learning disability in the area. Wirral Autistic Society provides a range of services and facilities, which are fully utilised by the service users, accommodated at The Green. The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on two days and lasted 4.5 hours. During the inspection time was spent in the office examining records and policies and procedures and talking to the manager. Staff and service users were spoken with. A tour of the home was undertaken. Staff were observed delivering care to service users. What the service does well: What has improved since the last inspection? What they could do better: The content of the contracts/terms and conditions and the way they are drawn up could better support the interests of service users. Service users would benefit from staff receiving accredited training around the management of challenging behaviour. Improvements need to be made to the record keeping in relation to incidents of physical intervention by staff. A full record must be made of any incident that is detrimental to the health or welfare of a service user. This is to include an account of how the injury was sustained and any follow up action taken. The delay in meeting the requirement made at the last inspection in March 2005, to address the risks presented by the lack of security provided by two doors at the home, does not support the well being of service users. The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 6 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 Green DS0000019008.V257091.R01.S.doc Version 5.0 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 Green DS0000019008.V257091.R01.S.doc Version 5.0 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): 2 and 5 A full assessment would take place to ensure that a service user’s needs could be met. The contracts/terms and conditions could better support the interests of service users. EVIDENCE: There have been no new service users admitted to the home since the last inspection. New service users would be assessed by the manager for the home and by a representative from day services. The manager would visit a prospective service user where they are living. Information would be gathered from the service user, their carers, social worker and any other relevant agencies. An examination of an initial assessment pro forma at a previous inspection indicated that all the information recommended in this standard is available. An assessment would be made if a service user moved to the home from another home within Wirral Autistic Society. This information would be recorded. The contracts/terms and conditions between the home and the service user are in the process of being reviewed. At the last inspection it was recommended that service users be supported by family, friends and/or advocate, as appropriate when drawing up the contract and that clear information around any costs a service user has when they go out with staff is provided. At a previous inspection it was reported that when service users go out with staff they sometimes pay for refreshments for staff. The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 9 The Green DS0000019008.V257091.R01.S.doc Version 5.0 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 and 9 In general, care planning reflects the assessed and changing needs of service users. Service users would benefit from staff receiving accredited training around the management of challenging behaviour. EVIDENCE: A sample of service user plans were examined and contained detailed and clear information to enable staff to provide appropriate support around day-to-day living and personal goals. These plans are formulated at a service users review and cover the information required by the National Minimum Standards. A review had taken place within the last 6 months. The documentation available from reviews indicated that the service user, their relatives, social worker and other relevant individuals are invited to contribute to reviews. An examination of the service user plans indicated that service users’ rights to live as independently as possible, in accordance with their abilities, is promoted by the home. Risk assessments are available which indicate why service users’ rights need to be limited in order to safeguard their wellbeing. Reactive plans which detail behaviour management strategies are also The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 11 available. These indicate that as a last resort physical intervention is used. The records made following an incident of physical intervention were in general satisfactorily maintained and indicate that physical intervention is not used frequently. One record did not clearly indicate the behaviour that had led to the need for physical intervention to be used. Four records did not adequately describe the nature of the physical intervention used. This is to be addressed. All records of incidents of physical intervention should be signed by the manager to indicate that these are subject to management overview. Staff are trained in behaviour management strategies such as supportive holds and breakaway techniques as part of their induction. The manager reported that this training is not accredited. Any training that provides guidance on physical intervention must be accredited. A behaviour management plan for a service user identified with the manager at this inspection needs to provide clearer information on the action staff are to take to support this service user. The Green DS0000019008.V257091.R01.S.doc Version 5.0 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): 11, 12, 13 and 16 Service users are able to take part in appropriate activities that provide opportunities for their educational, social and personal development. Links with the local community are good. The daily routines ensure that the preferences of service users are provided for. EVIDENCE: Service users attend day services five days a week where they are provided with a range of opportunities to promote their personal development. Service users have a timetable of activities, which has been drawn up