Care Home: Suez Road (128)

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What the care home does well Residents are encouraged to be as independent as possible. An example of this is some residents have completed a `travel skills course`. Risk assessments were on residents` files. These demonstrated staffs` understanding of how residents` needs had changed. Additional measures had been put in place to protect and support residents in undertaking activities, which have a degree of risk. Care plans were innovative, for example, one resident with sleep disturbances, had been referred to `sleep clinic,` for a full investigation rather than assumptions being made about the reasons for disturbed sleep patterns. What has improved since the last inspection? We felt that the home continues to improve and find new and innovative ways of improving the service they deliver. What the care home could do better: We have received a number of recent medication error notifications. Action must be taken to ensure that medication errors do not occur. CARE HOME ADULTS 18-65 Suez Road (128) Cambridge CB1 3QD Lead Inspector Shirley Christopher Unannounced Inspection 11th October 2007 12:00 Suez Road (128) DS0000015168.V353348.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 Suez Road (128) DS0000015168.V353348.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. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Suez Road (128) Address Cambridge CB1 3QD 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) 01223 572158 128Suez@grantahousing.org.uk www.grantahousing.org.uk Granta Housing Society Limited Ms Dinah McLeod Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2006 Brief Description of the Service: 128 Suez Road is a detached house situated in a residential area about a mile from the centre of Cambridge. It is a care home for adults with a learning disability. Accommodation is on two floors and consists of eight single bedrooms, a lounge, dining room, kitchen, two bathrooms, 3 WC’s, and a games room. There is also staff accommodation of an office and a staff sleep-in room with en-suite facilities. There are front and rear gardens. The home is within walking distance of all local amenities. Weekly fees are £350. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, The Commission for Social Care inspection visited the home at 12:00 pm on the 11 October 2007 to carry out a key inspection, where the majority of the national minimum standards were inspected. The Manager completed an Annual Quality Assurance Assessment, (AQAA) which was returned to the CSCI before the inspection. Some of this information received in this document has been included in this report. Other evidence came from speaking to the majority of residents and staff on duty, the manager and a visitor to the home. A number of records were inspected including staff and residents’ records and there was some observation of practices within the home. We did a tour of the home. What the service does well: What has improved since the last inspection? 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. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 6 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 Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 7 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): 2,5 People who use this service experience good quality outcomes in this area. People using this service can be assured that the staff will meet their needs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: We looked at a number of residents’ records, but did not look at the original pre admission assessments as all the residents had lived at the home for many years. Residents’ needs are constantly reviewed and care plans are updated when necessary. The home involves the Learning disability partnership, in the assessment of need. Licence agreements were on file. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 8 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): 6,7,9 People who use this service experience good quality outcomes in this area. Personal plans demonstrate how residents are encouraged to maintain their independence, with due consideration for the risks involved. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: We looked at two residents’ records and spoke to these residents and the staff who support them. The residents have lived at the home for twenty-four years and have formed close friendships with each other. They have links with family members and the local church. Care plans were informative and showed that the home regularly review and revise residents care plans. They involve other agencies where appropriate. There was a pen portrait on file, which looked at the emotional support a resident may need, their communication and independent living skills. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 9 Risk assessments were comprehensive and aimed to promote independence rather than stifle choice. One risk assessment looked at the risk to a resident from choking. One of the recorded actions was if the resident was chocking to use the Heimlich manoeuvre. The manager stated this would be used as a last resort. A sample of staff records showed that some staffs’ first aid training needed updating. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 10 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): 12,13,15,16,17 People using this service experience excellent quality outcomes in this area. Residents are given opportunities to participate in appropriate activities and to be part of the local community. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We, through case tracking were able to get a picture of what life is like in the home. The residents are able to access local facilities and use public transport. A number of residents’ physical and mental health has declined and this has been recognised by the home. Risk assessments are robust to ensure appropriate steps are in place to safeguard residents wherever possible. Care plans seen addressed ‘inappropriate’ behaviour. These were clearly described and appropriate measures and risk assessments put in place. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 11 Care plans were in place for residents’ palliative care needs and there was evidence that residents and their families had been asked about what their last wishes would be. We spoke to most of the residents. Four were at home during the inspection and other residents were met as they returned from different day activities. One resident had been playing in a football team; another resident was going to an evening class, another to keep fit. One resident has retired but goes to a group one day a week run by the local church. One resident works at the local Sainsbury’s. One resident is at home throughout the day and has different activities to participate in. On the day of inspection a man accompanied by his dog arrived. He was part of the ‘pat a pet’ scheme. This appeared to bring mutual benefit to the residents and the volunteer alike. Privacy and dignity is respected. Staff were observed interacting appropriately with residents. Consent was on residents’ files for National vocational qualification (NVQ) observations to be carried out, essentially on staff as they work with residents. Residents had their own front door and bedroom door keys. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 12 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): 18,19,20 People who use this service experience good quality outcomes in this area. Personal care is given in an appropriate way and residents’ physical and emotional health care needs are met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Residents are supported in accessing appropriate health care. A number of residents were thought by the home to be displaying the early on set of dementia. This is being fully investigated by the relevant health specialist. The manager and senior attended a conference in June with regards to supporting people with dementia. It has been identified as a training need for care staff through their annual appraisals. Gender specific care was addressed by one of the care plans seen. The manager stated that a senior member of staff audits the medication and ensures that residents’ medication is reviewed. The manager stated that the prescribing pharmacist do not audit medication. Medication records were checked in respect of the two residents being case tracked. Records were Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 13 accurate. There have been two occasions recently where medication has been administered incorrectly. The home followed the correct procedures. The safe administration of medication was discussed with the staff and the manager. We felt that a disproportionate amount of time is being spent administering medication. Staff confirmed that medication could take up to an hour to administer. There were only two members of staff on duty on the day of inspection. A lot of the medication was not in blister packs, but stored separately and included creams and inhalers, making administration quite a complex task. One staff member cited a change in residents’ needs and an increase in medication as a concern. It was pleasing to see that there was a current list of medication for each resident, as well as a description of the medication and the benefits and potential effects of the medication. Monthly weight charts are kept and sample menus were seen which showed that residents are offered a healthy balanced diet. We looked at two care plans, which had details of residents’ last wishes. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 14 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): 22,23 People who use this service experience good quality outcomes in this area. The home has adequate systems in place for ‘safeguarding’ adults. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were informed that the home has not received any complaints we haven’t received any complaints either. The home has an adequate complaints procedure and an adult’s protection policy. Staff have received training in the protection of vulnerable adults. This should be updated for some staff who have not had training for several years. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 15 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): 24,30 People who use this service experience good quality outcomes in this area The residents live in a clean, comfortable environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We had a tour of the home. The home appears to be appropriate to residents needs, but may require adapting in the future, as the residents get older. The ground floor is accessible, but there is a step to the games room, which is marked by tape. The games room had been newly painted and was not fully functional. There are bedrooms both on the ground floor and the first floor. There was a separate lounge, a dining room and a separate kitchen. The outside space was enclosed with a patio area and pots of plants. On the day of inspection none of the residents had been identified as having mobility difficulties and no specialist equipment was considered necessary. There were two bathrooms, one with a separate shower. The space in this Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 16 area was limited and one of the baths had a bath seat and rails. The manager stated that occupational assessments are carried out when necessary. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People who use this service experience good quality outcomes in this area. The home is managed in the interest of residents and staff are well trained and supported. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The current staffing arrangements were confirmed with the manager. She stated that there was one full time and one part vacancy, but she was interviewing the following week. The home use an agency to cover any care hours, which cannot be filled by their own bank staff. On the day of inspection there were two staff on duty, one being the manager. The manager stated that there would usually be three staff on shift, and one person sleeping in. There is a domestic and a person employed to do the ironing. At night a monitoring device is used. The manager stated that consent is sought from residents for its use, although written evidence of this was not seen. There are also pull cords on both floors and the landing. Staff spoken to stated that they are not disturbed at night. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 18 We inspected four staff files, including agency staff. The home receives a profile of agency workers, including their experience, background, appropriate checks and relevant qualifications. They also complete an induction when they first arrive to the home. The other staff files showed evidence of induction, training, supervision and appropriate pre requisite employment checks. We spoke to staff on duty and they confirmed that they were well supported and were adequately trained, receiving both mandatory training and training specific to the needs of the residents, examples being; challenging behaviour, death and dying and self harm and suicide. Staff had completed equality and diversity training. Some staff needed a refresher course in the protection of vulnerable adults, (POVA.) The manager was asked to consider requesting new CRB checks on staff who have been employed for some years. This is not mandatory, but good practice. We saw evidence of detailed staff supervision records, which are carried out every two months. Appraisals are also carried out. Some documentation was not seen on staff files such as one file only had one reference and no induction record, but this was for a staff member who had been employed at the home for many years. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People who use this service experience good quality outcomes in this area. Residents benefit from living in a well managed home, which actively listed to residents and staff and bring about improvements where identified. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home was well organised and well managed. This was evidenced thought the discussions held with the care staff on duty, observations and the records inspected. The manager also completed a detailed Annual Quality Assurance Assessment. This was well written and clearly highlighted the strengths of the service and potential for improvements. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 20 Granta review their performance by using staff questionnaires, which look at the purpose of the job, budgetary constraints, client factors and environmental factors. They also use resident questionnaires, which are audited independently The manager stated that regular staff, and separate resident meetings are held. A number of records were seen and these were satisfactory. They included; water temperatures, tests for legionnaires disease, portable appliance testing, five-year electrical checks, in-house weekly health and safety checks, gas safety records. Finance records were seen in respect of the residents who were case tracked. The staffing rota was seen and the manager was advised that correcting fluid must not be used, as this is a legal document. Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 X 4 X 5 3 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 X 26 x 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 X X 3 X Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Evidence must be provided that there are adequate systems in place for the safe storage and administration of medication, including evidence of regular drug audits. Timescale for action 30/11/07 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 YA23 Good Practice Recommendations CRB checks should be renewed for staff who have been employed at the home for a long time, And would have had CRB checks before the introduction of the POVA register. Refresher POVA training should be carried out for some staff. Correcting fluid should not be used on the staffing rota. Risk assessments state that staff should use the Heimlich manoeuvre if a resident is chocking. Staff should receive training, if this is an appropriate course of action. Risk assessments where appropriate should be drawn up in consultation and agreement of a multi disciplinary team. 2. 3 4 YA41 YA42 YA42 Suez Road (128) DS0000015168.V353348.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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