CARE HOME ADULTS 18-65
The Grove 65/67 Belfield Digmoor Skelmersdale Lancashire WN8 9HQ Lead Inspector
Val Turley Unannounced Inspection 10th November 2005 10:45 The Grove DS0000005996.V264388.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 Grove DS0000005996.V264388.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 Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Grove Address 65/67 Belfield Digmoor Skelmersdale Lancashire WN8 9HQ 01695 725119 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) Dawaking Care Ltd Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. This home is registered for a maximum of 7 service users to include: up to 7 service users in the category LD - (Learning Disability) needing personal care only. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 21st December 2004 4. Date of last inspection Brief Description of the Service: The Grove is at the end of a terrace comprising of two properties in the Digmoor area of Skelmersdale. It provides long- term placements for seven adults with a learning disability. The home is well situated in relation to local shops and facilities. The home has been extended and provides single bedroom accommodation on three levels. There are two lounges, a dining room, kitchen, clinical room and a laundry room. There is a bathroom on each floor. The home can provide accommodation for one service user with a physical disability as it has a ground floor bedroom and a ground floor toilet and shower room. The grounds of the home are paved with planted areas and provide ramped access to both the front and rear of the house. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in November 2005 by one regulation inspector. The inspection involved observation of and discussion with the service users who lived at the home and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. As part of the inspection, the inspectors used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspectors to focus on one of the service users living at the home. All records relating to that individual were inspected along with their room. Where possible the service user is invited to discuss their experiences of living at the home however this was not to the exclusion of other people living there. What the service does well: What has improved since the last inspection? The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 6 The home now has a health action plan in place for each of the service users and a person centred plan. These give service users an opportunity to receive appropriate health care and to have an opportunity to discuss their own support needs in conjunction with any goals or ambitions. 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 Grove DS0000005996.V264388.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 Grove DS0000005996.V264388.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 The pre-admission process was in sufficient detail to ensure that prospective service users supports needs are fully assessed before admission. EVIDENCE: The file of the most recently admitted service user was examined. This indicated that a great deal of work had gone into the pre-admission process ensuring that the needs of the prospective service user could be met. The Social Services Department had provided a very detailed assessment; the home had undertaken its own assessment and meetings had been held with social care professionals to discuss the service users individual needs. A care plan had been developed based on this pre-admission information outlining the service users support needs. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 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 and 7 Care plans for the service users living at the home were detailed outlining individual support needs. Although they could have benefited from some additional detail, they ensured that staff were able to provide a safe and structured environment for the service users. EVIDENCE: The file of one service user was examined and the care of that service user was tracked. The care plan described in detail the individual support needs, including the preferred routines of the service user. There was a recognition of the support required by the service user in order for him to have a positive day and there were procedures and activities built into the plan in order to promote this. The staff could explain how the service user made his wishes known. It was recommended that the care plan should contain information as to how best to communicate with the service user and to also include details of the signs and gestures he used to communicate with others. Discussion with staff suggested that they had a good understanding of the service users needs and staff were observed to provide appropriate support. As the service user had some communication difficulties an advocate had been
The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 10 involved in the development of the care plan to ensure as far as possible that the plan represented the service users best interests. There was evidence that the plan had been reviewed on a six monthly basis. It was clear from discussion at the home with both service users and staff, that service users received support with a view to achieving more independence. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 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 and 17 Service users participated in appropriate activities and staff supported them to do this. The home provided a range of meals and snacks for the service users, taking their personal preferences into account. EVIDENCE: There was evidence within the daily record sheets and within the care plan, that the service user whose care was ‘tracked,’ had been involved in a range of activities including swimming, walking, shopping, watching football matches and attending church. Discussion with the staff confirmed that the service user had been involved in these activities. The service users bedroom had been equipped to allow him to control his environment by using electrical switches. The service users held regular meetings at which they were encouraged to make decisions about meals and menus. The minutes of these meetings stated that service users could always have alternatives to the menu if they wished. A service user confirmed that this was the case and that the food was good. The menus indicated that a range of well-balanced meals was provided. Drinks and snacks were available between meals and during the course of the inspection service users were observed to access these. Support staff were observed to
The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 12 provide appropriate support to service users at meal times which were relaxed and unhurried. A policy was in place to support this approach. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 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 had good procedures in place to ensure that medication in the home was managed safely, although some additional work could be undertaken to strengthen these procedures. EVIDENCE: The homes medication policy included all the necessary detail and this underpinned the homes procedures for managing medication. Medication Administration Records for one service user were examined and these were seen to be accurate. Information on the service users file outlined the service user health support needs and discussion with the staff team indicated that they had an understanding of these. There was also evidence on the service users file that his consent to medication had been sought. As the service user had some communication difficulties the information concerning the administration of medication had been presented in a more accessible format and an advocate had also been involved in the process of requesting the service users consent. There was a health action plan in place for the service user and this included a medication review. The acting manager stated that the staff all received training in the administration of medication through the Learning Disability Training Consortium. It was recommended that the acting manager periodically supervise staff administering medication, to help ensure that good practice is maintained. A record should be kept of this supervision.
The Grove DS0000005996.V264388.R01.S.doc Version 5.0 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): 22 and 23 The home had good policies and procedures in place in order to protect service users. EVIDENCE: The home had a clear and robust Complaints Policy and Procedure in place. This was displayed within the home and was available within the Service Users Guide in an accessible format. There was evidence within the complaints log that complaints were dealt with appropriately and within the stated timescales. The home was able to access the assistance of an advocate, to support service users to make a complaint. The home had a policy in place that dealt with the Protection of Vulnerable Adults. This was comprehensive in content and included guidance for staff as to the action they should take if they suspected abuse or become aware of any allegations of abuse. A comprehensive policy was also in place that dealt with the management of physical and verbal aggression. Again these gave guidance to staff as to action they should take. The homes policy and procedures regarding service users money and financial affairs was put into practice to protect the interests of the service users. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 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): 24 and 30 Although the home was in need of redecoration it was clean and comfortable and provided a safe environment for both the service users and support staff. EVIDENCE: The home provided a comfortable, clean, bright and cheerful environment for the benefit of the service users. Service users were encouraged to personalise their own rooms and support staff were observed to assist them with this. The home would benefit from redecoration. The home was well placed for local facilities. The home could accommodate one service user with a physical disability, with one ground floor bedroom and bathroom. The home had been visited by an Environmental Health Officer in July2005 and a positive report had been provided. The laundry in the home was appropriately positioned. A hand wash basin was situated within the room. The homes policies and procedures for the control of infection included all of the necessary detail and gave support staff guidance as to the procedures they should follow. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 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): 34 The home had a thorough recruitment procedure in place, which ensured as far as possible the protection of the service users. EVIDENCE: The files of three recently appointed staff were examined. There was evidence that a thorough recruitment policy was in place, which ensured that the necessary checks were undertaken before potential staff commenced work. This was confirmed in discussion with the acting manager. Each member of staff had been given a statement of terms and conditions. All new staff were subject to a three-month probationary period before being confirmed in post. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 17 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): None of these standards were assessed at this inspection. EVIDENCE: The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 18 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 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Grove Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000005996.V264388.R01.S.doc Version 5.0 Page 19 No 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard YA6 YA20 YA24 Good Practice Recommendations Additional information should be included in care plans to ensure that care staff are aware of service users individual communication support needs. The acting manager should periodically supervise staff administering medication to ensure that good practice is maintained. A record should be kept of this supervision. The home should be redecorated. The Grove DS0000005996.V264388.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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