Care Home: Outreach Community & Residential Services 2 Devonshire Place

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Outreach Community & Residential Services 2 Devonshire Place 2 Devonshire Place Prestwich Manchester M25 3FF two star good service The quality rating for this care home is: 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 8 1 1 2 0 0 8 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 Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Outreach Community & Residential Services 2 Devonshire Place 2 Devonshire Place Prestwich Manchester M25 3FF 01617989023 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) Wendy Ann Hardman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 2 1 1 care home 4 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The home is registered for a maximum of 4 service users, to include: Up to 2 service users in the category of MD (Mental Disorder under 65 years of age); Up to 1 named service user in the category of MD(E) (Mental Disorder over 65 years of age); Up to 1 named service user in the category of LD(E) (Learning Disabilities over 65 years of age). That the service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection A bit about the care home Devonshire Place is one of a group of care homes managed by Outreach care services. Outreach is a charitable organisation offering 24-hour care, predominantly to Jewish people with learning disabilities or mental health needs. 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 How we did our inspection: This is what the inspector did when they were at the care home Our visit took place over four hours. We looked around the house and checked some paper work about the running of the home and the support people receive. We talked briefly people who live at the home as well as the manager and a support worker. We also asked the manager to send us information about the home. We sent out questionnaires to people so they could tell us what the service was like. What the care home does well What has got better from the last inspection People are being encouraged to do more jobs around the house. There is a new settee and chairs in the lounge and some parts of the house have been decorated. What the care home could do better 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 33 Greycoat Street London SW1P 2QF 02079792000 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 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 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 . Before moving into the home people are assessed to ensure that their needs can be safely met and that they get on well with the people already living there. Evidence: No new people have moved into the home since our last visit. The people living at the home have lived together for a very long time and their original assessments have been archived. There are no plans for anyone to leave or move into the home at this time. There are policies and procedures in place to ensure that if there were any future admissions an appropriate assessment would be undertaken. Compatibility with people already living at the home would be taken into account. The manager said that people got on reasonably well for most of the time and had learnt to tolerate each others different ways. We were informed that all the people living at the home had had reviews this year. However we were concerned that one person with a high level of need did not appear to have had a routine CPA review for sometime and there was a possible conflict in information held about this persons status. The manager agreed to check this out to see if the person required a review. 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 had started to become more involved in developing their person centred plans to ensure that they were in agreement about their support needs and personal goals. Evidence: Two care plans were examined. These were seen to be person centred and covered areas such as personal care, diet, social contact, skills, competence, decision making and informed choice, individuality, dignity and respect, continuity, religion and culture, independence, relationships, sexuality and community presence. There was a lot of information about people and this was reviewed regularly. A daily record was also made about what people had been doing during the day. The manager was in the process of updating the guidelines for people to ensure that support workers were clear as to how people were to be supported. The manager said that there was a need for people to become more involved in developing their person centred plans and a need to evidence this. Risk assessments were in place, for example whether people were safe to stay in the home unsupervised for short periods of time or whether they were able to take their medication safely. There were also behavioural management strategies. Where restrictions were in place a healthcare professional was aware of the arrangements. House meetings take place every week. People talked about what they wanted to eat and the complaints procedure to ensure that they knew what to do if they were unhappy about something. People wanted to have a party to celebrate Hanukkah and this had been arranged. People signed memos from the organisation and were starting Evidence: to become involved in looking at policies and procedures and recruitment. The daily routines were observed to be flexible. For example a person was observed getting up in the morning at a time that suited them and to choose how they spent their day. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are actively supported to lead meaningful lives within the community, maintain contact with family and friends and their religious and cultural needs are respected. Evidence: Peoples independence is promoted whenever possible to develop practical and personal life skills. For example, shopping, washing up and setting tables, changing beds etc, with support as necessary. Two people have been referred to an occupational therapist for assessment to help them gain more independent living skills. People are involved in a range of individual community based activities. They use public transport to access community facilities. People living at the home are involved in attending college and day centres, visiting family and friends, working in charity shops and going for meals out. People also attend the contact and leisure group in the evening. On the day of our visit three people went out with a volunteer to a local cafe and the fourth person went out for lunch with a relative. In the afternoon one person went out for a bus ride and another enjoyed watching an old film on the television. 