CARE HOME ADULTS 18-65
York Road, 73 73 York Road Southport Merseyside PR8 2DU Lead Inspector
Mr Paul Kenyon Unannounced Inspection 13th February and 15th March 2006 13:00 York Road, 73 DS0000005271.V282792.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 York Road, 73 DS0000005271.V282792.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. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service York Road, 73 Address 73 York Road Southport Merseyside PR8 2DU 01704 567592 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) Speciality Care (Rest Homes) Limited Mr James Michael Delaney Care Home 5 Category(ies) of Learning disability (5) registration, with number of places York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 5 LD Date of last inspection 31st October 2005 Brief Description of the Service: 73 York Road is a registered care home offering support for five younger adults with a Learning Disability. The home is managed and operated by a subsidiary of Craigmoor Care known as Speciality Care Limited. The home is designated as a ‘Home for Life’ and former students using the educational facility at Arden College in Southport live there The home is a semi-detached property within the Birkdale area of Southport. It is close to local shopping facilities and other amenities. The home has not been purpose built yet has been adapted to become registered by the previous Registration Authority. Jim Delaney who has worked there for a number of years manages the home. Facilities are spread over four levels. The basement contains the office; staff sleep- in facility and laundry. The ground floor includes two lounges, a dining room combined with a kitchen. On the remaining two floors are bathrooms with toilets as well as all service user bedrooms. The address does not cater at resent for those with additional physical disabilities and as a result contains no specialist adaptations or passenger lift. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection to be held this inspection year (April 2005 to March 2006). The inspection took place over two days and was unannounced. The first day of the inspection included discussions with four residents, a tour of the premises, discussions with staff and an examination of records. The second part of the inspection was announced and involved discussions with the Registered Manager. In total the inspection lasted three hours. National Minimum Standards for Younger Adults were used to measure the quality of care offered by 73 York Road. The nature of the disability of residents is such that direct quotes are not always possible rather ‘yes’ or ‘no’ responses to questions. Comments have been included as far as possible in this report. What the service does well:
The service is good at ensuring that the hazards faced by residents through daily living are taken into account and minimised. The service is good at fostering and maintaining family contact for residents and in sustaining any relationships they have in the wider community. The service is good at providing a choice of meals for residents and enabling them to be involved in the planning of menus and the preparation of food. The service is good at providing personal support to residents through prompting them to maintain personal hygiene needs, enabling them to make decisions about their appearance and in providing a keyworker system. The service is good at meeting the health needs of residents. The service is good at maintaining a clean and hygienic environment for its residents. The service is well managed by an individual who has the necessary experience to fulfil the role and has been provided with a job description relevant to the post. Comments from residents included:
York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 6 ‘I am alright’ ‘I don’t like it here, I want to live with my girlfriend’ ‘I like the food here’ ‘I do hoover’ ‘I have a key to my room’ ‘I get up when I want, I go to bed when I want’ ‘I like staff here’ ‘I like the food here’ ‘Staff do all the cooking’ ‘I like staff they listen to me’ ‘Staff are helpful and so is my keyworker’ ‘I see my dad’ ‘I like the food’ ‘I do cooking’ ‘I hoover up and mop and clean’ ‘I don’t like getting up sometimes’ What has improved since the last inspection?
