CARE HOME ADULTS 18-65
Victoria House 63 Victoria Road Chester Cheshire CH2 2AX Lead Inspector
Mr Val Flannery Key Unannounced Inspection 8 and 13 November 2006 02:00 Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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 Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Victoria House Address 63 Victoria Road Chester Cheshire CH2 2AX 01244 382897 01244 381773 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) www.macintyrecharity.org MacIntyre Care Mr William Parker Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. This home is registered for a maximum of 6 service users in the category LD (Learning Disability) 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 must comply with any guidance which may be issued through the Commission for Social Care Inspection 14th November 2005 Date of last inspection Brief Description of the Service: Victoria House is a large two-storey detached building with a passenger lift to the first floor. The home supports six adults with a learning disability. Located in Chester the home is within walking distance of the city centre and other local amenities. All the service users are physically able and can move about the home without mobility aids. The bedrooms are single; five of them are on the second floor of the main building. An adjacent building has been adapted to provide a self-contained flat for one service user. Two of the bedrooms have en-suite toilet and bathing facilities. The home provides a communal bathroom and toilet on the ground floor and two toilets, a bathroom and shower on the second floor. Staff are on duty twenty-four hours a day to deliver care to service users. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced visit took place on the 8 and 13 November 2006 and lasted 5 hours. Val Flannery, Regulatory Inspector, carried out the visit. The visit was just one part of the inspection. Before the visit the registered manager was also asked to complete a questionnaire to provide up to date information about the service. Questionnaires were also made available for service user’s, families, health and social care professionals to find out their views. Other information received since the last inspection was also reviewed. During the visit various records and the premises were looked at. A number of service users and staff as well as the registered manager were spoken with and they gave their views about the service. Information provided by the manager showed that fees range from £332.27 to £750 36. Further information about fees and other costs can be obtained from the manager. What the service does well:
The pre-admission procedure, that includes the statement of purpose and service users guide, is available for prospective service users and their families. This will help prospective service user’s and their representatives by providing information about the service and will also help them make an informed choice about the home. There is a range of information available about service users that show their individual needs have been identified and plans are in place to meet these needs. Risk assessments have been carried out that show how service users can be best supported in the home and in the local community. These also ensure the service users are enabled to choose how they live their daily lives whilst at the same time maintaining their safety and independence. Service users are encouraged to make decisions about their chosen lifestyles, for example, where they spend their leisure time in the home, when they have their meals and make full use of available activities. Relatives are able to visit the home as they wish and are kept informed of events/accidents/incidents that affect service users. Service users’ have access to a range of health care services and are supported by staff or relatives when visiting the medical centre or hospital. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 6 The complaints procedure has been provided in a format that makes it easier for service user’s to understand. The location of the home makes it easily accessible for relatives and other visitors. Two service users, three relatives and one care manager/placements office comment cards were returned. Comments included: • • • The home is very nice I am very happy at Victoria House and the staff are very nice people In my opinion Will Parker (Registered Manager) bends over backwards to please and accommodate residents, family and friends at Victoria House 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. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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 Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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): 2/3/4/5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to able to visit the home and meet other service user’s and staff before making a decision about moving in. EVIDENCE: The service user who has recently come to live in the home was spoken with during the visit. He said he was able to visit the home before making a decision about moving in. This included visiting to have meals with the other residents and overnight stays. The records seen showed that the care manager from the placing authority provided an assessment of the service user’s needs. The service user said he ‘liked living in the home’ and that he is able, with staff support and guidance, to be as independent as possible. He also said he prefers living with other people as his previous placement involved living in a flat. A copy of the placement agreement between the service user and MacIntyre was seen during the visit. Other service user’s spoken with talked about their routines and how staff help them do the things they want to do, for example, plan holidays, attend collage courses and attend social events in the local community. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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): 6/7/8/9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The views of service users, on how their individual needs are to be met, are central to the way the home operates. EVIDENCE: Two service user records were seen during the visit, one of a service user who has lived in the home for sometime and these of the service user new to the home. The service users and staff on duty were also spoken with. The service user who has lived in the home for some time was able to discuss the contents of his file including his person centre plans, risk assessments and programme of activities. Also included were daily entries, written by the staff, of the service user daily routines and significant events. Although there was a range of information about the service user new to the home this has not being included in person centred plans. Risk assessments were not available on the service user to show how his well-being and safety are to be monitored, both whilst in the home and in the community. