Care Home: Allenscroft

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What the care home does well People living in the Home receive good support from a staff team that knows their needs. Staff is well informed as to the needs of people, the way they spoke to and interacted with the people was positive, and there was a good understanding of peoples` communication needs. Staff had a variety of skill, experience and understanding of complex needs, which means they can meet the needs of people in a caring and positive way. The service supports over forty people on a respite basis, providing a muchneeded service to families and carers some of whom have utilised this for eighteen years and speak very positively of their experience. The home is well decorated and furnished so people have a homely, comfortable and safe place to live. There is a good range of communal space for people to use, including a second lounge with computer, music centre and games. People are supported to enjoy activities in the local community. They said they continue with the activities they enjoy whilst living in their own home, as well as having new opportunities, one said, "I like Allenscroft because I meet my friends, I can cook and look after myself and then go back home to my family." People at Allenscroft said their family and friends are made welcome at the Home. Each person has their own bedroom where they can spend time in private if they want to. All the staff had completed NVQ level 2 in care, which helps to ensure that they have the skills to support people and meet their needs. People said, "I trust the staff and like the staff if anything goes wrong they are always there to help". " Staff listens to me" "Staff here are great, really friendly and I love to come and stay". What has improved since the last inspection? People who use the service have been supported to `sign up to` their care plan, this means they are fully involved in the decisions in their plan and that Allenscroft can demonstrate this. There has been further progress in ensuring the people who receive respite care have a care plan and health care plan that shows in detail the type of support the individual requires. This means staff can meet the needs of people in a consistent manner. The choices that people make in relation to the activities they undertake whilst at Allenscroft have been clearly defined in the care plan, this means people who receive respite can continue their preferred options without disruption whilst staying at Allenscroft.A number of improvements have been made to the facilities ensuring a nicer, and more comfortable environment for people. The lounge and bedrooms have been redecorated, and last year bathing and toilet facilities were improved to provide facilities more suited to the people who use the service. The manager has introduced personal development plans for all staff, these ensure training gaps are identified and planned for. This will help structure staff training so that it is suited to meeting the needs of the people using the service. The risk assessment for fire safety has been developed to show the control measures that are in place to protect people, this means staff know what to do to keep people safe in the event of a fire. What the care home could do better: The development of a Homes brochure and improvements to the Statement Of Purpose would ensure people considering using the service have accurate, up to date information in a format suited to their needs. CARE HOME ADULTS 18-65 Allenscroft 153 Allenscroft Road Kings Heath Birmingham B14 6RP Lead Inspector Monica Heaselgrave Key Unannounced Inspection 19th November 2007 10:50 Allenscroft DS0000033647.V350310.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 Allenscroft DS0000033647.V350310.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. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Allenscroft Address 153 Allenscroft Road Kings Heath Birmingham B14 6RP 0121 444 7097 0121 444 3734 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) Katy meakin @ Birmingham.gov.uk www.birmingham.gov.uk Social Care and Health Mrs Ellen Jefferson Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered to accommodate 5 adults under the age of 65 who are in need of respite care for reasons of learning disability and 5 adults under the age of 65 who are in need of long-term care for reasons of learning disability. Registration category will be 10(LD). However, future provision of this service should make separate provision for respite service users from long-term service users. That minimum staffing levels are maintained at: Monday to Friday - 7am-4pm 1 duty manager and 1 care assistant - 4pm-10pm 1 duty manager and 2 care assistant Saturday and Sunday - 8am-10pm 1 duty manager and 2 care assistants Care managers hours and ancillary staff should be provided in addition to care staff. Reprovision plans to progress at a pace that is acceptable to CSCI to allow continuation of registration. Short-term care is only offered to known service users where benefits can be demonstrated for both the respite and long term service users. New referrals for respite must have a care plan and be admitted for services following an agreed planned programme of admission. 4th December 2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Allenscroft is registered to provide accommodation care and support for up to 10 people who have a with learning disability. The service is registered to accommodate five people under the age of 65 who are in need of respite care and five adults under the age of 65 who are in need of long-term care. Currently there are four people who live in the home and at any time a further six respite people accommodated for varied short stay care. Some people who use the service have additional needs in relation to communication, behaviour, hearing, and continence. For some individuals their first language is not English. The Home is run by the Local Authority and provides a service for people requiring long-term care and also for regular planned respite care. An outreach team providing support to people living in the local community is also based at Allenscroft. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 5 The present situation (mixing respite and permanent care) is not considered to be ideal but this is under review. The people who live at Allenscroft have previously indicated that they enjoy seeing the other people who come to stay on a regular basis. The house is spacious and comfortably furnished. The facilities are not suited to someone who has a significant physical disability. The accommodation comprises of two communal lounges, dining room, kitchen and a laundry. There are ten single bedrooms these provide a good degree of comfort for the people accommodated. There is also a separate kitchenette where people can make their own drinks and snacks independently. There is a good degree of space ensuring people can choose to what extent they socialise with others. There have been a number of improvements made to include redecoration of all the bedrooms, lounge and dining area. Bathroom and toilet areas have been refurbished and now provide some facilities for those people who require assistance. These facilities have been fitted with hand grab rails and walk in shower. The rear garden is level enabling people who use Allenscroft to make full use of it. The home is situated on a busy residential road close to local shops and bus routes. Off road parking can be difficult. The Fee level for the Home is set by Birmingham City council. This alters according to the service provided and the length of respite stay. Allenscroft also accommodates four people on a permanent basis. The current charge for living at the Home is £323.00 per week. Additional charges include, outside activities, trips and outings, hairdresser, newspapers and additional meals out. The fee level for the Home needs to be made available in the Service User Guide when this has been updated. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork of this unannounced inspection took place over one day lasting about 8 hours, enabling the lunchtime and evening routine to be observed. Prior to the inspection the manager completed an AQAA (annual quality assurance assessment), which tells CSCI about how well the Home is performing and achieving outcomes for the people who live in the Home. It also provides some factual information about the Home. Information from the AQAA was used to help inform the inspection process. Reports of any accidents or incidents reported to CSCI involving people using the service were looked at, as part of the planning of the inspection. As part of this inspection visit the Link Resident Scheme was used. One individual agreed to introduce this at Allenscroft. The Link Resident Scheme is a way for people to tell us how they like the home they live in, what they feel about living there and what they would like to change, if anything. The link resident scheme is one way the Commission can involve people in the inspection process. The inspector was very pleased to see that this had worked well at Allenscroft, Twelve surveys had been returned. This was clearly down to the efforts of the Link Resident who put such effort into distributing surveys and ensuring they are returned to the Commission. Thank You. The surveys received from people who use the service all made positive comments relating to being able to do the things they enjoy, and having enough activities to engage in. A visiting relative was spoken with and information received from another relative via a telephone call to the Commission. The inspector met people living at the Home, spent time observing support and interactions from staff, had a tour of the premises including peoples bedrooms, looked at care records and health care records and medication management. Health and safety records and staffing records were also assessed. All information looked at was used to determine whether peoples varied needs are being effectively met. Four people were identified for close examination this included reading their care plans, risk assessments daily records and other relevant information. This is part of a process known as “case tracking” where evidence is matched to outcomes for people using the service. The inspection focused on the last requirements and recommendations and what progress had been made towards these since the last inspection. What the service does well: People living in the Home receive good support from a staff team that knows their needs. Staff is well informed as to the needs of people, the way they spoke to and interacted with the people was positive, and there was a good understanding of peoples’ communication needs. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 7 Staff had a variety of skill, experience and understanding of complex needs, which means they can meet the needs of people in a caring and positive way. The service supports over forty people on a respite basis, providing a muchneeded service to families and carers some of whom have utilised this for eighteen years and speak very positively of their experience. The home is well decorated and furnished so people have a homely, comfortable and safe place to live. There is a good range of communal space for people to use, including a second lounge with computer, music centre and games. People are supported to enjoy activities in the local community. They said they continue with the activities they enjoy whilst living in their own home, as well as having new opportunities, one said, “I like Allenscroft because I meet my friends, I can cook and look after myself and then go back home to my family.” People at Allenscroft said their family and friends are made welcome at the Home. Each person has their own bedroom where they can spend time in private if they want to. All the staff had completed NVQ level 2 in care, which helps to ensure that they have the skills to support people and meet