to meet their needs, skills and individual preferences. Some of the opportunities available are horticulture, craftwork, community work experience, drama and physical education. Activities are provided by either Wirral Autistic Society’s day services or by outside organisations such as local colleges. Service users are provided with work experience opportunities in accordance with their abilities. There are opportunities for service users to become involved in the local community. For example, the service users visit local shops, go to the gym, cinema, bowling and participate in community life through attendance at The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 13 college courses. The home has access to private transport and there is easy access to train and bus services. Discussions with the staff and observations confirmed that the home’s routines are flexible as much as possible. The records inspected indicated the support service users need in their daily lives in order to make decisions and encourage independence. The Green DS0000019008.V257091.R01.S.doc Version 5.0 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): 19 and 20 The physical and emotional health needs of service users are met. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Visits to service users from medical/health care professionals take place in private. Records of reviews indicate that service users have access to medical/health care professionals as needed. Service users are supported to attend health care appointments. Service users are supported and facilitated to take control of and manage their own healthcare in accordance with their abilities. A revised medication procedure is available which provides clear guidance. Observations of staff administering medication indicated that they are following this procedure. Medication is stored securely. Members of staff interviewed reported that they have been trained in the administration of medication. A selection of medication administration record sheets and corresponding medication were inspected and found to be in order. Any service users who self – administer their own medication do so in accordance with a risk assessment. The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 15 The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 16 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): 23 The practices at the home, in general, provide protection for service users. EVIDENCE: A copy of Wirral Borough Council’s adult protection procedure was available at the home. A shorter and more accessible version of the adult protection procedure has been made available by Wirral Borough Council and was at the home for staff to refer to. Staff have received training in the adult protection procedures. A member of staff interviewed was clear about what to do in the event of a suspicion of abuse. The record of accidents held at the home where in general suitably maintained. There was insufficient information recorded about how a service user had sustained an injury. The manager was fully aware of the incident and could explain what had occurred. A record must be made of any incident that affects the well being of a service user, especially where an injury is sustained. This is to include an account of how any injury was sustained and any follow up action taken. From discussion with members of staff and from an examination of the financial records, the home’s policies and practices with regards to service users’ money and financial affairs safeguard service users. The Green DS0000019008.V257091.R01.S.doc Version 5.0 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, 28 and 30 In general, the home provides a safe, comfortable and pleasant environment for service users. EVIDENCE: The premises are accessible to all service users. The home offers access to local amenities, transport and relevant support services. The premises provide a comfortable environment to service users and are in general well maintained. The paintwork to the hall and stairwells and to some skirting boards in the communal areas is showing signs of wear and tear. The manager has identified these areas for redecoration. At the last inspection a requirement was made that the registered persons must ensure that action is taken to address the risks identified by the two doors at the back of the home that are not secure from inside the home. At this inspection this had not been addressed. An immediate requirement was made and this matter was attended to within the given timescale. A sample of safety check records and tests were inspected. In general these were in order. Evidence that the small electrical appliances at the home have been tested within the timescales recommended by the Health and Safety The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 18 Executive (HSE) is to be forwarded to CSCI. HSE guidelines indicate that small electrical appliances should be visually checked on a 6-12 monthly basis and that a combined inspection and testing should occur every one to two years. Each flat has a kitchen with a dining area and either a through or separate lounge. There is a patio and a garden to the rear of the home. Service users can receive visitors in private in their bedrooms. Staff are able to store personal belongings in the office. It continues to be recommended that alternative sleeping –in accommodation is provided as the current arrangements of two staff sleeping in, in the service users living rooms has implications for the service users’ being able to access this area. A tour of the home showed that the home was clean. There are procedures for staff to refer to about hygiene and infection control. The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 19 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 and 33 Service users are supported by the number of staff available and the training staff receive. EVIDENCE: An examination of the rota for the week of the inspection and a discussion with staff indicated that staff are appropriately deployed to meet the needs of the current service users. At night there