CARE HOME ADULTS 18-65
Zion House Zion House Trevellas St Agnes Cornwall TR5 0XS Lead Inspector
Lynda Kirtland Unannounced Inspection 16th January 2006 12:00 Zion House DS0000064502.V267540.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 Zion House DS0000064502.V267540.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. Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Zion House Address Zion House Trevellas St Agnes Cornwall TR5 0XS 01872 552650 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) Mrs Paula Elizabeth Stevens Mr Malcom Stevens Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14 July 2005. This was carried out with the previous registered providers. This is the first inspection with the current registered providers. Brief Description of the Service: Zion House is a registered care home providing care for eight adults with a learning disability, one of whom also has a physical disability. Mr and Mrs Stevens became the registered providers of Zion House in September 2005. They purchased the home from their parents and therefore Zion House has remained as a family run care home and buisness. Mr and Mrs Stevens have many years experience in the field of learning disability. Accommodation is provided on the ground floor with single bedrooms for 7 service users and one room is shared on a temporary bases as the homes premises are in the process of being extended. Residents have access to a lounge, dining area, kitchen and sufficent toileting facilities. Zion House is set within large grounds with facilities for residents to pursue hobbies and interests in the grounds, in workshops and greenhouses. Residents with limilted mobility or specialist equipment can access the gardens and some parts of the ground floor accomodation. Public transport to nearby towns is available to a limited degree but the home provides regular transport for anyone wanting to go out to shops or clubs etc. Residents have an active life with opportunities to be part of the local community. Conditons of Registeration: Service users to include up to 8 adults with a learning disability (LD) Service users to include up to 1 adult with a physical disability (PD) One bedroom can be used to accommodate 2 service users until 31.03.06 Total number of service users not to exceed a maximum of 8 Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Zion House Residential Home on the 16 January 2006 and spent five hours at the home. This was an unannounced inspection. Mr and Mrs Stevens were approved as registered providers for Zion House in September 2005. Therefore this is the first inspection undertaken with them as legal owners of Zion House. The registered providers were aware of the previous requirements and recommendations identified in the last report that were the responsibility of Mr and Mrs Gauge (previous registered providers). Mr and Mrs Stevens have taken these into account as they are in the process of developing the service at Zion House. The purpose of the inspection was to focus on the following key areas of care: choice of home, care planning, health care, leisure, complaints, staffing and some management areas. On the day of inspection 8 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents and the registered providers to gain their views on the services that Zion House offer. Zion House records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
Residents stated they were all ‘happy’ and ‘pleased’ that Mr and Mrs Stevens and their children are living at Zion House and are managing the home. As Mrs Stevens was previously the deputy manager at the home residents know her well, in addition they still have regular contact with the previous providers, Mr and Mrs Gauge and this has helped with the transition of the management of the home. As residents, their representatives and staff were consulted throughout this process there has been minimal disruption to the smooth running of the service that Zion House provides and minimum anxiety to those who live at, visit or work at the home. Residents all stated that Zion House provides good quality care and accommodation. They felt that they were consulted about their views of the home and listened too. They felt all their care needs are met. This was evidence by detailed care plans and a variety of documentation. Residents have appropriate access to health care. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. Residents were satisfied with the provision of food. Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 6 Residents stated that they had no issues of concern and that if they had any worries or anxieties about their care that they felt able to approach the registered providers at the home. They felt confident that any concern would be listened too and acted upon. The registered providers have ensured that residents,their relatives and staff are fully aware of the changes that are happening at Zion House, especially in respect of the 3-bedded extension to the home. The residents, relatives and staff views have been sought throughout this process. The registered provider consults with residents, their representatives, staff and external agencies that use Zion House facilities to gain their views on the service that Zion House provides. Ideas for areas of improvement or developing services are readily accepted and considered by the management team as they wish to continue to improve on the service that Zion House provides. Mrs Stevens has completed the Registered Managers Award, NVQ level 4 course. Both Mr and Mrs Stevens have previous experience in managing a small care home and are competent to manage Zion House. What has improved since the last inspection?
This inspection highlighted that since the registered providers have been in post that many positive changes to the services that Zion House have been made. The registered providers are currently in the middle of building three en-suite bedrooms for service users use. In addition they have plans to redecorate the home and are involving residents in this process. CSCI will undertake a site visit to the home in the next few months to gain an update on the progress of the extension. The registered provider has developed individual care plans, which demonstrate clearly resident’s individual needs. Daily records of events for residents have been introduced and are shared with them. Risk assessment processes for residents have been reviewed and improved clarity as to what risk is acceptable or not and reasons for this decision. Again residents are involved in this process. The registered provider has reviewed job descriptions for staff and has improved the recruitment processes. The registered provider has ensured that all appropriate recruitment checks are carried out and has implemented a detailed induction programme. The registered providers have reviewed staffing levels in the home and have concluded that two additional care staff must be employed and have arranged funding for this to occur. All staff have recently attended or due to attend mandatory courses.
Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 7 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. Zion House DS0000064502.V267540.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 Zion House DS0000064502.V267540.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): 1, Zion House has produced informative documents that explain the services that the home provides for residents and their representatives. EVIDENCE: Zion House have an informative statement of purpose / service users guide which accurately details the services that the home provides. This is presented in pictorial and written manner so that a wider audience can understand it. Zion House residents are long-term placements and therefore admission processes/ trial visits have not needed to be used for some time and are not envisaged to be needed for some time to come. Therefore this part of the standards was not inspected on this occasion. However the registered provider is aware of the necessary expectations and documentation needed in line with the national minimum standards when this situation arises and has assured this will be adhered too. Zion House DS0000064502.V267540.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): 6,7,8,9,10, Each resident is involved in the development of his or her care plan and subsequent review. Residents are encouraged to partake on the running of the home and their views on the service are continuously sought. Risk assessments are undertaken to ensure that appropriate decisions regarding care whilst ensuring that risk is minimised are taken. All information is held in a confidential manner. EVIDENCE: The registered provider has developed individual care plans that covers health and social care needs. The registered provider was aware of the previous recommendation to include the area of hobbies and individual aspirations. It was noted that hobbies are now included in the care plan and the registered provider commented that she wishes to expand the individuals aspirations section further. The care plans evidenced that residents had participated in their formation and were involved in the reviews of their care needs. Individual decision making and choice was evident from documentation and discussion with residents and the registered provider. Residents are encouraged to paricipate in the day to
Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 11 day running of the home and undertake some domestic tasks which promotes self caring skills. Daily logs have been introduced to record residents activities/ incidents which are shared with residents. Residents meetings with the registered provider are held to enable residents to voice their views on the facilities that Zion House provde, plus to discuss the current changes that are occuring in the home. Residents also have access to local advocacy services or may choose to ask their relatives to act on their behalf. The registered provider has developed risk assessments to ensure that appropriate decisions regarding care whilst ensuring that risk is minimised are taken. Residents are involved in their risk assessments, and the registered provider will seek professional advice if needed. These documents clearly identify the level of risk and what actions must be taken. They are presented in an understandable format for all who need to be aware of them in the home. The home adheres to maintaining confidentiality and all records are maintained and adhere to the Data Protection Act. Zion House DS0000064502.V267540.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): 17 A varied and nutritious diet is provided to all residents in a relaxing atmosphere. EVIDENCE: Standards 11 – 16 were not inspected in any detail. At the previous inspection it was noted that residents partake in social activities of their choosing. This was again confirmed during this inspection from discussions with residents, registered providers and documentation. Residents confirmed that they were satisfied with the provision and quality of food. Residents are involved in the development of menus within the home. No issues regarding food were rasied. Staff were aware of any special dietary needs and would contact specialist if a specific diet was needed to ensure that the home catered for this correctly. Catering staff were apporapitely qualified and aware of the responsibilities in ensuring that food was stored, prepared and cooked correctly and recorded this accordingly. Zion House DS0000064502.V267540.R01.S.doc Version 5.0 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): 18,19,20,21 The staff team have a good understanding of the residents support needs. This is evident from positive relationship that has been formed between the staff team and residents. Medication is administered safely. Resident’s health needs are identified and liaison with appropriate health professionals is undertaken. EVIDENCE: From discussions with residents and the registered provider plus documentation inspected it was evident that health needs are identified accurately and appropriate medical advice sought. Access to local health and specialist services was evident as was obtaining residents wishes and views when seeing these professionals. Health notes showed that access to health services is not a difficulty. The Monitored Dose System for administrating medication is used at Zion House. From a tablet count this tallied correctly with the medication records. The MAR sheets were completed satisfactorily, and tablets were stored and disposed of appropriately. A recommendation was made to ensure that the quantity of medication received was entered on to the MAR sheets so that auditing of medication is easier. In addition Zion House had two medication policies, the inspector recommended that these are reviewed and made into a combined policy to ensure that one document covers all medication issues. The
Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 14 registered provider agreed to address this. Staff have attended training in the administration of medicines. The registered provider has where able, sought individual wishes in the event of resident’s health deteriorating or their death. Zion House is not a nursing home and will seek support from community health colleges in these events and will review if they are able to continue to provide a placement as the individuals care needs change. The inspector advised that the homes policy is expanded especially regarding what support the home can provide and how it will involve other specialist agencies. Zion House DS0000064502.V267540.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): 22,23 The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff have good knowledge of adult protection issues, the written policy needs to reflect this. EVIDENCE: Zion House has a complaints policy, which explains how the home will investigate any concerns raised. From observations during the inspection it was evident that residents had a positive relationship with staff. Some residents said they could share their worries with staff. The registered provider is keen to encourage residents and their representatives to raise any concerns so that she can then look into them and take appropriate action. Quality assurance surveys and residents meetings are venues were views could be expressed on Zion House as well as on an individual bases. The registered provider is aware that a previous requirement was identified in respect of amending Zion House adult protection policy. The registered provider stated that she is still reviewing this document therefore advice only was given during this inspection. Zion House DS0000064502.V267540.