Inspection on 02/02/06 for 14 Norfolk Road

This inspection was carried out on 2nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

14 Norfolk Road 30/09/09

14 Norfolk Road 15/10/08

14 Norfolk Road 28/02/07

14 Norfolk Road 16/06/06

14 Norfolk Road 19/09/05

14 Norfolk Road 21/03/05

14 Norfolk Road 16/08/04

14 Norfolk Road 19/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 14 Norfolk Road Carlisle Cumbria CA2 5PQ Lead Inspector Cath Wilson Unannounced Inspection 2 and 3 February 2006 10:00 nd rd 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 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 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 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. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 14 Norfolk Road Address Carlisle Cumbria CA2 5PQ 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) 01228 592515 www.c-i-c.co.uk. Community Integrated Care Mrs Fiona Byers Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of LD (Adults with learning disabilities) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 19th September 2005 Date of last inspection Brief Description of the Service: 14 Norfolk Road is a detached three-storey property. Community Integrated Care provides the care and services. The home is registered to provide care for six people with a learning disability. Service users only use the ground and first floors, with staff accommodation on the top floor. It is situated in a residential street approximately one mile from the City of Carlisle and is indistinguishable from other properties in the area. A staircase provides access between the floors. There is a private and enclosed garden area to the rear of the building and car parking to the front. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection to the home. It took place over two days throughout the early morning and afternoon periods. Service users, the registered manager and staff were met during the inspection and the home’s premises inside and out were inspected. A sample of administration records and service user’s files were assessed and the requirements made at the previous inspection were checked. What the service does well: What has improved since the last inspection? What they could do better: Complete the work underway on the environment and implement the requirements made at this inspection. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 6 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. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 7 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 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed at the previous inspection. EVIDENCE: 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 There are care plans for each service user that are being developed and strengthened so that individual life styles can be further enhanced. EVIDENCE: The manager and staff are progressing the work needed on individual care planning so that a person centred approach to care planning can be further developed. Different aspects and approaches to individual communication are also being developed with the assistance of appropriate professional personnel. This will work alongside the person centred planning and will be undertaken at each person’s pace. The good thing is that this work is now underway and will progress from here. The manager and staff are supportive and encouraging in their personal dealing with service users. The manager and organisation are monitoring the staffing levels so that every effort is made to sustain the work force necessary to progress the work that develops. Risk assessments and management strategies are undertaken and these are also included as active assessments in the planning for individual life styles. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14, 15 and 16 Service users are assisted and supported to have a good quality of life and access to a variety of life experiences. EVIDENCE: People in the home have individual interests and activities and these are detailed in their care plans. The manager and staff encourage and support service users to make their own decisions and make choices about their lives. Records show how individual rights and choices are recognised and promoted and this underpins the value base of the home. There are risk assessments and management strategies in place and these are part of the home’s reviewing system. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed at the previous inspection and the requirement made following this inspection regarding the storage of medication has been implemented. EVIDENCE: 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home has a satisfactory complaints system. EVIDENCE: The home has a complaints procedure that indicates the appropriate 28-day response time. A record is kept of any complaints or concerns that are expressed. Information about this can also be found in the home’s Statement of Purpose and Service User Guide. The involvement of advocacy personnel will greatly assist service users in these matters. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 27 There are arrangements in place to complete the work on one bedroom and the bathing and toilet facilities. Further attention is still required regarding one other bedroom. EVIDENCE: The programme of repairs needed at Norfolk Road is underway for completion. As stated in the previous inspection report, some of these matters had been outstanding for some time so it is reassuring these are now being attended to. The work to the toilet area in the upstairs area needs to be progressed fairly rapidly. There are wardrobes in one bedroom that are warped with ill- fitting doors. This room would be greatly enhanced by the provision of new furniture for appropriate clothes storage. A requirement has been made regarding this. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were assessed at the previous inspection. There were requirements made to review the strategies for the recruitment and retention of staff and to ensure that there will be sufficient staff on duty to meet the needs of service users. These matters are being attended to and the registered manager is closely monitoring the availability of staff. This is crucial if the care planning development is to progress successfully. EVIDENCE: 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The health, safety and welfare of services users are promoted with the exception of the home’s utility room. EVIDENCE: Staff had received training to ensure the health and safety of service users and themselves. The utility room is a well used room. It is cluttered with ill-fitting cupboards and little workspace. A requirement has been made regarding this matter. 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 16 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 X 3 X 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 X ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X X X X X 2 X 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 17 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 2 Standard 24 24 Regulation YA42 YA24 Requirement Upgrade the utility room to health and safety standards. Ensure that the clothes storage in one service user’s bedroom is appropriate to meet their needs. Timescale for action 01/06/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 14 Norfolk Road DS0000022573.V277371.R01.S.doc Version 5.1 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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