Care Home: Outreach Community & Residential Services 17 York Avenue

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Outreach Community & Residential Services 17 York Avenue 17 York Avenue Prestwich Manchester M25 0FZ The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Bodell Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 28 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Outreach Community & Residential Services 17 York Avenue 17 York Avenue Prestwich Manchester M25 0FZ 01617735053 01617405678 akila@outreach.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Outreach Community & Residential Services Name of registered manager (if applicable) Mrs Jeanette Simone Taylor Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 Care Home 4 learning disability Additional conditions: The registered person may provide the following categories of service only: Care home only - code PC, to people of either gender whose primary care needs on admission to the home are within the following categories:- Learning Disability - code LD The maximum number of people who can be accommodated is: 4 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home 17 York Avenue is a small care home in a residential area of Prestwich. There are three single bedrooms on the first floor and one on the ground floor. The home has a small, enclosed lawned area at the rear and on street parking outside. There are shops within close walking distance and public transport is available nearby. Fees are arranged individually and are dependent on the level of support required. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 28 How we did our inspection: This is what the inspector did when they were at the care home Our inspection visit took place over four hours. The home had not been told that we would visit. We looked around parts of the building and checked some paper work about the running of the home and the care given. To get more information we spoke with three people who live at the home, the manager and a support worker. We also watched as staff members went about their work. We requested information from the service before our visit, which was returned to us. This is called the Annual Quality Assurance Assessment (AQAA) and tells us what the home feels that it does well and what needs to be done to improve the service. We received surveys from four people using the service and one from a support worker. The responses we received were generally positive about the service. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well From speaking with people and information they gave in returned surveys it was clear they were in the main happy with the care and support provided. People said it was a happy home and this was observed during our visit. People are encouraged to take part in, community activities of their choice, such as work, college courses, leisure activities with staff support if needed. They take some responsibility for keeping the house clean and tidy and shop for food and prepare and cook their meals. People make their own choices about things such as daily routines for example what time they get up or go to bed, activities and meals. Cultural needs are met by making sure that only kosher food is brought into the house and by following Jewish customs and practice. People had no hesitation in approaching staff members if they wanted to speak to them. Interactions between people were frequent and friendly. The atmosphere was very relaxed. The home is good at making sure peoples health was taken care of by regularly seeing doctors and other health care workers. Care Homes for Adults (18-65 years) Page 8 of 28 What has got better from the last inspection What the care home could do better Support workers need to write down when they have checked that a person is selfmedicating safely and check out with this persons GP to ensure that they are taking one of the medicines, as they should be. The training record for the staff team would benefit from showing the date when training was undertaken. Care Homes for Adults (18-65 years) Page 9 of 28 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Julie Bodell 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 01772 730 100 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 10 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Systems were in place to ensure assessments were completed prior to people moving in so that people can be sure that the home would meet their needs. Evidence: All four people living at the home had done so for many years. People spoken with said that they generally got on well with each other and that it was a happy home. We looked at the personal file for one person. It contained a copy of the persons community care assessment and a care plan that had recently been reassessed by the placing authority. Assessment documents were comprehensive and covered areas such as family and social contact, assessment and management of risk, methods of communication and personal support. We were informed that all the people who lived at the home had recently had an annual review. There was evidence on the persons file that this was the case. Two people spoken with confirmed that they were involved in their reviews. One person had a copy of the minutes of their review that had been completed in a picture format. If any new people were to come to live at the home in the future the organisation have systems in place to ensure that admission would be handled appropriately. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were supported in a positive and enabling way and were involved in planning their support needs and personal goals to ensure that the arrangements made were what they wanted. Evidence: One person centred support plan was looked at. There was a biography about the person and a lot of information about the persons health and social care needs. This included risk assessments and information about the persons daily routines and how they liked their care and support to be provided. The plan covered areas such as individuality, activities, continuity, skills and competence, decision making and informed choice as well as religious and cultural needs. An activity sheet showed what the person had planned to do for the week. For example going to work, attending college, going to the gym, shopping for food, cleaning their bedroom and visiting their family. One person had prepared a written Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: plan of forthcoming events for the week for their key worker and what support they would require that week. At their person centred plan review people set out personal goals. These goals were kept under review to make sure that they happened. For example one person wanted to start going to the swimming baths in the New Year and it was recorded that this had happened twice. The routines of daily living were seen to be flexible and people said that they were able to choose how they spent their day and what to have to eat. People were supported to be as independent as possible to manage their own money, medication, shopping, meals and mealtimes. There is a house meeting every Monday. Records and discussions showed that people were involved in choosing colours for the decoration of the communal areas of the house and the new carpets. They had also discussed arrangements for Hanukkah and meals. They had requested the use of brighter light bulbs throughout the house. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were actively supported to lead meaningful lives within the community, maintain contact with family and friends and their cultural and religious beliefs were respected. Evidence: The staff team looked at ways of providing opportunities for people to develop practical and personal life skills. For example menu planning, cooking, shopping etc. People led busy lives. On the day of our visit one person had just come in from work, another from college and another person returned home following a meeting with the local mayor. A person who needed more support had been with a staff member to attend an eye appointment. On their return they went to the bank to draw out money from their account and then went out to buy food. People are encouraged to take part in community activities. They were also involved in household tasks and were responsible for keeping their rooms clean and tidy. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: At home people were seen to enjoy pastimes such as watching television, DVDs and listening to music. Two people have computers and had Internet access, which they used, regularly. One person had Sky plus and had kindly recorded a programme for a person who had been out at college and they were watching it together before they had their tea. The atmosphere at the house during our visit was very relaxed and friendly. Staff were observed to respect peoples privacy when entering bedrooms. People said that nobody would enter their rooms without permission and mail was given to them unopened and this was observed. They said that they could choose what time they got up or went to bed and how they spent their time. People were also observed using their own front door and bedroom keys. Most people kept in regular contact with family and friends and spent time with family members at their homes. Personal plans contain a section covering relationships, sexuality and partnerships. Cultural and religious needs were respected. For example, there was an expectation that only kosher food would be brought into the house. Jewish festivals are celebrated. People said that they had choice about what they had for meals. They shopped individually and had their own cupboards in which to store their food. They said that they prepared and ate their meals at the times they chose and the support worker confirmed this. They also said that they were free to make themselves drinks or snacks whenever they wished. On Monday and on Friday evenings for Shabbas, people sat down together to share a communal meal. People living at the home at the Shabbat meal led prayers. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Personal and healthcare needs of people were well met, promoting good health and independent living skills. Evidence: People had lived at the home for a long time and staff are fully aware of their needs and how each individual preferred to be supported. People were able to express their wishes about the way they were supported. It was clear, from discussions with people that they had choice about their daily routines. People were encouraged to be as independent as possible. People were generally self-caring and any assistance from support workers was mainly by encouragement and reminders. Descriptions of individual support needs matched the information recorded. Relationships between staff and people living at the home were seen to be warm, caring and respectful. Interactions between people were very frequent and friendly. People said that they were happy with the way that staff members treated them. There was evidence that peoples health care needs were regularly monitored. People were provided with support to attend regular health care appointments and check ups. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: Details of appointments were clearly recorded on a designated sheet. Specialist services were obtained if necessary. The home had written guidelines covering medication. Good practice was promoted as people were actively encouraged and supported to look after their own medication. Records were kept of current medication as well as risk assessments about their use. We were informed that staff working in the home had completed medication training. We looked at one persons medication and found that important medication had been taken as prescribed. The risk assessment states that staff need to check that medication is taken properly. The person concerned confirmed that staff did check that they took the medication but there was no written evidence to support this. Another medication was prescribed as to be taken daily, but the person was only taking this medication as and when needed. Clarification was needed from the persons GP to ensure that this is right. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Policies, procedures and training were in place to safeguard people from abuse or harm and for taking any concerns, seriously. Evidence: A complaints procedure is in place. The home or we have received no formal complaints since our last visit. A system is in place for recording complaints. People who returned surveys and those spoken with confirmed they knew whom to approach if they had a concern or complaint. In answer to the question do you know who to speak to if you are not happy one person stated, my key worker, staff member or the manager. People also had the opportunity to raise any issues they had at the weekly house meeting. The home had a copy of the local authority safeguarding procedures, which was available to staff. Training in the signs and recognition of abuse is covered during induction and as part of National Vocational Qualification training. Training records showed that permanent staff had attended training. The manager said that she was also planning to access more in depth safeguarding awareness training for the staff team through the local authority training partnership. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a spacious, safe, clean and homely environment that meets their needs. Evidence: The home is an end terrace house in a residential area of Prestwich. Communal space comprises of a lounge, dining room, kitchen, bathroom and two toilets. There are three single bedrooms on the first floor and one on the ground floor. The home has a small, enclosed lawned area at the rear and on street parking outside. There are shops within close walking distance and public transport is available nearby. It is not identifiable as a care home. Two people showed us their bedrooms. Both were very spacious and highly personalised with their own belongings. People had keys to their bedrooms. Both people said that they were very happy with their bedrooms. One person had recently had their bedroom decorated and had chosen the colour scheme and purchased new furniture. Since our last visit some improvements have been made to the home. The bathroom and upstairs toilet have been fully refurbished to good effect. The communal areas have been repainted and new carpets have been fitted. People were involved in choosing the colours for the paintwork and the carpets. Now this work is complete a leather suite and lounge furniture are to be purchased as well as a new dining table Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: and chairs. At our last visit it was noted that an area of damp was visible in the lounge, to an outside wall. The manager confirmed that this matter had been addressed and that the problem had not happened again. Responsibility for cleaning housework is shared between people who live at the home and staff. The home was clean and tidy on the day of our visit. Infection control measures are in place with liquid soap and paper towels provided in toilets. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from a stable and trained staff team and their views and opinions are taken into consideration when new staff are recruited. Evidence: There are currently vacancies for a part time senior support worker and a support worker at the home. The director of operations informed us recently that plans are now in place to trial new employees through a recruitment agency. If the period of employment is successful Outreach will recruit them on a permanent basis to work at the home. An Outreach bank worker to ensure continuity is currently covering the support worker vacancy. In a returned survey a staff member stated, Although the house is short staffed, the manager ensures there is enough staff to meet the needs of the service users by making use of bank staff. The rota confirmed that a regular bank worker was used. No outside agency staff were being used. Support workers work alone at times and on call arrangements were in place. The two support workers holds a National Vocational Qualification Level 2 in care and one of them is keen to undertake NVQ Level 3 in promoting independence. Staff recruitment records are kept at the Outreach Head Office. A sample of recruitment files across all the registered Outreach homes was looked at during a visit to the office in July 2008. In the main recruitment records indicated that all necessary Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: recruitment checks had been undertaken. Employment checks that had been done included obtaining employment histories, written references, medical declarations, photographs, Criminal Records Bureau disclosures and Protection of Vulnerable Adults register checks. A number of issues were raised during this visit including the need to verify references to confirm that the previous employer exists and where appropriate ensure that the registered manager or responsible individual and not a member of staff give the reference. All legal working documentation needed to be in place. We were informed by the director of operations that these issues have now been resolved or are in the process of being addressed. People living at the home will be involved in the selection of permanent staff to be based at the home in the future. We looked at the staff training matrix for the home. Although it was not dated the record showed that the two permanent workers had undertaken all the mandatory health and safety training including, food hygiene, moving and handling, fire safety, first aid, protection of vulnerable adults, health and safety, medication, dementia care, mental health and epilepsy. In addition staff undertake training in Jewish customs and traditions. It is recommended that the dates that training took place are added to the training records. Supervision records were securely held. The registered manager confirmed that these were held bi-monthly. The supervision record looked at was very detailed and an action plan for any points raised was in place. Team meeting minutes were also available. People living at the home can attend the non-confidential part of the meeting if they chose to do so. One person attended the last meeting and all the people living at the home attended the meeting before that. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed and the health and safety of people is promoted. Evidence: The manager is registered with the CSCI. She has worked for Outreach for 17 years and has been a manager for 8 years. She is qualified to NVQ level 4 and holds the Registered Managers Award. She keeps her continuous professional development updated by attending regular training in topics such as the mandatory health and safety and is undertaking a management and leadership course. The manager is also the registered manager for a second Outreach home that is in close proximity. The registered manager confirmed that she had been able to carry out her role and responsibilities at both houses. During the inspection, it was observed that people living at the home and the support worker had no hesitation in approaching the manager if they had anything they wished to discuss. A manager from another home had recently made a formal unannounced quality assurance visit to the home. It was noted that a new format was being used and that Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: it was very detailed and highlights the areas that need improvement. The manager confirmed that an annual review of the service had been undertaken since we last visited and that the response had been very positive. One area of concern had been raised and this was in the process of being addressed through the review process. We looked at maintenance and servicing records for the home and all were found to be in order. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended that the staff team record as evidence when they undertake checks to make sure a person is taking their medication properly. It is recommended that the registered manager confirms with the identified persons GP as to whether a prescribed medication is to be taken daily or as and when needed. It is recommended that the staff training matrix shows the dates that training was undertaken by the staff member. 2 20 3 35 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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