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 10 During the visit staff were observed talking with service users and responding to their requests for assistance with personal and social care tasks. Services users are encouraged and supported to take responsible risks, for example, using community facilities without staff supervision, helping with meals, managing their finances and crossing busy roads. Staff said that central to helping service users be independent is to encourage them to take such risks. The staff spoken with were aware of the capabilities of service user and are also able to recognise when individual service user’s require additional support. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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): 12/13/15/16/17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user’s daily routines are individually geared to ensure they are able to maintain fulfilling lifestyles, both in the home and in the local community. EVIDENCE: The service users spoken with said they are able attend day care centres, collages courses and employment opportunities where appropriate. They also said that the staff would encourage and support them but that they like to do as much for themselves as possible. On the day of the visit service users were seen returning from various community-based activities, for example, helping in a charity shop. Also two service users were seen leaving the home unescorted to visit local shops. Staff spoken with were aware of the rights and responsibilities of service users and, in their roles as support staff, they offer support and encouragement so that service user’s have control over their daily lives. Staff were seen helping a service user with dressing and supporting service user’s to prepare their
Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 12 evening meal. Service users said they could choose what they want to eat, a number said they are able to prepare their own meals without staff help. One service user continues to receive guidance from staff, and other professionals, with her personal relationship with a former service user who is now living independently. The manager said there are issues that are causing concern and that the service user is receiving support to ensure she retains her independent living skills. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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): 18/19/20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user’s receive support with their personal and healthcare needs in a way they prefer. This helps ensure their wishes and choices are respected. EVIDENCE: Service user’s spoken with said staff ‘help them with their problems’. One service user said he ‘knows he cannot do everything by himself’ and that staff ‘do things for him when he asks them’. Another service user, recently moved into the home, said staff ‘are great’ and that he likes having people around just in case he needs help. All the service user’s said they could approach staff at any time for help with any problems or ‘just to talk to’. The person centred plans and risk assessments, for one of the service user’s, show that his preference on the level of support he needs have been recorded. The service user was able to discuss the contents of his personal file. Although service user’s have differing levels of capabilities all are able to move about the home without staff assistance. Records were seen that showed service user’s healthcare needs are meet including visit to doctors surgeries and that they are supported by staff to attend hospital appointments. Service user’s said they ask to see the doctor if
Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 14 they are not feeling well. Also seen were records that showed that other healthcare professionals are consulted as necessary. Wherever possible individual service user’s are enabled to managed their medication. During the visit a member of staff was seen administering medication to a service user. MacIntyre have provided policies and procedures for staff on the administration of medication to service users. The record of medication administered to one service was seen during the visit, this was satisfactory. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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): 22/23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory procedures are in place to ensure service users are protected from abuse. Service users, and other visitors to the home, have access to a complaints procedure that enables them to raise issues of concern. EVIDENCE: A copy of the complaints procedure is available in the home. Details on how to contact the Commission for Social Care Inspection are included in the procedure. The manager and staff spoken with said the home has not received any complaints since the last inspection. A copy of the complaints procedure has been provided in picture format that makes it easier for service users’ to understand. The Commission for Social Care Inspection have received a letter from Chester & Ellesmere Port Independent Advocacy service in which concern was express about manner in which a former service user had left Victoria House. The issue raised was referred to Cheshire County Council contracting/commissioning department. MacIntyre have provided an Adult Protection Procedure, a copy of which is kept in the home. Included in the procedure is a copy of the government guidelines ‘No Secrets’. Staff spoken with said they knew about the complaints and adult protection procedures and what to do if a problem arose. They said they would refer any concerns to the senior member of staff on duty. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 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): 25/26/27/28/30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient private and communal space is provided to meet the needs, and suit the lifestyle, of the service users. EVIDENCE: The home provides service users with a homely and comfortable environment. Decoration and furnishings are of a high standard, maintenance issues are addressed promptly. Service users said they are satisfied with the appearance of the home – both inside and out. Since the last visit the following internal improvements have been carried out: • Dining re-carpeted and redecorated • New lounge furniture including settee • New gas fire in the lounge Service user’s said they had chosen the décor and furniture. The bedrooms seen were individually decorated and furnished. Services users, including the most recent admission, said they had been involved in choosing the décor and furniture in the rooms. Service users were seen moving freely
Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 17 between their bedrooms and communal area. All the service users have keys to their bedrooms. This helps promote their independence. The home provides a comfortable lounge and separate lounge/dining room, these are located on the ground floor. Beside the two en-suite bathing and toilet facilities a bathroom and toilet is provided on the ground floor and a bathroom/shower/toilet on the first floor. The self-contained flat provides bathing and toilet facilities. Service users are able to use the well-maintained gardens to the front and rear of the home. On the day of the visit contractors were working on the gardens. On the day of the visit the home was clean and free from unpleasant odours. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 18 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): 31/32/33/34/35/36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by staff that are aware of their assessed needs and how these needs are to be met. EVIDENCE: Two staff were spoken with during the visit. They confirmed that they receive individual supervision from the manager. They also said they have access to a range of training opportunities provided by MacIntyre. Training records seen showed that the following courses are provided for staff: administration of medication updates, health/safety, risk assessment, fire awareness, first aid, manual handling and POVA. Staff also said they receive support from the registered manager and senior support worker. The pre-inspection questionnaire showed that five staff have achieved an NVQ. In discussion with staff they confirmed that it is the policy of the organisation that all staff achieve an NVQ as part of their on-going development. The information provided by the manager in the pre-inspection questionnaire showed that six staff have obtained an NVQ in Care. An agreement has been reached between the Commission for Social Care Inspection and MacIntyre on a format for maintaining staff details in the home. The staff records seen during the visit were satisfactory. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 19 During the visit staff were seen caring for service users and offering them support and encouragement. Service users were seen communicating their needs to staff and were comfortable in approaching staff for assistance with personal care. Staff said they are made aware of their roles and responsibilities to service users. The staffing rota showed that there are occasions when there is only one member of staff on duty. Arrangements are in place for other MacIntyre homes in the area to provide additional support in the event of an emergency. MacIntyre have also provided a risk assessment on lone working, a copy of which was seen during the visit. One of the service users spoken with said he is involved in a project whereby the needs of service user’s and how they wished to be supported are to included as part of staff recruitment. Other service users within MacIntyre are also involved in the project. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 20 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): 37/39/42/43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall management of the home is good and is geared to improving the quality of life for the service users. EVIDENCE: Service user’s spoken with said the manager, and support staff, talk with them about issues/changes in the home. For example, the re-decoration and refurnishing of the communal areas was discussed with them and they were involved in choosing the furniture and colour scheme. They also said they are involved in projects, organised by MacIntyre, where their views are sought on how the organisation can best meet their needs. For example, one service user is part of a group that is developing a procedure that will be part of staff recruitment within MacIntyre. During the visit staff were spoken with about the overall management of the home and the support they receive from the manager. They said the manager is supportive and offers advice and guidance on issues that may arise. They
Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 21 also said that meeting service user’s needs is ‘what there are about’. Because the manager, and a number of support staff, are experienced and have worked in the home for a number of years they are committed to continually improving the quality of care offered to service users. A copy of the action plan for the home for 2006 was seen during the visit. MacIntyre have provided an equal opportunities policy, a copy of which is included in individual staff development files. MacIntyre have set out their corporate Health and Safety Objectives for 2006/07, a copy of which was available in the home. Fire safety and portable appliance test records were seen during the visit and were satisfactory. A maintenance contract for the passenger lift was also seen. The manager also confirmed that ‘brushes’ have been replaced on fire doors and that new thermostatic controls have been put on radiators. A record of the monthly visits, carried out by a manager from the organisation, are sent to the Commission for Social Care Inspection. The manager said that families and advocates are consulted about the service offered at the yearly reviews. The Commission for Social Care Inspection received a letter from Chester & Ellesmere Port Advocacy service in which they questioned the situation with regard to the ownership of the home. During the visit the manager was spoken with about the conditions of ownership. Although MacIntyre are responsible for the overall running and management of the home they are not the owners. Victoria House is owned by one of the service users parents who rent the home to MacIntyre. The manager said decisions about who comes to live in the home or who leaves the home is determined by a number of factors, for example, can the home meet the assessed needs of the service user. He said the owners of the property are not involved in this process. Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 22 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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 3 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 3 Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 23 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 YA6 YA9 Regulation 15 4 (b) Requirement The registered person must ensure plans of care are available for all service users. The registered person must ensure risk assessments are in place to ensure service user’s safety and well being Timescale for action 08/12/06 08/12/06 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 Standard Good Practice Recommendations Victoria House DS0000006548.V312845.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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