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Inspection on 25/06/09 for Castle-Ford

Also see our care home review for Castle-Ford for more information

This is the latest available inspection report for this service, carried out on 25th June 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service now provides improved information to people looking to move into a residential care home. It provides an improved and better assessment of diverse and individual needs, and it informs staff of how these needs should be met in a person centred plan of care, that accounts for risks to be taken, and encourages self-determination. The service offers good opportunities to indulge in activities within the community or in the home, encourages and facilitates appropriate relationships and respects and recognises people rights and responsibilities. It also provides satisfactory foods at appropriate times and in an acceptable setting. The service gives good support and personal care to people in the way they prefer and choose, and physical and emotional needs are well met because of this. The service also provides a robust system for handling medications and safeguarding people form the risk of harm from taking the wrong medicines. The service listens to people`s views when they complain and tries to resolve problems quickly and it has good systems in place to protect people from abuse, neglect or self-harm. The service generally offers a homely, comfortable and a safe environment to live in, that is clean and hygienic. The people in the home are cared for and supported by qualified, well recruited and trained staff in sufficient numbers to meet heir needs. The service is well run, for the benefit of people in the home and uses their views to underpin self-monitoring, review and development of the service. The service ensures the health, safety and welfare of people and staff are promoted and protected.

What has improved since the last inspection?

All of the requirements made at the last key inspection have been met with the exception of two and these have been moved into the recommendation section of the report. The required areas where action has been taken, showing an improvement since the last inspection, include assessing of needs, encouraging selfdetermination, offering more activity and pastimes, decorating some of the home, increasing the staffing levels, using recruitment systems more carefully, making sure staff completes planned training and ensuring staff undertake fire safety training drills. The recommended areas where action has been taken, also showing an improvement since the last inspection, include reviewing of the statement of purpose, improving the opportunities to lead more independent lives, ensuring Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 complex health care needs are screened and met, that staff have undertaken updated medication administration and safeguarding adult`s training, implementing of the new complaint procedure, updating the maintenance renewal programme, providing of mandatory training, notifying the Commission of regulation 37 incidents, the manager completing a management course and improving the quality assurance system.

What the care home could do better:

The service could try to implement the new menus again and offer more home cooked foods where possible, so people are confident they are well nourished and their good health is promoted. It could make sure staff administering medicines use the correct omission codes on MAR sheets, so people are confident drugs are being administered safely and according to procedures and legislation. The service could continue to make efforts to eradicate the damp odour from the double ground floor room, so people have a pleasant environment to live in, redecorate bedrooms as identified and redecorate the lounge and television room, so people have a pleasant environment to live in and continue to make sure the garden is maintained and the fencing and gate is repaired, so people are able to use it safely. The service could also continue to provide staff with mandatory and other related training to skill and equip them to care for people with complex learning disabilities and associated conditions and especially ensure records of such are dated and signed, so people know their needs are met. And finally it could make sure the quality assurance system includes other information from areas of the service that are monitored, such as reviews, staff training, staffing levels etc. He should also make sure any surveys sent out to people, relatives and staff are dated on return and a signature obtained if possible so they can be authenticated. All this is so people are confident their views are underpinning the self-monitoring, reviewing and developing of the service.