their needs. People said, “I trust the staff and like the staff if anything goes wrong they are always there to help”. “ Staff listens to me” “Staff here are great, really friendly and I love to come and stay”. What has improved since the last inspection? People who use the service have been supported to ‘sign up to’ their care plan, this means they are fully involved in the decisions in their plan and that Allenscroft can demonstrate this. There has been further progress in ensuring the people who receive respite care have a care plan and health care plan that shows in detail the type of support the individual requires. This means staff can meet the needs of people in a consistent manner. The choices that people make in relation to the activities they undertake whilst at Allenscroft have been clearly defined in the care plan, this means people who receive respite can continue their preferred options without disruption whilst staying at Allenscroft. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 8 A number of improvements have been made to the facilities ensuring a nicer, and more comfortable environment for people. The lounge and bedrooms have been redecorated, and last year bathing and toilet facilities were improved to provide facilities more suited to the people who use the service. The manager has introduced personal development plans for all staff, these ensure training gaps are identified and planned for. This will help structure staff training so that it is suited to meeting the needs of the people using the service. The risk assessment for fire safety has been developed to show the control measures that are in place to protect people, this means staff know what to do to keep people safe in the event of a fire. 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. The summary of this inspection report can be made available in other formats on request. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 9 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 Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering the respite service at Allenscroft have information about the Home that helps them to make an informed decision. Improvements to the format to ensure it is suited to their needs would enhance this further. The assessment of peoples’ needs before they move into the home is comprehensive and ensures that the person’s needs, can be met. EVIDENCE: Allenscroft provides a unique service both long term and respite care is provided. Four people live in the Home on a permanent basis. Allenscroft also offers respite care to a number of people who have used this facility for over twenty years. Six additional respite people are accommodated on a weekly basis. A community support team works with and supports a number of families within the community these staff are based at Allenscroft and work within the home to provide progression for their clients. The three services compliment each other with positive outcomes for the people who use Allenscroft. There have been no admissions to the service for long term care. Three new respite people have been introduced this year with no disruption to the existing client group. The service only provides respite care to people who have used the service for a number of years. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 11 The staff team are managing an exceptionally high volume of work. Since the last visit to Allenscroft revised care plans, reviews and risk assessments have been put in place to ensure that sufficient detail is available to support those people receiving respite care. There is a robust system in place to ensure the support needs of people are in sufficient detail to inform care planning, this means that the assessment of need now says exactly what support is needed and how it will be provided. The manager and staff team have clearly worked hard in developing this system for the benefit of the people who use the service. The Statement Of Purpose and Service User Guide were in small print, lacked some detail and would benefit from photographic input. The manager has stated in the information provided to the Commission prior to the inspection visit that they wish to develop a brochure and improve the Service User Guide so that this is in a format more suited to the needs of the people who use the service. Allenscroft has however developed a ‘welcome pack,’ which contains photographs and sufficient information to enable people to know what to expect from the home and help people to make decisions in this area. Appropriate arrangements are made to enable people to visit, meet the people who live at Allenscroft and have an opportunity to stay overnight, to support them in their decision to use the service. Comments from people spoken with at the time of the visit confirmed that they had favourably introductions, and an important factor to them was that they could be accommodated during the same period as friends who also used the service. It was positive to see that the compatibility or ‘mix’ of people staying at any given time is carefully considered to ensure both people who live at Allenscroft and those that receive respite care have their needs met. A relative telephoned the Commission to say that she was impressed with the care standards and that her relative who receives respite care receives a high level of attention and care from a committed staff team. Twelve completed surveys were received and all but one (which was an emergency admission) stated that people had sufficient information to help them make a decision about using the service at Allenscroft. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to make choices and decisions about their day–to-day lives. Staff had the information they needed so they know how to support peoples’ individual needs. People are supported to take risks within a risk assessment framework ensuring their safety and wellbeing. EVIDENCE: Four peoples care plans were looked at for the purpose of this inspection. Care plans were up to date and set out in detail the care required to be carried out by staff and included information on the persons likes and dislikes, health needs, personal care, culture and preferences. Staff had consulted with a range of professionals to promote best practice for the individual. As advised at the previous key inspection care plans had been extended to those people receiving a respite service. The key worker system has also been introduced for people having respite care, this has ensured that their wishes and choices are known and carried through into their care plan. The risk assessment and daily report notes were crossed referenced and showed that these are linked to the I.S.S. (care plan), and the Health Action Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 13 Plan. The Health Action plan is in pictorial format and large print making it easier for people to understand. The specific support the individual requires is clearly detailed and allows staff to provide a consistent approach to meeting people’s health care needs. Peoples plans showed how decisions about accessing employment and education options are made, what weekly activities people wish to engage in, the support they wish to make friends and how they are to stay healthy. It was evident that staff have explored with individuals, specific routines that are important to them. This means that the person has positive and planned interventions designed to meet with the individuals’ choice and capabilities. Behaviour management strategies on sampled files had been kept under review and gave information on how best to support people. People are supported to make choices about what and when they eat, when to go out, how to spend their time when to see family and friends. Daily records seen indicate the choices that people make. The risk assessment report on file covered general health, personal hygiene, independent travel, finances, behaviour and vulnerability. Discussions with the manager indicated that risk-taking is seen as an essential feature of supporting people to be safe and to promote their independence. A number of risk assessments were sampled and indicated that they are kept under review and update due to changes in needs or circumstances. There is good consultation with people who use the service, regular key-worker meetings, and resident meetings take place, meetings are recorded in audio so that those who are not present can catch up on news as apposed to reading it, this ensures that people have a better improved degree of choices and means of consultation. It was positive to see that goals are more specific and measurable, for example the planning and cooking of a meal, this means staff are able to support people in meeting goals and assessing if they had been met. The inspector met the ten people who were living or staying at Allenscroft, all expressed their views as to how far they are consulted with regards to events within the home. They reported being involved in the redecoration of their bedrooms and the lounge, also that they had been provided with a lockable facility in their bedroom to safeguard valuables and money. One person said he had been supported to maintain his involvement in advocacy groups, and in local elections. Several people made decisions about holidays, activities and managing their finances. Three people had recently returned from a holiday of their choice. Twelve surveys had been received from people who use the service all made positive comments relating to being able to do the things they enjoy, and having enough activities to engage in. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 14 The minutes of meetings showed that views are sought about the facilities, standards, staffing and their key-workers. This means people are supported to express their opinion with a view to making improvements to the service. As part of this inspection visit the Link Resident Scheme was used. One individual discussed this with the inspector and agreed to introduce this at Allenscroft. The Link Resident Scheme is a way for people to tell us how they like the home they live in, what they feel about living there and what they would like to change, if anything. The link resident scheme is one way the Commission can involve people in the inspection process. The inspector was very pleased to see that this had worked well at Allenscroft, Twelve surveys had been returned. This was clearly down to the efforts of the Link Resident who put such effort into distributing surveys and ensuring they are returned to the Commission. Thank You. The surveys received from people who use the service all made positive comments relating to being able to do the things they enjoy, and having enough activities to engage in. Allenscroft has actively supported people to express their faith this includes people who receive respite care attending their own places of worship during their stay. Cultural and dietary needs had also been explored. People have identified needs in their care plan relating to their food requirements, and sexuality. A very positive initiative has been the introduction of ‘Must’ ‘Must not’ sheets, these identify at a glance crucial aspects of information, for instance ‘must use a wheelchair when out’, ‘must not have a bath as I do not like the bath and cannot get in or out’. The financial arrangements showed how people are supported with their money management. People confirmed they have access to their money to buy personal goods or clothes. They were happy with these arrangements. Records sampled showed that cash balances held on behalf of people are maintained satisfactorily and audited to ensure any mistakes are rectified. There was good information, and risk assessments in place to support people who may be at risk due to their vulnerability. A plan for self-neglect, and deteriorating mental health, was evident and provided staff with good information as to recognising changes in mood and how to respond to these appropriately. The risk assessments are reviewed routinely as significant incidents, or changes occur, this ensures service users wellbeing. Observations took place at different times throughout the fieldwork visit people received good support from staff that spoke calmly and respectfully. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 15 Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to take part in activities in the community and experience a meaningful lifestyle. People are offered a varied and balanced diet. EVIDENCE: People living in the Home are involved in a whole arrange of daytime activities. Some of the people attend structured day centres, or college and some plan their own activities and daytime occupation. There is evidence from discussions with people that they have been supported to try new activities including college and work placements. Personal records showed that people are able to engage in activities of their choosing, this included social clubs, shopping, theatres, church, library, restaurants, cinema, and planned trips. The staff at Allenscroft ensures that the social, educational and recreational interests and commitments that respite people have are continued during their respite stay, and that options not otherwise available to them are also considered. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 17 People care plans had details of activities that they take part in and their interest and hobbies. The manager ensures transport is available to enable people to attend their usual programme of preferred activity people also use public transport or taxis to access a wide range of community facilities. Four people said they had enjoyed a recent trip to Weston and they said “it was great” We went out to lots of different places” “ I really like Weston that’s why we went there”. People said they have been to the theatre, concerts, pantomime, Walsall lights, and lunches out. A record is held which shows what activity took place and the comments people had about whether they enjoyed it or not, this is a good way to review the activity ensuring it suites the people who live in and stay at Allenscroft. People at Allenscroft told the inspector that their individual plans included both practical skills development, as well as social and education opportunities. One person said he has support to manage money, choose daily activities, and cook. Another person said ‘I like going to on holiday every year, staff always ask where we would like to go, I enjoy the cinema, trips out, and I love Christmas because a big group of us go out for a meal and then the pantomime.’ Contact with family and friends are well established, as the majority of people at Allenscroft are having respite care. People spoken with said they visit and telephone their family independently and some relatives visit the home and may stay for a meal. On the day of the visit one relative was visiting and told the inspector that he is always made welcome and can stay as long as he wants, he said communication with staff and the management team is consistently good and he is very happy with the care his son receives. A phone is available so people can make private calls and some of the people said they have their own mobile phones that they choose to use. Routines were relaxed and people chose were to sit and when to spend some time in their own rooms. There is a second lounge which has a computer and music centre for people to enjoy, some said they like to spend time in their rooms, however the majority of people having respite care said they enjoy sitting in the lounge because they can chat with their friends who they may not have seen since the last visit. To the rear of the home there is a large garden, which some people said they use in the summer. Discussions with people indicated that issues of privacy and independence are addressed. People have their own bedroom door keys, and showed the inspector their bedrooms. They have appropriately equipped toilet and shower facilities to ensure a degree of privacy and independence. People made a choice about what they wanted to eat for their evening meal. One of the people said they are supported to make their own lunches each evening for the following day and they enjoyed this. People said” the food is good” and “I can choose what I want to eat”. Food stocks seen indicated a range of produce is available. A record of food served is kept and ensures that staff can monitor Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 18 that people are eating a healthy diet. One care plan specified how risks through poor diet are managed through appropriate intervention. This included guidance from other professionals involved to ensure nutritional needs are met. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for personal support are good and ensure people have support in the way they prefer and require. Health care is well planned, which ensures peoples’ needs are consistently well met. Medication is well managed, which ensures people get the right medication at the right time. EVIDENCE: Peoples personal appearance was good and indicated that they receive good support to attend to their personal care needs. They wore clothing appropriate to their age, culture, time of year and activity. Care plans had details of people’s personal care routines and preferences. There was enough staff on duty to support people in the way they prefer and require. All people currently living in the home are mobile and the home has no lifting aids or adaptations. There is a walk in shower facility on the first floor. The home does not have adaptations for people with a physical disability. The home has a stable staff team which gives continuity of care to people living in the Home. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 20 The manager has continued to develop health action plans; a health action plan is a plan of what a person needs to do to stay healthy. Specific health needs had been identified and when required people had been given support to receive input from a range of health professionals including community Nurses and psychiatry. Plans to underpin healthcare needs have been revamped since the last inspection. There is now a lovely system which is in written and pictorial format and enables the individuals at Allenscroft with support, to say what their health care needs are, and what support they need in order to maintain good health. This gives clear details on any concerns to look for and how staff should respond to these. There was also a good section on appointments attended, treatment received and next appointment date, this made it easy to track health care therefore appointments are not overlooked. Since the last visit there has been some progress in ensuring all health care plans are completed in full for those people who receive respite care. Sampling of the accident records and regulation 37 reports showed that accidents are followed up and recorded to show what steps were taken to ensure the wellbeing of the person. Medication is stored in a separate locked cupboard in the office. Medication records were sampled. Medication administration records (MAR) had been signed when medication had been administered. Sample signatures were available for all staff that administer medication and a protocols were in place for medication taken on an as required basis which ensure that the homes medication procedures promotes safe practice for people living in the home. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements in place to ensure that the views of the people living in the home are listened to and acted on. Robust procedures ensure people who live at and receive respite care at Allenscroft, are protected from abuse. EVIDENCE: The complaints procedure was on display in the hall and has been produced in pictorial, CD and audio format suitable for people living in the home so they know how to make a complaint. Several people spoken to during the visit said they can talk to staff or the managers if they are not happy about something, one said “I trust the staff and like the staff if anything goes wrong they are always there to help, and Staff listen to me”. Twelve completed surveys from people who live at Allenscroft and those that receive respite care, showed that people know who to talk to, know how to make a complaint and are confident staff listen to and act on their concerns. The style of management is open and inclusive, opinions are heard and acted upon, with good examples of them being at the forefront of consultation through resident meetings, carers meetings and key worker meetings. The home had not received any complaints since the previous inspection and CSCI had not received any concerns, complaints or allegations about the Home. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 22 Staff had received training in protection matters so they know what to do in the event of an incident occurring in the home. The manager has ensured that staff had regular ‘refresh’ sessions where they discuss safeguarding procedures so that they are confident what to do should an issue arise. Multi agency procedures advising staff what to do and who to contact were available in the office. The responsibility of reporting protection issues is known, discussions with staff confirmed that they had training in this area and understand the steps that need to be taken to protect people in their care. The AQAA provided information that indicated a whistle blowing policy was available ensuring staff know the expectations of reporting matters of protection. Discussions and observations at the time of the fieldwork indicated a commitment by the manager to the safeguarding of the people who live at and receive respite care at Allenscroft, whilst also ensuring that people live independent lives and supported to take acceptable risks within a risk assessment framework. CSCI have been appropriately notified of incidents that have occurred in the Home. Regulation 37 reports have been completed logged and forwarded for information, ensuring there is a thorough paper trail in place to demonstrate that issues have been dealt with appropriately. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The well-maintained environment has benefited from some adaptations to meet the needs of the people who use the service. The home is pleasant, comfortable and clean. EVIDENCE: Previous inspection reports identified shortcomings with the building and physical environment at Allenscroft. The premises are old and do not meet the current standards. The home has some adaptations for people with a physical disability but is not suitable for people with a significant physical difficulty as there is no lift facility to reach the bedrooms on the first floor. To support the current people there are handrails situated on staircases and a bathroom has been converted to a shower room this is now more accessible and equipped for peoples’ varied needs. A new shower has been fitted in the existing bathroom, which now provides a further choice of facilities to suite individuals. There is a spacious toilet area on the ground floor, which allows room for those who may require assistance this is fitted with grab rails, new sink and toilet and level access for people this Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 24 enables people to be more independent in their personal care, which means their dignity is further promoted. Since the last inspection the main lounge and the bedrooms have been redecorated. The second lounge area has benefited from improved storage facilities and this also provides a space where people can engage in quieter pursuits such as board games, meet visitors in private, or choose to spend time away from the main group. There clearly has been a lot of work on improving the facilities and comfort for people who use the service, the programme of redecoration continues with the manager identifying funding to decorate the second lounge and replace existing carpets. People who