CARE HOME ADULTS 18-65
Thistle Close (24, 30 & 33) 24, 30 and 33 Thistle Close St Peter the Great Worcester Worcestershire WR5 3DP Lead Inspector
Christina Lavelle Unannounced Inspection 11th January 2006 03.30 Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 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 Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 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. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Thistle Close (24, 30 & 33) Address 24, 30 and 33 Thistle Close St Peter the Great Worcester Worcestershire WR5 3DP 01905 611147 01905 612958 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) SCOPE Mr Andrew Joseph Deakin Care Home 6 Category(ies) of Physical disability (6) registration, with number of places Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The Home may accommodate no more than 1 resident in 24 Thistle Close, 3 residents in 30 Thistle Close, 2 residents in 33 Thistle Close The Home is primarily for people with physical disabilities but may also accommodate people with associated learning disabilities. The home can accommodate one named person in the category PD/E Date of last inspection 5th July 2005 Brief Description of the Service: The service provider of 24, 30 & 33 Thistle Close is SCOPE and the home is part of the scheme 1st Key Worcestershire, set up in 1993. The properties are owned by a Housing Association and leased to SCOPE to run as a care home. The home consists of three seperate bungalows, which are close together in a cul-de-sac. It is situated on a large modern housing estate, a couple of miles from Worcester city centre. This is convenient for access to the cities facilities and services as the home provides two adapted vehicles for transport. There are also local facilities nearby such as a large supermarket, shops and pubs. Thistle Close offers accomodation with personal care to six adults (men and women). Service users must require care due to cerebral palsy and/or similar physical disabilities and may also have an associated learning disability. The main aim of the service is stated as being to support the people living there to empower them to live an independent life and be part of the local community. One of the bungalows is for three service users (30), one is for two (33) and the other for just one person (24). Service users have single bedrooms, none of which have en-suite facilities. Each bunglow also has a kitchen/dining room, a sitting room and there are assisted showers and bathrooms for everyone to use. Various aids, adaptations and equipment are provided (some to meet individual’s needs) such as hoists, overhead tracking and wheelchairs. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out in just over two hours in the late afternoon on a Wednesday in winter. The main aim was to obtain an impression of service users’ lives at Thistle Close from observation and by talking to service users and staff on duty. For more detailed information about the home you should also read the report made following the inspection undertaken on the 5th July 2005, as this was a fuller inspection of the service. Two of the bungalows were visited and several service users were spoken with privately about the support they receive at the home and how they spend their time. Staff were open and helpful with the inspection process. Their training, the home generally, service users and their care were discussed with them. Some records were looked at and all the correspondence and/or contact with the home since the last inspection was taken into consideration. This included notifications of events affecting the home and service users. Also reports from the provider following their monthly visits to check how the home is running. What the service does well: What has improved since the last inspection?
One service user was now doing a college course to develop their life skills. Some work had been carried out in one of the bungalows, in particular new flooring had been fitted which was much more practical and looked nicer. The staffing situation was more stable which meant that agency staff were not being used very often. This is good as contracted staff are likely to know the service users and their needs better and also to provide more consistent care.
Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 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 Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 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): EVIDENCE: These Standards are not assessed because no new service users had been admitted to the home since the last inspection and there were no vacancies. The two newest service users had settled in and said they were happy to be living at Thistle Close in their own bungalow. Staff provided them with support as flexibly as was feasible, whilst at the same time monitoring their situation and letting them have as much independence as they want and could manage. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 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): EVIDENCE: These Standards were not fully assessed. However it was previously confirmed that all service users have a care plan containing some details of their assessed care needs and how staff and the service should help to meet them. One service user’s care records were looked at briefly. As well as their plan there was information about their daily routines and a risk assessment of the support they need with moving and handling. A community care assessment of this person’s needs had been completed just before their admission to the home. This staff said was to be reviewed soon by the funding local authority with the home, as the service user will have been living at the home for a year. Keyworkers from the staff team are allocated to particular service users, which can make the support given to them more personal. Staff said that as keyworkers they were involved in the care planning and reviewing process, in consultation with their allocated service users. This “person centred” approach should be reflected in the care planning system. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 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 the following standard(s): 12, 14 & 15 Service users were being enabled to take part in appropriate leisure and other activities and staff supported them to maintain links with their families. EVIDENCE: Service users had their own package of support for their chosen activities. One service user had recently enrolled on a course at the local college. Staff time was also arranged flexibly to facilitate their social and leisure activities, such as shopping and going to the local pub. One service user has their own car and the home also has adapted vehicles to provide them with transport. It is good that service users choose their own meals and mealtimes. One service user said they managed their own food budget and that staff supported them to do their food shopping. Staff were observed preparing this evening’s meal and all the service users chose and received what they wanted. Staff also gave each individual any assistance they needed with their meal. One service user discussed their regular contact with and holidays spent with their family. Some had their own telephones and staff helped them make calls.
Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 11 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): EVIDENCE: These Standards were not fully assessed. However it was previously found that suitable arrangements were in place to ensure service users’ personal and health care needs were met appropriately. Service users said that staff continued to provide the support they needed. However, although they had some flexibility in their daily routines this was to some extent affected by staff availability, due to some people’s disability and so high dependency on staff for their physical care. Staff confirmed this had been discussed and agreed with the service users. One service user’s care file included information about their physical condition, health and any medical input and routine check ups were also being recorded. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 12 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: These Standards were not reviewed in this inspection. However it was previously confirmed the home provides a suitable complaints procedure and that SCOPE provide policies and procedures for the protection of service users. There had not been any complaints raised with the Commission about the service since the last three inspections of the home. One matter had been appropriately referred by the home through the interagency Protection of Vulnerable Adults procedures. Relevant people had been involved and staff were now monitoring the situation. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 13 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 & 29 Overall the accommodation is suitable and aids, adaptations and equipment are provided to meet the special needs of service users. The quality of the environment would be improved (and so be nicer for service users) when work planned to decorate and upgrade some aspects is completed EVIDENCE: Thistle Close is conveniently located and provides ordinary housing, which is compatible with the local community and so promotes service user’ integration. Appropriate aids, adaptations and equipment are provided (such as hoists, overhead tracking and wheelchairs) to promote service users’ independence and to allow staff to assist them as safely as possible. Bungalows 30 and 33 were seen and although homely and comfortable overall some parts did look rather shabby and/or cluttered. Although new flooring had been fitted in one sitting room the kitchen still needed upgrading and the spare room was full of old furniture etc. The paintwork and walls in the communal areas of the other bungalow were scratched and frayed. Also an armchair was ripped, the sofa covered with a throw and in the bathroom mops and buckets were kept out on display.
Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 14 The Housing Association retain some responsibility for structural repairs and internal fittings of the properties. They apparently intend to replace two of the kitchens soon. Staff also discussed the home’s plans for a conservatory to be built onto the sitting room in bungalow 30, funded from voluntary donations to the service. This will be beneficial, as it will provide extra space for the three people living there. It is also intended to put up a shed, which would be used to store equipment and spare furniture etc. and so free up space inside. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 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 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: None of these Standards were fully assessed, although the following information was obtained. There were two staff on duty when the inspector arrived, including the deputy manager. When she left another support worker had started their shift, and one of these staff was to be sleeping in tonight on-call. Staff said they felt this level was sufficient for them to meet the service users’ needs. There were two staff vacancies at this time and one person on long-term sick leave. However the home now employed its own relief staff who were working regularly and so agency staff were only very occasionally being deployed. It is positive that the staff situation was more stable as agency staff are less likely to know the service users and their needs as well. The ongoing use of agency staff can also be unsettling for service users and affect the consistency of care. Two new relief staff had been employed since the last inspection. The deputy manager confirmed they were currently doing the SCOPE induction programme which is an accredited scheme for staff who care for people with disabilities. One staff member on duty had completed all the required health and safety training and was currently doing NVQ level 3.
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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): EVIDENCE: These Standards were not reviewed in full, although the management arrangements for the home had not changed. The manager has responsibility for all 1st key services in Worcestershire and a deputy manager supports team leaders (who are based at the homes) in the day-to-day management. Since May 2005 only four reports had been received by the Commission from a representative of the provider organisation (SCOPE) as is required. No health and safety hazards were identified during this inspection. The fire log was also looked at and all the required tests and checks on the fire safety system and equipment were recorded as having been carried out at the specified intervals. Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X X X X X X X Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions that must be taken so that the registered person meets the Care Standards Act 2000, the Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider must comply with the given timescales. No. 1 Standard YA24 Regulation 23 Requirement Upgrading must be undertaken to improve the quality of some aspects of the environment. The work needed should be recorded in a planned renewal programme for the fabric and decoration of the premises. This was a requirement from the last inspection of the home and is carried forward with an extended timescale. Monthly visits to the home must be made by the provider to monitor the standard of care. A report must then be made about the conduct of the home, a copy of which is supplied to the CSCI. Timescale for action 30/06/06 2 YA43 26 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1 YA6 Further development of assessment and care planning is needed to ensure that all aspects of service users’ needs and personal goals are reflected in their plans. 2 YA7 Not reviewed in this inspection and so carried forward. A more “person centred” approach to assessment and care planning should be introduced. Not reviewed in this inspection and so carried forward.
Thistle Close (24, 30 & 33) DS0000018693.V277094.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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