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 and some people regularly attend Shull. Members of the staff team were observed to respect peoples privacy when entering bedrooms and the bathroom. Nobody entered their rooms without permission. Evidence: Interactions between members of the staff team and people were observed to be frequent and friendly. People spoken with said that they liked the staff who supported them. Most people kept in contact with family and friends. Some regularly spent time with family members at their homes. The manager said that relatives and friends were welcome to visit the home at any time. People said that they had choice about what they had for meals. People are encouraged to assist in the preparation of a meal, and making a meal without staff assistance, particularly breakfast and lunch, where possible. Their are communal meals for Shabbat and throughout the weekend and evenings. The home was well stocked with food and the manager said that she was introducing more home cooked meals. People are more involved in deciding what they want to eat and shopping for food. 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 . People are encouraged to remain as independent as possible in their personal care needs and have regular checks with healthcare professionals to promote good health. Evidence: People are encouraged to be as independent as possible and to do as much personal care for themselves as they can. Assessments and care plans contain a lot of information about peoples preferences and chosen lifestyle. Everyone had lived at the home for a long time and the staff team were aware of their needs and how each individual preferred to be supported. Relationships between staff and people living at the home seemed warm, friendly, caring and respectful. There was evidence that the peoples health care needs are regularly monitored. People are provided with support to attend regular health care appointments and check ups, details of which are recorded clearly in a designated sheet. Specialist services were obtained if necessary. The manager spoke knowledgeably about the emotional needs of the people and how to respond to any problems. At the last inspection it was required that a persons weight needed to be monitored regularly. It was observed that this person still appeared to be underweight. This person has seen a dietitian, who had told the staff not to weigh the person but there was no written evidence to support this. Weight checks must be made regularly to ensure that the persons weight remains stable and to help determine whether any further action needs to be taken should weight loss continue. The requirement is therefore repeated. The home had medication policies and procedures. Medicines that were kept in the home where stored in a locked cabinet. No one looked after their own medication. No Evidence: issues were found in the recording and administration of medication. However we did find some homely remedy suppositories that had not been prescribed and that support workers had not been trained to administer. It was agreed to destroy them. Also PRN paracetamol for two people was found to have recently expired. The manager said that this had happened in error and that new medication had been returned to the pharmacy by mistake. The manager addressed this problem immediately. 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 are in place to help safeguard people from abuse or harm and for taking any concerns people have seriously. Evidence: A detailed complaints procedure and a system for recording complaints is in place. No formal complaints have been received by us and no complaints have been made directly to the home since our last visit. In a returned survey a person living at the home said that they did not know who to speak to if they were unhappy or wanted to make a complaint. However it was noted that the complaints procedure was discussed at a recent house meeting. The complaints procedure is also available to people in the form of a CD that they can listen to. One allegation of abuse has been made to the home sometime ago. This was dealt with by the local authority and no action was required. There have been no further safeguarding issues at the home. All staff have done safeguarding training or have been identified to attend in the near future. This must be done to ensure that support workers are clear about what action to take in the event of an allegation being made or witnessing an incident. The manager has attended the two day Safeguarding Adults Investigating Officers course. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provides a comfortable and clean environment for people to live in but a number of health and safety matters need to be addressed to ensure their safety. Evidence: The home is situated in the centre of Prestwich village, close to bus and tram routes, shops, banks and synagogues. The house is a large terraced home, similar to other properties in the area. It is not identifiable as a care home. Outside there was a small car parking space at the front and an enclosed yard at the back. The lounge, dining room and kitchen were furnished and equipped in a homely way. The home was generally found to be in good order. There are plans in place to upgrade parts of the home in the near future but the maintenance and renewal programme could not be located at the time of our visit. The lounge suite has recently been replaced and the lounge has been decorated. People said that they liked the house. There is a separate laundry area. There is a need to have a smoke detector in this area as the washer and dryer are situated on a means of escape route out of the home in the event of a fire. The home still does not have any emergency lighting and this was a fire safety requirement by the fire officer in 2006 and a recommendation at our last visit. All the people living at the home have access to torches in their bedrooms. Bedrooms were seen to be fitted with mortice locks. This type of lock would not allow staff members access in the event of an emergency and they need to be changed. The stair carpet was torn on a step and was presenting a trip hazard to people. The home purchased some non slip tape to cover the area. The manager said that plans were in place to replace the stair carpet after the hall, stairs and landing had been decorated. There is a bathroom with toilet on the first floor and a toilet on the ground floor. To improve control of infection practises the ground floor toilet needs to be fitted with a Evidence: hand wash basin and paper towels and liquid soap needs to be provided. Standards of cleanliness were good. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home would benefit from a staff team who had received training around their specific mental health needs. Evidence: On arrival at the home the manager and two support workers were on duty. One support worker was about to go off duty following a sleep in. There have been one full time and one part time vacancy at the home for sometime. No agency staff have been used to cover the shortfalls. Hours have been covered by a regular bank worker who was formerly the registered manager for the home and the two existing support workers. Although this provides good continuity for people living at the home the rota did show that a support worker was working for a long period without a day off. The director of operations, who attended the feedback, said that the vacancy situation had recently been resolved. Agreement had been reached with an agency to supply the organisation with support workers who if they proved to be competent would be taken on permanently by them. On the basis of this information a requirement has not been made. Both support workers hold an NVQ Level 2 and one also has NVQ Level 3. There are gaps in the mandatory training. However it was clear from discussions with the manager and the support worker that shortfalls were in the process of being addressed. Mandatory training includes moving and handling, food hygiene, safeguarding vulnerable adults, medication, infection control, first aid and fire safety. The staff also need to have mental health training around peoples specific needs to ensure that they understand them and help them support people effectively. This was a recommendation at our last visit and does not appear to have been addressed. In addition staff undertake training in Jewish customs and traditions. Staff recruitment records are kept at the Outreach Head Office. A sample of recruitment files across Outreach homes was looked at during a visit to the office on Evidence: 30th July 2008. In the main recruitment records indicated that all necessary recruitment checks had been undertaken. Employment checks that had been done included obtaining a photograph, employment histories, written references, medical declarations and a Criminal Records Bureau disclosure. Records showed that in the main gaps in their employment records had been looked into. However more attention was needed to be given to verifying 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 must be in place. We were informed by the director of operations that this process was being addressed by the relevant authorities and therefore a requirement has not been repeated in this report. It was noted that the longstanding volunteer had not been checked. The director of operations said that action would be taken immediately to address this matter. We checked the supervision records for one support worker. Supervision was seen to happen regularly and the records kept were detailed. A staff meeting had been due to be held on the day of our visit. 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, with quality monitoring systems in place enabling a regular review of the service received by people. Evidence: The manager has worked in social care for the last 20 years. She has worked at Outreach for 8 years and in a managerial capacity for 5 years. The manager has completed NVQ Level 4 in care and the Registered Managers Award. She keeps updated by attending regular training in topics such as the leadership and management course, medication, Parkinson awareness, dementia and the safeguarding Investigating Officers course with Bury Partnership. The manager is also the registered manager for a second Outreach home. She said that now the staffing issues at both homes appear to have been resolved she would be able to manage both homes effectively and safely. It was clear from discussions that the Registered Manager encouraged an open, inclusive atmosphere within the home. During the inspection, it was observed that people living at the home and their support workers had no hesitation in approaching the manager if they had anything they wished to discuss. A Regulation 26 visit had recently been undertaken by the quality assurance manager. The new report format is very detailed and the manager was clear about what needed to be done to address identified matters. Surveys have recently been sent out to people living at the home, their relatives and health and social care professionals to find out what they think about the service and how it might be improved. A good response has so far been received. Evidence: We checked maintenance records, which were generally in good order. We did ask the registered manager to check out the NICEIC certificate as it was valid for 10 years when 5 years is usually the norm. Fire records were in good order but the home still did not have emergency lighting as identified in environment section of this report. 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 1 19 12 (1) (a) The registered person must 31/07/2007 ensure residents weight regularly monitored when concerns relating to nutrition have been identified. 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 1 24 23 The registered person 09/01/2009 following a report from the fire officer must fit emergency lighting. A smoke detector also needs to be fitted in the laundry area that is adjacent to a means of escape. This needs to be done to ensure people can see to escape in the event of a fire and give early detection of a fire. 2 26 13 The mortice locks on peoples 09/01/2009 bedroom doors need to be replaced with a lock that can allow support workers access in an emergency. This needs to be done to ensure peoples health and safety. 3 27 13 A handwash basin needs to be fitted in the downstairs 09/01/2009 toilet. This needs to be done to improve control of infection practises. 4 35 18 The registered person must 30/01/2009 ensure that support workers receive mental health training specific to the needs of the people they support. This must be done so that support workers understand peoples individual needs and enable them to support people safely and effectively. 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 2 It is strongly recommended that the registered manager checks out the CPA status for an identified person and whether a formal review is needed. It is strongly recommended that people are more involved in developing their person centred plans and guidelines to ensure their agreement and that this is evidenced on the plan. That support workers received the planned safeguarding training to ensure that they know what action they need to take in the event of an incident or an allegation being made. That the NICEIC certificate is checked to ensure that it is still valid. 2 6 3 23 4 42 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 © (2008) 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. 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