live at and receive respite care at Allenscroft said they are pleased with the improvements to date, which provide a much enhanced environment, with facilities suited to a wide range of needs. The design of the premises are such, that adequate room is provided in the home to enable people to choose to what extent they socialise with peers, this is particularly important for people who may find socialising and group living, difficult. Nobody currently uses mobility aids. There is a pleasant communal lounge with a large television and plenty of comfortable seating, and a separate dining room. The standard of décor and furnishings is good, the communal areas were spacious comfortable and clean. Three people showed the inspector their bedrooms, these were individual, clean and comfortable, storage is limited as the rooms are below the national minimum standard, however those who use the service for respite care said that the accommodation was adequate for their needs as they generally only brought in a small amount of personal possessions. One long-term person was satisfied with his room, he had chosen to decorate and furnish in styles and colours he preferred, he said he had adequate storage and shelving. People had since the last visit been given a lockable facility in which to keep valuables, and said they were happy with this. Maintenance and repairs are acted upon ensuring that the environment is kept safe and comfortable. Cleanliness standards were good. Food hygiene and infection control measures are practiced and staff had good knowledge of these. People who live and stay at Allenscroft use a kitchenette. They can make drinks and snacks, giving them the opportunity to maintain some independence in this area. Three of the people staying in the home said, “I love coming here I have a nice room”. Another person said “I sometimes like spending time in my room I have lots of things that I like to keep here and they mean a lot to me”. “This is the best home I have ever lived in.” Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the services at Allenscroft have confidence in the staff that cares for them. There are creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of respite care and the changing needs of the people who use the service. Arrangements for staff support and development ensure that people needs are met. The recruitment practices ensure that suitable people are employed and people living in the Home are protected. EVIDENCE: The staff team is well established, and consists of people who have got to know the people who live in and stay at the Home, well over a period of years. Staff rotas show that staffing levels have in the main been maintained. The manager explained that due to the nature of the service, planning is essential, and if a week of respite is known to be a higher dependency group of people, staffing levels are adjusted accordingly. This means that the needs of people can be planned for, to ensure adequate staffing levels meet them. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 26 The people who live at Allenscroft and those on respite care described staff in very positive terms, they said they like them, enjoy good relations, and can talk to them. Interactions between staff and people in the home were entirely positive, and the way people were supported was respectful. Staff is skilled in using preferred communication techniques to support people with difficulty in communicating their needs. The manager oversees the management of the Peripatetic team who are based in the home. This team supports people within the community. This team also works within Allenscroft and this provides a good deal of continuity of care for people who use the service. Two staff files were looked at and showed that recruitment procedures are robust and ensure the safety of vulnerable people. Key pieces of documentation including ID, photo, health declaration and confirmation of CRB clearance, completed application form and two references, are maintained. Information provided by the manager prior to the fieldwork matched that seen on staff files; robust screening prior to staff commencing work in the home. The system in place for recruiting staff ensures that people are protected by the home’s practice. It was positive to see that service specific training has been completed to meet with the specific needs of people who use Allenscroft. This included sexuality awareness, Autism Awareness and Mental Health Awareness. Staff files contained details of training courses undertaken. All staff had completed the mandatory training including Fire Safety, First Aid, Manual Handling, Adult Protection and Food Hygiene. All staff had achieved NVQ level 2 or above in care. The consistently good approach to staff training and development ensures a competent and skilled workforce meets peoples’ needs. Each staff member has a PDR, which is a personal development review of his or her training needs, skills and training required. This further enhances future training, ensuring that gaps can be easily recognised, planned for and training purchased which is in line with the needs of the people and the aims of the service. Staff spoken too felt that they are supported to translate their training into good care with positive outcomes for people using the service. Discussions with staff identified that they had a good understanding of the specific needs of people to include their methods of communication, and understanding and anticipating behaviours; this ensured they had the skills necessary to support the individual in a positive manner. Staff records sampled showed that staff had received regular, formal supervision with a senior or the manager to monitor their performance and to ensure they know how to meet individual needs. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 27 Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a well-managed service providing positive quality of life and opportunities. The manager promotes equal opportunities, and understands the importance of person centred care and positive outcomes for people who use the service. The team are knowledgeable, working for continuous development, and ensure that the interests of the people using the service are foremost. Health and safety practices ensure the safety and wellbeing of the people using the service is promoted. EVIDENCE: Allenscroft has a stable management team, with a manager who has been in post several years and is well qualified for this position, having NVQ Level 4 and the RMA (Registered Managers Award.). The style of management is open and inclusive. People who use the service, staff and relatives confirmed this. The inspector spoke with one visiting relative and had a telephone call from another, twelve surveys were also returned to the Commission with all Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 29 comments being very positive for a service that has maintained consistently good standards of care. The opinions of people who use the service are heard and acted upon, with good examples of them being at the forefront of consultation through service user meetings, carers meetings and key worker meetings. The manager and her team has worked continuously to improve services and provide a strong focus on equality and diversity issues, she has recently been involved in a pilot study to explore how such issues affect people who receive care such as looking at promoting dignity, respect and fairness, and ensuring the individual has a plan of care that is person centred, that is tailored to their needs, their desires and choices. This was reflected in the care plans seen and the way in which staff promote the persons’ voice through looking at creative ways to consult with people and increase their access to information, such as the information that has been produced in audio, CD and pictorial formats suited to the needs of people using the service. The manager also promoted and embraced the use of the Link Resident Scheme empowering the people who use the service to take an active part in the inspection process. This has worked well with an increase in the return of surveys, which provide valuable information on how people view the service. There is a strong ethos of being open and transparent in all areas of running of the home. The manager leads and supports a strong staff team who have been recruited and trained to a good standard. The AQAA contained clear, relevant information that is supported by documents seen in the Home. The AQAA lets us know about changes they have made and the areas that they still need to make improvements and it clearly shows how they are going to do this. The staff team is well informed as to their role and responsibilities and had a good understanding of peoples’ needs. In addition to catering for the needs of the four permanent people, Allenscroft offers a respite care service to forty people in the community who have an established relationship with the home. Alongside this the Peripatetic team who provide outreach support to individuals in the community, are based at Allenscroft, this team is also managed by the homes manager. The office is the contact point for all of these activities and the management team are responsible for all the administrative demands that they generate. The staff team have continued to develop their quality assurance system, this takes on board all the views of the people who use the service, their relatives, and staff’s and other professionals’ view points. Relatives and carers have attended reviews and quarterly carers meetings, these have proved to be effective in communicating the procedures in the home and sharing ideas for improvements, suggestion boxes are also available in the home. Planned trips have been utilised to obtain the views of relatives this has been a creative way Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 30 to include people in the review process. Monthly Regulation 26 visits are carried out, this ensures that there is effective monitoring of the service and it’s standards. There are good arrangements to ensure the health and safety of people within the Home. Information provided prior to the fieldwork confirmed that servicing and maintenance of equipment had been undertaken as required, and this was confirmed when equipment was checked in the Home. Water temperatures are checked and recorded weekly, this minimises the risk of scolds to vulnerable people. Legionella checks were completed annually. There was a Gas Landlord Certificate in place, ensuring the gas supply was safe. Fire safety procedures are consistently carried out; emergency lighting is checked monthly, fire drills and weekly tests are undertaken. It was advised at the last visit to the Home that the fire risk assessment include a suitable emergency action plan showing control measures to ensure fire doors are kept closed especially during the night. This was seen to have been done and ensures staff knows how to protect people in the event of a fire. As identified in the previous two inspection reports the future of this service will need to be shared with interested parties. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 31 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 3 2 X 3 3 4 X 5 X 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 3 25 3 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 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 3 3 3 3 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 3 3 X X 3 X Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 32 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA1 Good Practice Recommendations Further development of the Homes brochure and Service User Guide would provide information in a format more suited to the needs of the people who use the service. Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Allenscroft DS0000033647.V350310.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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