Key inspection report CARE HOME ADULTS 18-65 Castle-Ford 46-48 Princes Avenue Withernsea East Riding Of Yorks HU19 2JA Lead Inspector Janet Lamb Key Unannounced Inspection 25th June 2009 09:20 Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle-Ford Address 46-48 Princes Avenue Withernsea East Riding Of Yorks HU19 2JA 01964 613164 01964 612412 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) Mr John Frederick Wright Christine Wright, Mr Mark Anthony Wright, Duncan Joseph Wright Mr Mark Anthony Wright Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 29th July 2008 Brief Description of the Service: Castle-Ford is a privately owned registered home catering for the needs of 18 people who have a learning disability. It is located in the seaside town of Withernsea and is within walking distance of the local shops and public transport. The home consists of three terraced properties converted into one building. There is a reasonably private garden and adjacent car parking. Accommodation consists of several lounges, an activities area, a sensory room, 4 double rooms and 10 single rooms none of which have en-suite facilities. There is no stair lift or hoist in the home, people who have mobility problems are situated on the ground floor and have access to bathroom and toilet facilities on the ground floor also. The home does not provide nursing care. The fees charged are £376.50 per person per week. An additional charge is made for one-to-one support where arranged with the placing authority or arranged privately and for newspapers/magazines, hairdressing, chiropody, and sweets. Information on the service is made available to people via the statement of purpose, service user guide and inspection reports upon request from the manager. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2-star. This means the people who use this service experience good quality outcomes. The Key Inspection of Castleford has taken place over a period of time. It involved electronically sending an ‘annual quality assurance assessment’ (AQAA) document to the home May 2009 requesting information about people and their family members, and the health care professionals that attend them. It also asked for numerical data held in the home. We received the requested information on 8 June 2009 and ten survey questionnaires were sent out to people in the home and six to the staff. Information received in fifteen questionnaires returned to us, from other sources over the last year and in notifications received from the home gave us an idea of what it must be like living in the home. Then on the 25th June 2009 Janet Lamb, visiting Inspector, carried out a site visit, to check out all of the information the Commission has received since the last key inspection and to ask people living there what it is really like. Several people living in the home, the manager, staff and visitors were spoken to and some interaction between people and between people and staff was observed. The communal parts of the home were inspected, and a small number of bedrooms were viewed with people’s permission. Care plans and all other documents relating to people, risk assessment documents and some records, etc. were read and staff files and training records were seen. All personal and private documents were only seen with the permission of the people they belong to. Safety maintenance certificates and records were also viewed. Requirements and recommendation made at the last key inspection were checked for compliance and action. This report is a summary of all the information viewed and obtained. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? All of the requirements made at the last key inspection have been met with the exception of two and these have been moved into the recommendation section of the report. The required areas where action has been taken, showing an improvement since the last inspection, include assessing of needs, encouraging selfdetermination, offering more activity and pastimes, decorating some of the home, increasing the staffing levels, using recruitment systems more carefully, making sure staff completes planned training and ensuring staff undertake fire safety training drills. The recommended areas where action has been taken, also showing an improvement since the last inspection, include reviewing of the statement of purpose, improving the opportunities to lead more independent lives, ensuring Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 7 complex health care needs are screened and met, that staff have undertaken updated medication administration and safeguarding adult’s training, implementing of the new complaint procedure, updating the maintenance renewal programme, providing of mandatory training, notifying the Commission of regulation 37 incidents, the manager completing a management course and improving the quality assurance system. What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. The use of a good ‘needs assessment’ document means that potentially people’s diverse needs are identified and planned for before they move to the home. This means people are fairly confident their needs will be met and staffing levels now enable needs to be well met. EVIDENCE: Discussion with people in the home, the manager and staff and viewing of files and documents with permission from the people they concern, and information in surveys, shows people have satisfactory assessments of need carried out, and those needs are now well met. The ‘statement of purpose’ and ‘service user guide’ was not assessed at this inspection, but we are informed they have been updated to include the new complaint procedure, and need further updates to show staffing changes. They continue to be fluid documents. They are also to be produced in a new format that is more accessible to people in the home. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 10 People are now given a detailed assessment of their needs covering such as personal care, health care, communication, social needs, religion, culture, behaviour, safety etc. Everyone in the home has been re-assessed since the last two key inspections with their placing authorities and documents are available as evidence that needs are now well assessed and documented. There is an assessment form in place compiled by the home to ensure any new person is equally as well assessed. The homes assessment contains fifty areas of need from mobility, dressing self, ability to change own clothes, continence etc. to diet, concentration level, ability to handle finances, sporting ability, religious belief, social interaction, behaviour, motivation, family contact etc. and has a simple tick box scoring of 0 – 5. The home also uses a checklist that contains 27 activities from watching television, doing craft work, receiving visitors, attending day centres, etc. to visiting museums and social clubs, going to parties, shopping, playing cards and board games, etc. Neither form provides opportunity for written comments though. The home provides written documentation that people’s assessed needs can be met by the competence and skills of the staff group, as required of regulation 14(1)(d), though no one has been admitted for some years for it to be used yet. Staffing levels have increased since the last inspection to enable needs to be met and people confirm they are doing more, receiving more support and enjoying more freedom and activities. There are also risk assessments on such as mobility and assistance with moving, falls, medications, senses, medical conditions etc. Those seen have dates ranging from 2006 to 2009 and all have evidence of being reviewed. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Peoples who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People enjoy making many of their own decisions in life, with good risk assessments enabling them to lead lives of reduced risk. Good person centred care plans are in place for everyone to reflect needs better and these are appropriately reviewed as requested, necessary or in line with the requirements of the providing authority. EVIDENCE: Discussion with people in the home, the manager and staff and viewing of files and documents with permission from the people they concern, and information in surveys shows people have their individual needs and choices well documented and met. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 12 There are detailed person centred care plans in place that reflect individual diverse needs of people and which direct staff to provide the support and care people require. Care plans cover health issues and health input from professionals, a personal history, assistance with personal care, daily routines, social activities, communication, religion and culture, a bereavement plan, behaviour, safety, finances, and relationships. Care plans also have accompanying records of such as diary notes, outings, time spent one-to-one with staff, time spent with key workers, behaviour or mood charts, financial balance sheets, details of appointments with health professionals, weight monitoring, and monthly monitoring forms. There is evidence people have been involved in their care plans in the form of signatures and dates. Care plans are reviewed twice yearly in conjunction with placing authority requirements and are also reviewed internally from the time of their completion. Evidence is available in the form of review minutes and revised notes in care plans. People are encouraged to make decisions of their own on a daily basis, an improvement since the last inspection, but they still require some guidance. There is observational evidence of people being asked about their personal care needs, about activities they wish to do and of making their own decisions. One person was seen asking to go buy CDs, one was observed just after being assisted with a shower, and one was observed deciding to take a shower himself. Two were seen going for fish & chips during the break in the rehearsal of a concert, we went to watch. Everyone involved in the concert very willingly took part in the rehearsal and enjoyed it very much. Some of the activity plans and records and diary notes were viewed and these also evidence new involvement in busy lifestyles and decision making for people. People were observed taking risks. People using the stage at rehearsals were going up and down steps and negotiating chairs etc. People standing outside the community hall were smoking or chatting, and two went to the fish and chip shop on their own, crossing roads etc. Risk assessment documents were viewed in files and evidence that risks are allowed. Dates of documents run from 2006 onwards and have been reviewed annually since then. They include assistance with moving and mobility, falls, use of medicines, poor vision and medical conditions for the two files. All risk assessments are pertinent to individuals. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People now enjoy an improved and good level of support and protection with their health care and personal care, and with administration of their medicines. This means people know their care and health care needs are met. EVIDENCE: Discussion with people in the home, the manager and staff, and viewing of files, records and documents with permission of people they concern shows there has been much improvement for people over the last few months in respect of their lifestyles and personal fulfilment. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 14 The manager informs us some people attend the local adult education centre now for computer, literacy and numeric courses. Also there is a Wednesday social club attended by many and there are other visits out to cafes, pubs and local shops on a daily basis. The local community is used even more than before and now on an individual basis for people. People in interviews say they are going camping for a few days at very low cost, that one person is already on holiday and is soon to return. They say they are using local shops, cafes and churches, and that they often visit the sister home. They say they are going out more, enjoy doing in-house activities with the newly employed activities coordinator, and look forward to other planned projects. The coordinator says there is a trip planned to Twycross Zoo Tuesday next. Also that the sensory room is greatly used and people have hand and foot massages. People also do puzzles and jig saw, sing, bake and cook, make ‘smoothies’ and listen to audio novels. The coordinator consulted people and produced activity plans and records for monitoring the success of activities. She has taken over a small thru-lounge as the activities room and is following themes for people to read up on and learn about. People are then doing practical tasks in connection with each theme, such as agriculture and food and growing plants and vegetables from seed. People are soon to have the rear garden opened up, cleared and cultivated and a greenhouse put up to grow foods for consumption in the home. Another theme looked at is people and relationships and people in the home have made their own jig saws from photos of themselves. We saw items that have been produced as well as the plans and evaluations. We observed people being more animated, lively, interested and willing to talk about activities, than on the previous two inspections. We saw people rehearsing a concert, by far the biggest project undertaken. This is to be performed for family and friends only next week. Costumes have been hired, scripts produced and lots of rehearsing is going on. Some staff are also doing numbers with people from the home. From observations made on the day people seemed to be very much enjoying themselves, as they smiled a lot and looked comfortable on stage singing and dancing. People also say they see their family often, visit them for tea and stay over and all families are to be invited to the concert next week, while phone calls are made to them to keep them informed of illness, accidents etc. We observed people being more relaxed, more tolerant of each other, relating more as a family unit and sharing in the fun and hard work. Some people were demonstrably caring towards others. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 15 We viewed case files and evidenced details of friendships and arguments in diary notes and behaviour/mood charts. As for the daily routines within the home we observed one person being assisted with hair drying after her shower, others making decisions for themselves, and almost everyone getting ready to go out to rehearsal. Lunch time plays a particular role but even that was only a necessity that had to be fulfilled. One person was seen taking clothes to the laundry after his shower, two were seen eating late breakfast and one was observed going to the local shops. It seems that since the activities coordinator has been employed and lots of new projects and pastimes have been put in place, people are more interested in these than in the daily routine, which is now less important and done as a necessity to be ready for the day and activities on offer. The focus for people has changed from the daily personal care routine being the event of the day to activities taking that priority. There is also much more interaction between people and staff now. People have good access to their bedrooms and the rest of house that is communal space, and any chores they do are specified in care plans. People say they can have keys to their room, open their own letters and are called by the name they prefer. Much of this was viewed in care plans and diary notes as confirmation of the above. Discussion about meals and mealtimes with people shows they enjoy the food and usually eat what they choose. There has not been much change to this area of the service since last year. The home did try to introduce new menus and healthy eating but it proved to be very expensive and some of the menus have reverted back to how they were. Lunch is usually a light sandwich or soup etc. and dinner is in the evening, a hot cooked meal sometimes and processed others. There has been no real discussion or checking of meals on this site visit, but people did not feel sufficiently strongly enough to make any adverse comments. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People now enjoy an improved and good level of support and protection with their health care and personal care, and with administration of their medicines, so they know their care and health care needs are met. EVIDENCE: Discussion with people in the home, the manager and staff, viewing of files, records and documents, and observing practices shows people have much improved personal and health care support since the last inspection. We observed that people are receiving care how they seem to need it, as staff know them well. Advice is offered to those self caring on such as personal hygiene and care. People choose their own clothes, and how they want help. We saw the medicines storage and medication administration record sheets. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 17 We were unable to observe medicines being given out because no one has any at lunch time except for one person that uses an inhaler. Viewing of files and records took place for evidencing the personal care and health care and support that is given. Daily diary notes show when people are assisted with bathing, dressing, use of the toilet, feeding and so on. Files have records for personal support, professional support to maintain health, weight charts, as needed medication protocols, daily routines, 1-1 time, health monitoring forms, and separate health action plans. Health action plans are now very detailed and person centred. They were compiled following a visit by a health care professional from the local GP surgery and with help from East Riding Health Authority. As part of this some people needed health screening. One person has completed her own health action plan and even typed some of it up. These plans cover medication, illnesses, chiropody, dental and optical and audio needs, sun protection, elimination, mobility, flu injections, weight, seizures and so on. Viewing of medication administration record (MAR) sheets and other medication records evidenced that people are well supported in taking medication safely. Staff medication administration training details, courses done with Leeds College over three months and completing of a booklet, evidences the training and competence of staff to give out drugs. Also Boots Chemist is now used for dispensing in a monitored dosage system and a representative from the company has been to view storage facilities. A new drugs cabinet and fridge are to be provided, and training is being offered but only new staff will do this. There is only one shortfall in the medication handling systems and this is that omission codes have not been used on the MAR sheets, so this report is recommending omission codes be used properly when someone refuses it or is not available to take it. Discussion with the manager confirms the information about people’s support needs, health care issues, handling of medications and staff medication administration training. People also say they are well looked after, have appointments at hospital and with their GP, and are improving in their general health. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People and their relatives have access to good complaint and protection systems within the home, which have been improved. They are confident their concerns are dealt with appropriately and that they are protected from harm or neglect. EVIDENCE: Discussion with people in the home, the manager and staff, and viewing of records and documents, with permission shows the systems for making representation and complaints and for protecting people from harm are appropriate and should now be effective. There is a newly devised complaint procedure in place that everyone has been informed of. The statement of purpose also contains this information. People say they know who to go to if they are unhappy about anything and demonstrate confidence in speaking to any member of staff at any time. People sometimes make their views known without realising they are actually complaining. Issues are sorted as quickly as possible to prevent dissatisfaction escalating. There is a record of complaints