CARE HOME ADULTS 18-65
The Peacocks 10 Stithians Row Fourlanes Redruth Cornwall TR16 6LG Lead Inspector
Lynda Kirtland Unannounced 01 September 2005 14:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Peacocks Address 10 Stithians Row Fourlanes Redruth Cornwall TR16 6LG 01209 218271 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Margaret Hinchliffe Care Home 3 Category(ies) of Learning Disability (3) registration, with number of places The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15 June 2005 Brief Description of the Service: The Peacocks is a registered care home offering long term care for a maximum of three younger adults with a learning disability. The home provides accomodation and personal care according to individaul needs. The house is a large double fronted property set in a rural area but within easy reach of loacal towns and coastline. The service provider has two private vehicles that are used to transport service users on outings or appointments. The home operates on a family style with provider and service users going on hoilday away from the area several times each year. Service users, family and friends are welcomed to visit the home and there is a spare bedroom in the home that can be used as a guest room. Service users here generally attend weekday activities which are arranged and commissioned by the local Social Services Department as part of their overall package of care. The Peacocks has pets and therefore service users must be able to them. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited The Peacocks Residential Home on the 1st September 2005 and spent over four hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 15 June 2005. In addition the inspector focused on the following key areas of care: leisure, complaints, staffing and health and safety issues. On the day of inspection four service users were resident in the home. The Peacocks are only registered to provide care and accommodation for a maximum of three service users. Therefore they are in breach of the Care Standards Act 2000 as they were providing a service above their registration numbers. In addition on arrival no staff were present at the home, leaving four service users with no support systems in place. These breaches of regulations are being addressed via consultation with the local Social Services Department and CSCI legal team. The methods used to undertake the inspection are to meet with a number of residents, staff, and the registered provider to gain their views on the services that The Peacocks offer. Some of the Peacocks records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
Residents stated that The Peacocks provides good quality care and accommodation. They felt that they were consulted about their views of the home and are listened too. Residents have appropriate access to health care. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. Residents stated that if there were any issues they felt able to approach the registered provider and thought that their ideas would be listened to and where appropriate acted on. The home actively seeks resident’s views by holding residents meeting. The Peacocks is a clean and attractively furnished home. Staff are aware of what measures are needed to promote infection control. The Peacocks have well-maintained gardens that are accessible for residents use. The Peacocks ensures regular maintenance of the home to ensure the health and safety of all who live, work or visit the home.
The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: This section of standards was not inspected. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9 Individual risks assessments must be developed further to ensure that potential risks are identified and action taken to minimise risks. EVIDENCE: As residents were left unsupervised for some hours during this inspection the area of residents risk was inspected. A resident was perceived by the others to be ‘in charge’ of the home in the absence of staff. However on asking all residents what actions they would take in an emergency, they were unable to answer this without a lot of prompting. The level of abilities for each individual varied and it is of concern that what was expected is perceived to be too high for the individual skills people posses. Therefore it is of great concern that residents were unaware of what to do if they needed assistance. Therefore in the inspectors view this risk was too high. In discussion with the registered provider it was acknowledged that this risk had not been thought through in depth. Therefore risk assessments must be reviewed to ensure that unnecessary risks are prevented to ensure the health and safety of residents in the home. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,16 Links with the local community are good and support and enrich resident’s social, educational and leisure opportunities. The level of resident’s responsibility needs to be reviewed to ensure that it is of an appropriate level and a realistic responsibility. EVIDENCE: This section was inspected in detail at the previous inspection and the standards assessed met the national minimum standards guidance. From discussion with residents it remained evident that all have a varied and active social life with attendance at work placements, college or day care. All spoke about a recent holiday that they enjoyed. For the majority of this inspection residents were left with no staff support. One resident was seen to the person in charge. It is questionable whether this responsibility for the other residents was appropriate or if the resident was aware of and understood the responsibilities he was given. In later discussions with the registered provider she acknowledged that no risk assessments to the appropriateness of this responsibility had been assessed. She also agreed that she had not considered fully the risks that this could have imposed and stated
