CARE HOME ADULTS 18-65
Thingwall Lane, 28 28 Thingwall Lane Liverpool Merseyside L14 7NX Lead Inspector
Mrs Joanne Revie Unannounced Inspection 14th November 2005 10:00 Thingwall Lane, 28 DS0000021487.V263902.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 Thingwall Lane, 28 DS0000021487.V263902.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. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Thingwall Lane, 28 Address 28 Thingwall Lane Liverpool Merseyside L14 7NX 0151-228-0824 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) Community Integrated Care Miss Suzanne Walton Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service Users to Include up to 2 (LD) The service should at all times have a suitably qualified and experienced manager who has been approved by the Commission for Social Care Inspection 18/01/05 Date of last inspection Brief Description of the Service: 28 Thingwall lane is operated by the organisation C.I.C. Maritime Housing own the building and act in the capacity of Landlord. The service provides support and care to two service users with severe learning disabilities and challenging behaviour. The home is situated on the border of the borough of Knowsley and Liverpool. It is within easy reach of a local esplanade of shops and local pubs. The home is domestic in character and fits in well to the surrounding community. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was announced. Both service users were at home receiving support form two staff members. Discussions were held with one staff member A variety of documentation was viewed which is referred to in the evidence section of this report. The service users communication abilities are based on actions that are understood by people who know them well. For this reason discussions were not held with the service users although staff interaction with them was observed. What the service does well:
The service users are supported to live lifestyles that are as independent as possible. Staff know them well and were seen to interact and interpret the service users needs well. Trusting relationships have developed. Staff have clear written instructions available to refer to for guidance. These were very detailed and were written in plain English. This is important as both service users mainly communicate through body language and limited words. All staff and relatives are encouraged to develop the plans of care and to be involved in reviewing care. This reflects good practise as neither service user can read so it is important that views of all who know them are included. The service is very good at identifying and managing risk this means that both service users are encouraged to undertake all the usual activities of daily life safely such as visiting shops, places of interest, eating out, going on holidays. etc. The service has `access to a job training scheme which means that service users spend time with an outside job trainer who identifies suitable employment for the service users. This can be a lengthy process and shows the services dedication to the progress of the service users. Staff had identified that one service users needs had changed. This is being managed well and loved ones and all staff members are involved in developing anew plan of care, which should enable the service user to be supported. The service tries to support and develop relationships, which are important to the service user. This includes providing staff support when necessary. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 6 Service users are involved in all the domestic tasks that are part of running a “home”. This is managed in a risk assessment framework. This is important as it encourages both service users to experience normal daily life Mealtimes are planned with choices available. Service users are encouraged to go with staff to buy a weekly food shop. The staff recognise that each service user is an individual and provides support and choices, which meet their needs. The service is quick to recognise changes in the service users health and emotional needs and all staff are encouraged and supported by the manager to act as the service users advocate when these situations occur. This is important as the service user cannot always express themselves and without staff input changes in needs could be missed. Each service user has their own bedroom, which is furnished according to their needs and tastes. The home in general is comfortable and nicely decorated. The service users have access to a well-kept private garden. What has improved since the last inspection? What they could do better:
Although the service users are supported to take part in activities at times these were found to be repetitive. The manager is aware of this and asks staff for new ideas during their monthly supervision sessions. This work should be continued to ensure the service users are offered a quality lifestyle. The service has recognised that providing copies of food labels helps service users identify what food they would like to eat. Copies of labels with large print words have been made and the service intends to laminate these to encourage choice. This work reflects good practise and should be followed through. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 7 During the tour of the home it was noted that the grouting to the tiles of the kitchen and bathroom were grubby and stained and could benefit from steam cleaning. The flooring around the toilet was found to be cracked and smelt unpleasant and a wall tile was missing from the bathroom. These issues must be addressed. Although the service takes a responsible attitude to the prevention of fire an up to date risk assessment could not be found. The present Fire risk assessment must be reviewed and any required actions taken to keep the service users safe. 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. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed from this section on this occasion. Thingwall Lane, 28 DS0000021487.V263902.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): 6,7,9 Service users are encouraged to control their own lives (according to their abilities) within a strong risk assessment framework. Staff have clearly written instructions to follow EVIDENCE: Both service users plans were viewed. Both were comprehensive, written clearly and were individual to each service user. It was evidenced that the plans were above the national minimum standard required. A draft essential lifestyle plan was viewed for one service user whose needs have changed. This has been developed by all members of the staff team plus loved ones of the service user, which reflects good practise. Neither service user can read however families are asked to take part in the review of the plan and this is clearly documented. Each plan contains an essential lifestyle plan. These reflect what staff and relatives believe to be the aspirations of the service users and how staff are to provide support to enable this to happen. Clear guidelines exist which state how to interpret the service users body language to aid communication. A staff member confirmed that staff use the plans to remind themselves of how behaviours are managed once a problem subsides and then possibly reappears.
Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 11 The plans were found to be easy to understand as they were written in plain English. Information is contained within the plans as to how each service user reaches decisions and the support required to enable this to happen. Each service user is involved in the care plan review however this is lead by people who know them well, due to communication difficulties Risk assessments are also contained within the plan. These were individual to each service user and covered all aspects of life within and outside 28 Thingwall lane. All documentation was found to be reviewed regularly. A staff member stated that if staff come to the home that have not been before emphasis is put on this documentation so that the service users remain safe. Thingwall Lane, 28 DS0000021487.V263902.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): 12,13,14,15,17 Service users take part in the usual activities and recreation of daily life. Personal relationships are encouraged and supported by staff. Service users make choices from healthy options with appropriate support EVIDENCE: Two service users plans were viewed plus daily planners. Both service users respond to structure and with this in mind activities have been developed which are specific and enjoyable to each. Each receives individual staff support, which at times increases to two staff according to the activity and risk. The plans contain information on “working and recreation”- One service user is regularly meeting with a job trainer to build up rapport. The aim is eventually that this service user will undertake employment outside the home. Both service users are encouraged to take part in the usual domestic tasks involved in running a home. This is within a risk assessment framework. A section exists within the plan detailing education skills and abilities, use of money, awareness of shape, colour size etc. This helps to identify abilities and monitor progress.
Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 13 One service user is a member of a local video library. Both are registered with local G.Ps. Each service user regularly shops at local shops and one takes part in the weekly food `shop at bigger stores. Daily planners show that at times activities tend to be repetitive. A member of staff stated that the manager of the home is very aware of this and during staff supervision will ask staff for new ideas to develop activities further. Each service user has family contact with visits for one service user on the increase. Staff provide support with these visits as they are recognised as very important to the service users. Staff are supporting one service user to re establish a relationship with another service user that they used to live with as this service users development has progressed and they are more outgoing. Each service user has clear guidelines regarding their expression of sexuality in their plan of care. During observation it was observed that both service users were encouraged to choose food of their choice. Supporting the service user to choose food from the fridge or freezer does this. Staff encourage appropriate choices to be made. Menus exist and `staff record the meals chosen by service users. Staff have recognised that service users identify food by packaging and are in the process of developing a file of these to further promote choice. Both service users have their weight regularly monitored. One service user is supported to eat a special diet in line with their to cultural beliefs Thingwall Lane, 28 DS0000021487.V263902.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): 18,19 . Service user receive personal care as they prefer. Service users health and emotional needs are met EVIDENCE: Two care plans were viewed which showed staff have recorded in detail how service users make choices regarding personal care. Staff are familiar with the service users behaviour so are very aware if they are unhappy with a situation. Staff are also very familiar with service user abilities regarding washing and dressing and clear guidelines exist to promote independence. Both service users are registered with local G.P s and access services at Olive Mount resource centre. Each plan contains a list of the service user medical needs and support required to meet these. One service user is undergoing surgery in December; plans have already been developed as to how they will be supported with this. A new document titled” My Health” has been introduced to the plan of care. This is used to record Doctors, dentist, optician, and chiropodist visits. This also includes how to support service users with nutritional needs and details of any special aids required. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 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): EVIDENCE: No standards were assessed from this section on this occasion. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 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): 24,25,30 Service users live in a comfortable home and have bedrooms that are individual to them. Greater support is needed in some areas to keep the home clean and free from smells. EVIDENCE: A tour of the environment was undertaken .A staff member accompanied and discussed progress The bathroom was viewed. One wall tile was broken and the grouting to the tiles appeared dirty. The floor area around the toilet was worn and cracked and this area smelt unpleasant. Other wise the bathroom fittings were clean and tidy. Both service users bedrooms were viewed. Both were individual to the tastes and needs of the service users. It had been identified by the manager that the blind to one bedroom window was broken and a repairman had called to view this. A new bed has been purchased for this room since the last inspection. Communal areas were found to be decorated to a good standard and the home presented as a comfortable place to live The grouting of the tiles in the kitchen appeared dirty. Otherwise the room presented as clean with adequate storage. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 17 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): EVIDENCE: No standards were assessed from this section on this occasion however on the day of the visit both service users were receiving one to one support. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The service users lives in safe home EVIDENCE: Records were viewed which showed staff are monitoring the temperature of the water. . Viewing certificates showed that staff have been trained in First Aid and a member of staff has been identified as a first aid officer. Viewing fire records showed that the fire alarm is tested weekly and that a practise evacuation takes place every three months. Staff have received training in this subject. The home is equipped with an emergency lighting system and fire extinguishers which are monitored under service contracts. A fire risk assessment was in place but this was dated August 04. All portable appliances viewed had current safety stickers attached. A current gas and electrical safety certificate was viewed. No new risks to Health and safety were identified when touring the environment. Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 19 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 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 X X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Thingwall Lane, 28 Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000021487.V263902.R01.S.doc Version 5.0 Page 20 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. 1 Standard YA30 Regulation 23(2)(b) 16 (2)(k) Requirement The manager must ensure that maritime housing address the smell around the toilet in the bathroom by replacing the floor and that the grouting to the wall tiles in the kitchen and bathroom is steam cleaned. The missing bathroom wall tile must also be replaced. The manager must ensure that the fire risk assessment is reviewed and updated as necessary. Timescale for action 31/01/06 2 YA41 23 (4)(c)(v) 31/12/05 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 YA14 YA17 Good Practice Recommendations The manager should continue to explore further activities for the service users. The manager should follow through her intention to laminate food labels to provide further menu choice Thingwall Lane, 28 DS0000021487.V263902.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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