Although care plans were not directly assessed on this occasion, the Manager was able to show the Inspector how care plans have been made more accessible to residents. All residents have now got information in their bedrooms on prominent display that is unique to them and outlines a variety of aims that they want to achieve in their daily lives. These aims include aspirations they have in the short and long term, education and occupation, cultural needs, maintaining family links and activities. Photographs have been included and one resident confirmed that he was having some photographs developed the next day to add to the board. Three plans were evidenced and another resident confirmed that there was one in his bedroom. One resident stated that he was happy to have this in his room. This represented an ongoing process to make care plans more accessible to residents and increase their involvement with them. Two requirements have been addressed since the last inspection. One requirement related to a carpet in one bedroom that was beginning to become loose and represented a trip hazard. This has now been secured. Another requirement related to the work status of one member of staff. This has also been addressed. Although not an improvement since the last inspection, it has been noted over the past twelve months that the staff team has now stabilised and is a consistent group of people. Feature of previous inspections noted that the staff
York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 7 changed and that consistency when needed could not be provided. This has improved and now a stable staff team has been achieved. 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. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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 York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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): None of the standards in this section were measured. Standard 2 is not applicable at the moment because no new residents have been admitted since the last inspection. EVIDENCE: York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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): 9. Standards 6 and 7 were measured at the last inspection and were met. Residents are supported to take risks to pursue routines within the home and activities in the wider community. EVIDENCE: There are five residents living at York Road. Risk Assessments relating to all individuals were examined. All of them had been reviewed within the past six months with some having been reviewed earlier this year. In all cases, areas of risk are identified and these relate to the individual needs of residents. One risk assessment is particularly detailed and this reflects information that is outlined within the person’s care plan especially when in the local community. The assessment stresses the need for staff support when the person goes out and this was borne out by staffing levels noted on the day of the inspection and the staff rota. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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): 15,16 and 17. Standards 12 and 13 were measured at the last inspection and were met Residents are able to maintain family relationships and other friendships. Residents do not benefit from unrestricted access to all areas of the home excepting others bedrooms. Residents should be given the opportunity to be involved in daily routines in the home. Residents are offered a healthy diet with choices and the opportunity to plan and prepare meals with supervision. The kitchen units should be replaced. EVIDENCE: Details of the levels of contact residents have with families and relations were evidenced through records. These indicated that all residents maintain contact with their families and also have the opportunity to visit them or to stay with them on a regular basis. One resident has had an intimate friendship with an individual for some time. The individual stated that he was unhappy in the home yet this was mainly because he wished to share accommodation with this individual. Evidence was presented to suggest that discussions have been held with both parties to determine their wishes. The same individual confirmed that they are able to meet with this person on a regular basis and the relationship continues.
York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 12 Discussions between staff and residents noted that they were reminded that they could only enter each other’s bedrooms with the person’s permission. All have been issued with keys although these are not always used. One person consistently prefers his room to remain unlocked when not in use and this has been noted on previous inspections. Staff were noted to interact well with residents and maintain an informal and supportive stance. On many occasions, residents were able to pursue their own activities or to remain as a group. One person spent most of his time in his room and this appeared to be a common routine for him during the afternoon. There is an expectation that residents participate in daily household tasks. The Manager seeks to avoid imposing routines on residents in a rigid manner and recent supervision records for all staff evidenced this. In these sessions the Manager has sought to reinforce the need for a home-like atmosphere to the service rather than imposition of structure. At the same time there did not appear to be evidence that involvement in tasks is equal offered to all individuals. It is recommended that this be developed. All residents who spoke with the Inspector confirmed that they were able to get up when they wanted unless they had to pursue some activity and go to bed as they wished. At some points during the first day of the inspection, the kitchen was locked. No evidence was available to suggest why this was the case. It is required that this restriction is either stopped or that some justification for this restriction is formally provided and evidenced. The kitchen is domestic in scale although a recommendation from the last report about replacement of wall and base units remains. A menu is available and this serves as a record of food provided. Residents confirmed that they helped with shopping and in some cases are able to help in the preparation of meals. This was backed up by care plans. A dining area is available near to the kitchen. All residents are independent in eating and require no assistance. There is evidence that meals out are a regular feature. A meal out for the evening of the second day of the visit to celebrate one resident’s birthday and a menu was provided to evidence this. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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 and 19.Standard 20 was measured at the last inspection and was met Residents benefit from having the opportunity to decide how they wish to be supported and to maintain their wishes. Residents have their health needs met. EVIDENCE: No resident receives direct and intimate personal care. An emphasis is made through care plans on the independence of residents in dressing and maintaining their own personal hygiene although it was clear that staff have a role to prompt individuals to achieve this were necessary. Out of the five individuals who live at York Road, one is female. She has been provided with a female keyworker. Discussions with one resident noted that he had grown a beard since the last inspection. He said that he had wanted to do this and had been supported in making this decision about his personal appearance. All residents have a keyworker. The information about keyworkers is presented in the form of photographs located in the hallway so that residents are aware of who is their keyworker. This role had been reinforced through staff supervision and was evidence through an examination of records. An agenda for the next resident meeting was on display and this was to take place in the last week of March.