The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 11 that this situation would not occur again. CSCI are concerned to the level of responsibility placed on a individual service user in this instance and will be addressing this with consultation with the local Social Services Department. In addition residents did not have access to the kitchen area or were provided with a selection of beverages or snacks during this period of absence of staff. Whilst the registered provider has risk assessed that residents are unable to use the kitchen without supervision, as the risk is too high, substance should have been left in an alternative manner. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not inspected. The registered provider stated that no resident is prescribed medication; therefore this standard was not inspected. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Arrangements for protecting residents are not satisfactory placing them at possible risk of harm or abuse. Staff training in this area needs to be undertaken. EVIDENCE: The Peacocks has a complaints policy, which explains how the home will investigate any concerns raised. Residents commented that if they had any complaints they could raise these at their residents meetings or with the registered provider directly. The home has an adult protection policy the previous inspection required that the policy is updated to reflect current legislation. The registered provider stated this has been amended and agreed to send a copy of the policy to CCSI for CSCI consideration. Due to the potential risks of residents being left unsupervised in the home for over two hours, the potential risk or harm to residents will be addressed with the registered provider. In addition the inspector requires that staff at The Peacocks attend adult protection training so that they understand fully the whole concept of adult protection issues. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 The Peacocks provides a good standard of décor and furnishings creating a comfortable and safe environment for those living there and visiting. EVIDENCE: Resident’s accommodation is provided on the first floor with single bedrooms for 3 service users and one room is used as a guest room. Residents commented that they were ‘happy’ and had personalised their rooms. Residents have access to a lounge, dining area, kitchen and sufficent toileting facilities for the numbers currently registerd for. Residents have access to a attractive garden area. There are steps leading up from the garden to the property, plus residents accomodation is on the first floor which means that residents must be able to negoitate steps. The inspector did observe the home to be clean, tidy, decorated and furnished to a comfortable standard. Laundry equipment is sufficient. However laundry has to be carried through the kitchen area. The assistant manager stated that all laundry is bagged up to reduce infection control risks when transporting through the kitchen area. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35 The registered provider must ensure that experienced staff are employed in sufficient numbers at all times to meet residents needs. EVIDENCE: During this inspection residents were present at he home, but staff were not. In discussion with the registered provider she confirmed that The Peacocks have two volunteer staff that will assist if the registered provider and assistant manager need to leave the home. On this occasion they were not asked to support residents. The registered provider acknowledged this was not satisfactory due to the potential health and safety risks to each resident. The registered provider must ensure that sufficient qualified and competent staffs are on duty at all times to meet the needs of residents. Currently the residents have not been assessed as to if they are able to have unsupervised time at the home whilst taking into account their dependency skills and abilities. These risks assessments must be undertaken in consultation with the local Social Services Department. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,42,43 The home is maintained to ensure the health and safety for all who reside, work or visit the home. The Registered Managers Award has not been obtained. The homes quality assurance survey will be forwarded to CSCI. EVIDENCE: The assistant manager has nearly completed her Registered Managers Award. She has also applied for the registered manager post and her application is being processed with CSCI. The registered provider has many years of experience of managing The Peacocks. The registered provider stated that she has completed a quality assurance survey and agreed to forward the findings to CSCI. She reported that the findings from residents and their representatives were positive in respect of the care and accommodation that The Peacocks provide. The Peacocks undertakes regular health and safety checks in the home i.e. fire drills, lighting, COSHH, fridge and freezer temperatures and hot water risk
The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 17 assessments. In addition inspections from other authorities occur and no issues have arisen form these inspections. The registered provider stated that The Peacocks is economically viable and has appropriate insurance cover in place. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 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 x x x x Standard No 22 23
ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x x 1 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 1 x Standard No 31 32 33 34 35 36 Score x 2 1 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Peacocks Score x x x x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 3 3 D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 19 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. 2. Standard 1 9 Regulation 11 12,13,15 Requirement The registerd provider must adhere to The Peacocks registration numbers at all times. The registerd provider must review with service users their individual risk assessments to ensure that they reflect potential risk and what action must be taken to minise the risk. This must then be incoporated in the individuals care plan. The registerd provider must assess what responsibilities are appropriate for each individual service user, taking into account individual views, abilities and skills. This must then be incoporated in the individuals care plan The registered provider must ensure that access to refreshments for service users are available at all times. All staff must attend adult protection training. The Peacocks must employ suitable, qualified and competent staff at all times to meet service users needs. Achievement of the Registered Managers Award must be gained. Timescale for action 3.9.05 30.09.05 3. 16 13,15 30.09.05 4. 16 16 3.9.05 5. 6. 23 32/33 13 18 30.12.05 2.9.05 7. 37 18 30.12.05
Page 20 The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 3rd notification 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 23 39 Good Practice Recommendations The adult protection policy should be forwarded to CSCI for considertation. A copy of the homes quality assurance survey and its action plan should be forwarded to CSCI. The Peacocks D52-D04 S9079 The Peacocks V240622 010905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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