held though none have been received since the last inspection according to information on the AQAA and from the manager. No one makes any adverse comments about the service of Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 19 care and support provided and generally people are satisfied with the home they live in and the support they receive. People were observed discussing issues as they arise, and minor problems were resolved quickly through this discussion and negotiation with staff. There is a safeguarding adult’s procedure for staff to follow and staff now demonstrate good understanding of their responsibilities to protect people and promote their welfare. Since the last key inspection almost all staff have received information from the Mulberry House training pack and worksheets and had discussion sessions with East Riding of Yorkshire Council supporting staff and officers about responsibility and the procedures to follow. Evidence of their competence needs to be checked and recorded each year and full external training on safeguarding needs to be undertaken and evidenced at least every three years. A recommendation for this is made in this report. There has only been one safeguarding referral in the last twelve months and this was appropriately dealt with. Systems for making a serious complaint and for referring an allegation have not really been thoroughly tested yet. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People live in a satisfactorily furnished and equipped home, that is clean, safe and comfortable, though it could be made better if all communal areas were redecorated and refurbished. The home offers sufficient space, but not entirely of a good standard, so people are only potentially able to lead independent lives. EVIDENCE: Discussion with people in the home, the manager and staff and viewing of the communal parts of the home and some private areas, with permission, shows the home has improved environmentally in some areas since the last inspection and still requires more work in other areas. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 21 The home is suitable for its stated purpose of providing care and support and accommodation to young people with a learning disability, but is not suitable for anyone with a physical disability. One double bedroom on the ground floor has a serious odour problem and although this has been investigated there is no cause for why it should be like this. Further investigations are needed to determine why the room has a wet and musty odour. Some bedrooms and the dining room have been redecorated and the bathroom that was not useable has been renovated, while the bedroom without curtains or blinds has been refurbished as required at last inspection. There is now a maintenance and redecoration programme in place as recommended at the last inspection and in line with the financial business plan. Areas this highlights are to paint the exterior of the house, put up a home sign, open up the garden for growing produce and redecorate one of the lounges. Another recommendation at the last inspection was to repair the rear garden fencing to make the home more secure. This has not yet been achieved. Generally observation shows there are some well maintained areas and some not so well maintained areas. The lounge identified in the maintenance programme desperately needs redecorating and refurbishing. Equally the small television lounge next to it could also benefit from redecoration. Under standard 24.6 several areas need decorating, brightening up and making cleaner looking as a result. The home is entirely in keeping with the surrounding area. It is not accessible to people with mobility problems and such as bathrooms do not have appropriate equipment for them. As far as can be determined the home meets the requirements of the local fire service and environmental health department. The home follows basic hygiene and infection control measures having a policy in place and offering staff infection control training of which approximately three quarters of the staff have completed. Certificates are available in files. The staff training record is displayed in the office. As far as can be determined the laundry meets the Water Supply (Water Fittings) Regulations 1999. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People are now cared for by staff in sufficient numbers to meet their needs. Staff are now adequately recruited and training opportunities are much improved. Overall people are confident they are safely cared for. EVIDENCE: Discussion with the manager and staff and viewing staff files with permission and viewing of some of the records and documents in the home and observation of staffing levels and interactions with people in the home shows there are improvements in the staffing levels, recruitment practices and skills of the staff team. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 23 Staff enrol for NVQ level 2 and 3 qualifications where possible and there are now 8 from 14 care staff with level 2, resulting in 60 of the workforce being qualified. Evidence is found in staff training records. There is a balance of male and female staff employed in the home and there are now a minimum of four carers on each day time shift and two throughout the night. There is also an activities coordinator and the registered manager available to assist throughout the week. There are staff rosters available as evidence of staffing levels. When the activities coordinator is working people in the home are occupied in small groups or individually and usually this reduces the responsibilities of the care and support staff. It is observed now that the whole staff team works more as a team than they used to. There is a written recruitment policy and procedure in place and recruitment practices are now improved since the last key inspection, so that all security checks are obtained before staff begin working. Two staff recruitment files seen with permission contain job applications, written references and security checks with the Criminal Records Bureau. There is also evidence that inductions are completed and these follow the Skills for Care recommendations, while information in files confirms staff identities, thus meeting the requirements of schedule 2. Staff training and development records and information from the manager show there has been some improvements in staff skills since the last key inspection, due to having completed the training opportunities provided by the Hull City and East Riding of Yorkshire Councils. Some training is done in-house through the use of the Mulberry House training packages. These courses include first aid, ncfe medication administration, communication, autism awareness, stroke awareness, person centred planning, epilepsy, health and nutrition, challenging behaviour, protection of vulnerable adults, moving and handling, infection control, health and safety, food hygiene, fire safety, and deaf blindness awareness. Some of the Mulberry House training evidence is not dated however and therefore cannot be authenticated as to when it was done. All future training must be dated and signed and this is a recommendation of this report. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People enjoy the benefits of a well run home. The quality assurance systems are good for determining the quality of much of the service provided. Peoples’ care needs are well met and so they lead relatively fulfilling lives. Promoting and protecting of peoples’ health, safety and welfare is much improved and now good. EVIDENCE: Discussion with the manager and staff and viewing of some of the homes documents, records and maintenance certificates shows there has been more Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 25 improvement in the conduct and management and the safety and welfare systems within the home. The registered manager also one of the company providers, has almost completed the Leadership and Management in Social Care Settings course, and is also accessing some of the courses that care staff complete to improve his knowledge and skill. There is a quality assurance system in place that is based on the company aims and objectives and business objectives. It uses management meetings and has a monthly audit schedule for the coming year September 2008 to September 2009 for which surveys are completed by a sample number of people in the home, relatives and staff. Surveys cover principles of care, individual care, supporting services, safe environment, support to families and informal carers, staff development and support and service delivery. There are copies of survey questionnaires completed held in the quality assurance file. These have not been dated or initialled and there is no space to encourage comments, so it is difficult to authenticate them. There is also an improvement plan for the home based on the previous inspection report, interspersed amongst the quality assurance information. A recommendation is made to make sure any one completing a survey at least dates the document and that there be some space to make comments. The system also needs to develop to connect with other areas of the service where monitoring takes place, such as care planning and reviews, staffing levels, training etc. There is a health and safety policy within the home and several files containing maintenance check reports, certificates and records. Areas sampled include fire safety, electrical and gas checks, water storage and temperatures, control of substances hazardous to health (COSHH) and first aid and emergency call system. The fire book contains evidence of annual fire safety system checks with Pagasus, and annual extinguisher checks, of staff fire safety instructions with Hedon Fire, and of in-house weekly checks on lights, alarms etc. and of periodic in-house drills. Over the last year or so drills have been held less frequently but are now more concentrated to include all staff and are more detailed in content and procedure. There is also evidence that Richardson’s Electrical checks the fire detection system and the emergency lighting. The last electrical safety check was completed by Richardson’s Electrical in July 2008. The last landlord’s gas safety check was completed by Connaught, February 2009. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 26 Water storage was last checked for legionella this month and the samples have gone off for testing but results have not yet been returned. The latest available evidence of such testing is an Aquacert certificate dated April 2008. There is a risk assessment on the water storage tanks for February 2008 and reviewed February 2009. There are records of monthly checks on the shower heads for back flow and for weekly checks on the hot water temperatures at all outlets, and these are recorded. There is a COSHH file containing details of all products used, their dilution and safe use instructions. Products are safely stored and handled. The first aid boxes held in the home are checked each month for supplies and staff have completed first aid training. The emergency call system is checked each month and this is recorded. There is sufficient information to show the management is conscientious about maintaining health and safety within the home. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 27 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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 28 Castle-Ford DS0000019657.V376656.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA17 Good Practice Recommendations The registered person should try to implement the new menus again and offer more home cooked foods where possible, so people are confident they are well nourished and their good health is promoted. The registered person should make sure staff administering medicines use the correct omission codes on MAR sheets, so people are confident drugs are being administered safely and according to procedures and legislation. The registered person should continue to make efforts to eradicate the damp odour from the double ground floor room, so people have a pleasant environment to live in. The registered person should redecorate bedrooms as identified and redecorate the lounge and television room, so people have a pleasant environment to live in. The registered person should continue to make sure the garden is maintained and the fencing and gate is repaired, so people are able to use it safely. DS0000019657.V376656.R01.S.doc Version 5.2 Page 29 2 YA20 3 4 5 YA24 YA24 YA24 Castle-Ford 6 YA32 7 YA39 The registered person should continue to provide staff with mandatory and other related training to skill and equip them to care for people with complex learning disabilities and associated conditions and especially ensure records of such are dated and signed, so people know their needs are met. The registered person should make sure the quality assurance system includes other information from areas of the service that are monitored, such as reviews, staff training, staffing levels etc. He should also make sure any surveys sent out to people, relatives and staff are dated on return and a signature obtained if possible so they can be authenticated. All this is so people are confident their views are underpinning the self-monitoring, reviewing and developing of the service. Castle-Ford DS0000019657.V376656.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshireandhumberside@cqc.org.uk Web: www.cqc.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. 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