York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 14 The Manager reminded one resident that the issue of keyworkers was to be discussed and that residents’ satisfaction with their keyworker would be discussed. Records indicated that the health needs of residents are met. A daily diary is available outlining when appointments were due. These indicated that individuals had had the opportunity to attend dental, doctor and chiropody appointments since the last inspection in October 2005. Any outcomes of these visits are then included on an ongoing record maintained by the Manager. The second day of the inspection coincided with one resident attending his Doctors concerning an ongoing health issue. On their return, the Manager was able to discuss how the visit had been and any outcomes with the individual in an informal manner. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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): No standards in this section were measured given that standards 22 and 23 were measured at the last inspection and were met. EVIDENCE: York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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): 30. Standard 24 was measured at the last inspection and was met. Residents benefit from a clean and hygienic environment. EVIDENCE: A tour of the premises noted that the home was clean and hygienic. No offensive odours were detected. A laundry facility is available and this uses domestic appliances. This is located in the basement and is separate from food preparation areas. The needs of residents at present are such that there is no need for clinical waste facilities. Specialised flooring has been provided in one person’s bedroom to reflect a need that he has and this aids with general cleaning. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 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): 32 and 35. Standard 34 was measured at the last inspection and has now been met. Residents benefit from a staff team that they feel comfortable with. Residents do not benefit from a fully qualified staff team and do not have their needs fully met with the limited training provided by the organisation EVIDENCE: Residents were asked about their views of the staff team. All remained positive and were able to identify their keyworker using the photographic display in the main hallway. Staff were noted on both days of the visit to be interacting with residents in a supportive manner. Only one member of staff has attained NVQ Level 2. This was confirmed by training records but this leaves a further six staff who have yet to obtain this qualification. All have commenced this qualification this but the NVQ assessor used to support staff can no longer provide support to these staff. This has also affected the Manager’s attaining of the Registered Managers award. It is required that the organisation identifies another provider in the timescale identified in this report. Training records noted that training offered by the organisation was limited to statutory training although there had been training in abuse awareness and the management of challenging behaviour. A requirement is raised that
York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 18 training should be widened to include reference to training on awareness of the needs of residents. This requirement is raised while the NVQ qualification is yet to be completed and in order to assist in staff to better meet the needs of residents and to have the evidence to complete the qualification. Training in mandatory topics has not been fully completed by staff and this is outlined in Standard 42 of this report. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 19 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 and 39. Standard 42 was measured at the last inspection and has now been met. Residents benefit from a well managed service. The quality of the service provided to residents is not fully assessed by the organisation. The health and safety of residents is still not fully promoted. EVIDENCE: The Manager has been running this service for some time now and has the experience to fulfil this role. The Manager’s attaining of the Registered Managers Award has been affected by the situation with the NVQ Assessor. The Manager has a job description that is up to date and outlines his responsibilities under the Care Standards Act. The Manager continues to fulfil this role with evidence of, for example, developing care plans for residents as well as facilitating residents meetings. The Quality Assurance of the home is not completely adhered to. The Manager has not been receiving reports arising form visits by a representative of the organisation. This is raised as a requirement in this report. Other quality
York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 20 assurance issues include questionnaires to families and it was evidenced that these had been recently sent out in order to gain their views. The Manager also seeks to maintain residents meetings as a meaningful forum for residents to be informed of issues that affect their lives as well as making contributions. The completion of statutory training in health and safety issues was raised as a requirement at the last inspection and had not been addressed. This is raised as a requirement in this report and was evidenced through training records. York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 21 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 X 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 3 X 2 X X 2 X York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 22 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 Standard YA16 Regulation 12 Requirement The practice of locking the kitchen when not in use must cease or be justified by evidence of reasons for this restriction. A new provider of NVQ qualifications must be identified to enable 50 of staff to achieve at least NVQ Level 2 Training must be broadened to include training linked to the needs of residents Copies of reports completed on a monthly basis by a representative of the organisation must be made available to the Manager Statutory training must be consistently completed for all staff Timescale for action 31/03/06 2 YA32 18 30/04/06 3 4 YA35 YA39 18 26 30/06/06 31/03/06 5 YA42 13 31/05/06 York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 23 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 YA16 YA17 Good Practice Recommendations Evidence should be produced that all residents have the opportunity to be involved in daily routines The kitchen wall and base units should be replaced York Road, 73 DS0000005271.V282792.R01.S.doc Version 5.1 Page 24 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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