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): 30 The home is clean and hygienic EVIDENCE: These standards were viewed as met at the previous inspection. As the registered providers are in the midst of a redecorating and extension programme the environment was not inspected in detail. The inspector toured the main parts of the home that residents use and found it to be clean and comfortably furnished. The inspector would require that in respect of infection control that paper towel dispenser is situated in the communal toilet, that the carpet flooring is replaced in the shower room to impervious flooring and that a fly screen is placed on the external door of the kitchen, as this was open whilst meals were being prepared. Zion House DS0000064502.V267540.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): 31,32,33,34,35,36 Zion House ensures that experienced staff are employed. The registered providers are reviewing staffing levels in the home to ensure that they meet residents’ needs appropriately. Recruitment processes are robust. Access to training has increased to improve the awareness and provision of care to residents. Supervision and appraisals systems for staff are being developed. EVIDENCE: On the day of inspection the registered providers and a cook were on duty. Residents attend day care activities and therefore staffing during this time is minimal. Staff are employed when residents return to Zion House. The registered provider has reviewed staffing levels in the home as she has reassessed some residents whose dependency needs have become more complex. Therefore two additional care staff will be recruited to enable these care needs to be met to a more satisfactorily level. The registered provider aims to have two members of staff on duty at all times when service users are resident at the home plus sleeping in staff. Maintenance work is undertaken by one of the registered providers. From observations it was evident that staff have formed positive relationships with the residents and that they were competent in their work. The registered provider is encouraging the experienced staff team to access training via the local college. Staff have attended or are due to attend training courses in respect of moving and handling, food hygiene, first aid, fire and infection
Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 18 control. Supervision has commenced but this needs to be documented. The registered provider is reviewing the staff appraisal process. The registered provider is aware that 50 of staff must be trained to a minimum of NVQ level 2. The established and experienced staff group are reluctant to attend this training but have agreed to attend the mandatory courses. The registered provider stated that with the new posts created that she would ensure that staff hold or agreed to achieve this qualification. The registered provider is also considering staff attending the LDAF course. The registered provider has reviewed job descriptions, recruitment processes and has implemented a detailed induction programme. A previous recommendation to expand the application form to cover why the applicant has applied for the position at the home and their experience in social care has been complied with. The registered provider aims to involve residents in the recruitment process of new staff. From inspection of staff files this evidence that staff are recruited appropriately and satisfactory checks are made prior to commencing work at the home. Zion House DS0000064502.V267540.R01.S.doc Version 5.0 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): 37,38,40,42,43 The registered provider provides a structure, which creates an open, positive and inclusive atmosphere. The Registered Providers are competent to manager the home. Continuous review of the homes policies is ongoing to ensure that it reflects work practices within the homes to promote residents’ safety and rights. EVIDENCE: Mr and Mrs Stevens were approved as registered provider of Zion House in September 2005. They both have many years experience in working in the field of learning disability and previously were registered provider of a small care home for 2 adults with a learning disability. Mrs Stevens has gained the Registered Managers Award NVQ 4 and both providers are keen to attend training to ensure that their skills are up to date and share their knowledge with the staff team. Residents spoke positively about their skills and management of the home. It is evident that the registered providers ensure that residents, relatives and staff are consulted about how they view the service that Zion House provides.
Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 20 Resident meetings are held weekly to plan the next week’s activities and discuss any issues in the home. Staff meetings are also held. The registered providers are in the middle of their quality assurance survey and will send their conclusions to CSCI when completed. The registered provider has reviewed many policies. However some policies inspected need further amending and they were discussed with the registered provider and are detailed elsewhere in this report. The registered providers have ensured that Zion House is maintained to a safe standard for all who live, visit or work at the home. Documentation and observations demonstrated that appropriate health and safety checks and maintenance work is carried out. The registered provider is aware that the Environmental Health Inspection has not occurred since 23 March 2004 and will contact this department to request a further inspection. Records are kept up to date, accurate and stored in a confidential manner. The registered providers have demonstrated to CSCI that Zion House is economically viable and are able to proceed with the plans that they have to improve the service that Zion House provides. Zion House DS0000064502.V267540.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Zion House Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X 2 3 DS0000064502.V267540.R01.S.doc Version 5.0 Page 22 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 2 Standard YA40YA20 YA40YA23 Regulation 13 12,13 Requirement Zion House must have one medication policy that all staff are aware of and understand. The adult protection policy must be reviewed and amended, especially within the remit of the processes to be undertaken when an allegation of abuse is made. This must then be shared with staff. The registered providers must ensure that appropriate mechanisms are in place to promote infection control: paper towels must be installed in the communal toilet: impervious flooring must be replaced in the shower room: and a fly screen installed in the kitchen. A minimum of 50 of staff must be trained to NVQ level 2. The registered provider must arrange for a Environmental Health Inspection Timescale for action 30/03/06 30/03/06 3 YA30 13, 23 30/05/06 4 5 YA32 YA42 18 23 (5) 30/07/06 30/04/06 Zion House DS0000064502.V267540.R01.S.doc Version 5.0 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 3 Refer to Standard YA20 YA21 YA36 Good Practice Recommendations The quantity of medication should be recorded on MAR sheets. The policy in respect of managing a service users deteriorating health or in the event of their death should be expanded. Supervision sessions should be recorded. Zion House DS0000064502.V267540.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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