are two sleeping-in staff providing cover for the four flats. The manager has risk assessed this staffing arrangement. The manager reported that she keeps the staffing levels at the home under regular review and would deploy waking night/extra staff if necessary. There is a core staff team employed at the home. Bank staff are used to cover absences. Bank staff have been recruited to work for Wirral Autistic Society to cover absences in the homes if needed or to provide support within the day care service. A comprehensive induction and foundation training programme is provided to permanent staff. This includes training around how to support individuals with autism. Steps have been made to encourage bank staff to attend this training so as to ensure that they are appropriately trained should they need to be deployed. The induction and foundation training programmes have been developed in accordance with the National Training Organisation training targets. There was evidence that training is provided to meet the specific The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 20 needs of service users. 3 staff are currently undertaking a British Sign Language course. Observations indicated that staff are respectful and supportive of the service users. The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 21 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): 39 and 42 The quality assurance and health and safety systems in place at the home promote the well being of service users. EVIDENCE: The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 22 There are a range of quality assurance systems in place. Wirral Autistic Society is accredited by the National Autistic Society which carries out an inspection of services provided. Wirral Autistic Society conducts an internal audit of the society as a whole on an annual basis. The views of service users are obtained by key workers and the manager. A service user survey form is being used to also ascertain their views. There was evidence that the views of relatives and social and health care professionals are obtained about the service provided at the service users reviews. The day service also provides a forum for service users to give their views on the services provided there. The service users were encouraged to meet with the inspector. There was evidence of the representative of the registered provider undertaking a monthly visit to the home to assess the operation of the service. Training around safe working practices such as manual handling, fire safety, infection control and first aid is made available to staff as part of their induction. There is a rolling programme of training opportunities provided and staff can access this when required. There are a range of policies and procedures available that promote safe working practices. Wirral Autistic Society has a health and safety advisor who is available to provide advice and who has responsibilty for promoting a safe environment within the homes. There was evidence of a safe environment being provided at the home. The water throughout the home is regulated at the boiler to ensure it does not exceed 43 degrees centigrade. Records of thermometer temperature checks of hot water are undertaken. A risk assessment has taken place of the windows at the home and restrictors have been put in place. Risk assessments of the radiators have been undertaken. As a consequence radiator guards have been provided in some areas of the home. It is recommended that design solutions that control the risk from radiators that can exceed 43 degrees centigrade be provided throughout. The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 23 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 2 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X 2 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Green Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000019008.V257091.R01.S.doc Version 5.0 Page 24 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 9 Regulation 12, 18 Requirement Training provided to staff around any physical interventions used to support a service user’s behaviour must be accredited. A clear record must be made of the nature of any physical intervention used and the circumstances that led to the use of physical intervention. The behaviour management plan for a service user identified with the manager must provide clearer information on the action staff are to take to support this service user. A full record must be made of any incident that is detrimental to the health or welfare of a service user. This is to include an account of how any injury was sustained and any follow up action taken. The registered persons must take immediate action to address the potential risks to service users arising from the two ground floor back doors to the home that are not secure (previous timescale not met). Evidence that the small electrical DS0000019008.V257091.R01.S.doc Timescale for action 13/04/06 2 9 13 13/10/05 3 9 15 13/10/05 4 23 17 13/10/05 5 13 24 20/10/05 6 23 24 13/11/05 Page 25 The Green Version 5.0 appliances at the home have been tested within the timescales recommended by the Health and Safety Executive (HSE) must be forwarded to CSCI. 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 5 Good Practice Recommendations It is recommended that service users be supported by family, friends and/or advocate, as appropriate when drawing up the contract. The service user guide/contract should provide clearer information on the costs service users may have to meet when going out with staff. All records of incidents of physical intervention should be signed by the manager to indicate that these are subject to management overview. It is recommended that alternative sleeping-in accommodation for staff is provided. It is recommended that design solutions that control the risk from radiators that can exceed 43 degrees centigrade be provided throughout. 2 3 4 9 24 42 The Green DS0000019008.V257091.R01.S.doc Version 5.0 Page 26 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. 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