Inspection on 17/05/06 for 1a Garth Brow

This inspection was carried out on 17th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

1a Garth Brow 26/06/07

1a Garth Brow 28/09/05

1a Garth Brow 25/04/05

1a Garth Brow 01/11/04

1a Garth Brow 05/05/04

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 1a Garth Brow Kendal Cumbria LA9 5NN Lead Inspector Ray Mowat Unannounced Inspection 17th May 2006 10:30 1a Garth Brow DS0000022689.V291195.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 1a Garth Brow DS0000022689.V291195.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. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 1a Garth Brow Address Kendal Cumbria LA9 5NN 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) 01539 734111 carol.pounder@oakleatrust.co.uk The Oaklea Trust Mrs Carol Ann Pounder Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: 1A Garth Brow is owned by Fairoak housing and operated by the Oaklea Trust. Both are not for profit charitable organisations, specialising in services for people with learning disabilities. It is situated in a quiet residential area on the outskirts of Kendal, Cumbria. It is registered to provide a home for four people with learning disabilities, some of whom may be over sixty-five. The fees for the home are with the only additional charges being for personal sundry expenses. It is a detached property in its own grounds with gardens to the front and rear, where there is a patio area with seating. There is off street parking for two vehicles. It is only a short walk from the amenities of the town centre, however the residents also have use of a people carrier style vehicle that they share. Downstairs there is a lounge and a conservatory, which is also used as a designated smoking area. In addition there are two bedrooms, a toilet, a fully accessible walk-in shower and toilet, a large kitchen with dining area and a laundry/utility room. Upstairs there are two bedrooms, a toilet, bathroom with traditional style bath and a staff bedroom, which is also used as an office. The home has recently reviewed and updated their statement of purpose and service user guide, which are issued to prospective residents, and other interested parties and are available in the home. The fees are £642. The inspection reports are discussed with residents and displayed on a notice board. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 17.5.06. The inspector met with three of the four residents whilst they relaxed in the lounge or in their own rooms. I met with the senior member of staff on duty and three other care staff during the inspection. There were no visitors to the home during the inspection. The registered manager is currently on sick leave and the acting manager was on holiday. The pre inspection questionnaire was not been completed at the time of this inspection. 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. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 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 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is adequate. Although the assessment and admission process was thorough and followed good practice, the home has admitted someone who is out of category and whose needs cannot be appropriately met. The home’s systems and information are sound, however they have not been used effectively. This judgement has been made using all available evidence including a site visit. EVIDENCE: The home supplies existing and prospective residents with appropriate information as required by the National Minimum Standards. This had recently been reviewed and updated which is good practice as it ensures prospective residents have up to date and accurate information about the home. The home has a clear admissions policy and work closely with prospective residents, social workers and their representatives to assess the needs and compatibility of new residents. Social work and the home’s own assessments of need are held on file. A series of visits to the home are planned for either a meal or an overnight stay prior to any decisions being made. During this time a full assessment of needs and a pen picture are completed. It was evident from examining the resident’s files that one of the residents is outside of the categories the home is registered for. There is a multi-disciplinary health assessment that states, “They have both mental health and emotional problems”. It was evident from discussions with residents and staff that at times this disruptive behaviour was requiring a lot of staff input and therefore 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 8 having a negative impact on the quality of life of the other residents. It was also recorded that this resident has stated that they wish to leave the home and they have absconded several times. When speaking to staff they acknowledged that this resident’s needs were very different from the other people living in the home. Signed contracts of terms and conditions were held on file, which this particular resident was in breach of. The home is supporting them through this crisis through liaising with and getting support from a number of agencies. This is on the clear understanding that alternative accommodation is provided in the very near future. 1a Garth Brow DS0000022689.V291195.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, 9, 10. Quality in this outcome area is good. Care plans are comprehensive and used effectively to guide staff and provide appropriate support to individuals. Residents are involved in all aspects of home life and supported to lead an independent lifestyle. This judgement has been made using all available evidence including a site visit. EVIDENCE: All the residents have a comprehensive care plan in place with key workers now working closely with residents to develop Person Centred Plans. This has involved one to one meetings to record pertinent information about their lives, relationships and desires in a format that the resident can understand including photographs, written text and drawings. Based on the information that comes out from this work staff are able to provide a more personalised service, which is meaningful to the resident. A record is maintained of all routine and specialist health related appointments, which ensures all staff are kept up to date with changing needs. Based on the care plan records and discussions with staff it is evident the home are liaising with a range of other professionals such as the community health team, psychiatrist and social worker on an ongoing basis. This has been particularly 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 10 relevant for the resident with complex needs and has enabled the home to support them during this crisis period. The care plan files and other records in the home document how residents are being involved and supported in many aspects of decision making in their lives. Key workers take a lead role in ensuring individual needs are recorded and responded to appropriately. Residents meetings are also held on a regular basis with residents involved in all aspects of home life. There was evidence that care plans are kept under review with minutes of recent meetings held on file. Residents, their representatives and other professionals were involved in the meetings, with actions agreed in response to issues raised. A wide range of risk assessments has been developed to safeguard both residents and staff. It was evident residents were involved in the development of these with signed agreements in place. These are particularly important for one resident who leads a very independent lifestyle but is putting himself at risk through his actions. This has involved the home implementing its missing persons procedure on a regular basis in liaison with other agencies including the police. Files and records were securely stored in the office/sleep-in room and all computer records are password protected on the computer in the home. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 11 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): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. Residents enjoy a good quality of life both in the home environment and in the local community. They are able to pursue their hobbies and interest with appropriate staff support. This judgement has been made using all available evidence including a site visit. EVIDENCE: Three of the residents continue to attend a local day service on a part time basis. This provides them with a range of vocational, educational and social activities, both in the day centre and in the local community. Residents also enjoy some one to one time each week with staff from the home when they can pursue their own interests and hobbies or carry out personal business such as shopping or using the bank. One resident is very independent and requires minimal staff support outside of the home. Strategies and risk assessments have been agreed with them to try and safeguard them and guide staff. A timetable of regular weekly activities is agreed to enable the staffing and the resources of the home to be used effectively. This is kept under review to meet changing needs. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 12 Personal preferences with regard to activities and holidays have been explored as part of the person centred plan, which guides staff in providing personalised support to people to achieve their goals, which is good practice. Activities recently enjoyed by residents include day trips, holidays, working in the garden, attending church and going to a local football match. Menus are agreed with residents on a weekly basis, with residents going shopping for the food with staff support. Individual choices and preferences are incorporated, with menus being very flexible to accommodate different tastes. The menus examined gave a balanced and nutritious selection of food. All food was stored appropriately and clearly labelled when opened to ensure its freshness. Meals are mainly eaten in the kitchen/dining room with all the residents being together although sometimes people choose to eat separately. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 13 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): 18, 19, 20. Quality in this outcome area is good. Resident’s healthcare needs are well documented and they receive appropriate support to respond to changing needs. Records examined are in line with good practice and were up to date and accurate. This judgement has been made using all available evidence including a site visit. EVIDENCE: People’s needs within the home are quite varied, however the personalised care plans record this enabling staff to provide a consistent service to meet their needs. Specific strategies have been developed and agreed with residents and their representatives, which support and guide staff. There are clear records on file of all health related needs and interventions from a range of health professionals. The home works closely with them to monitor and respond to individual needs as they arise. Based on discussions with them key workers have a good knowledge of individuals and are committed to maintaining a good quality of care. Medication records were checked against the contents of the medication cabinet and found to be up to date and accurate. Recording systems were in line with good practice and monitored on a regular basis by senior staff. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. The policies, procedures and practice ensure residents are safeguarded and their concerns or complaints are heard. This judgement has been made using all available evidence including a site visit. EVIDENCE: The home maintains a complaints book, there were no recorded complaints although the home had received some compliments about the cleanliness of the home and the attitude of staff. All complaints are recorded at the head office of the organisation as well as in the home and are monitored by senior managers. The complaints procedure is issued to all residents in both audio and typed format. The home has appropriate policies and procedures in place to record and respond to suspicion or evidence of abuse. Staff receive appropriate training and were aware of their responsibilities in reporting issues. Information for residents about support from advocacy services were displayed in the home. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. On the whole the home and grounds are well maintained and provide a suitable living environment. There is an ongoing programme of repairs and renewals, which will ensure a safe and comfortable environment is maintained. This judgement has been made using all available evidence including a site visit. EVIDENCE: During this inspection I toured the premises and grounds of the home. There were no hazards noted and all areas of the home were clean and hygienic although there was an ongoing problem with a malodour in one room, which the home was managing satisfactorily. There is no need for any major aids or adaptations required in the home, although grab rails and hand rails have been fitted at strategic points to assist residents. The home has an up to date programme of repairs and renewals this included the decoration of the upstairs bathroom and toilet, which is needed. This is subject to a good practice recommendation. There is also a planned refurbishment of the conservatory and decoration of the living room, which will enhance the home environment. Through the resident’s meeting and person centred plans people have expressed a desire to get involved with the maintenance and planting of the garden. Residents have been involved in designing and planning the changes 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 16 including the planting of a vegetable patch and flowerbeds, which is good practice. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. Quality in this outcome area is good. The home is operating with a full staff team who are receiving suitable training and support to guide them in their role and maintain good practice. This judgement has been made using all available evidence including a site visit. EVIDENCE: Staff were receiving regular supervision from the manager at which issues relating to roles and responsibilities are discussed. Records were sampled and found to be up to date and in order. All staff had been issued with job descriptions and contracts, copies of which are held on file. On examining the staff rota it was evident there is a full compliment of staff in the home. The home operates a two-week rota, which showed an average of 169 hours are provided each week. This provides a double up of staff at key times during the week enabling residents to work on a one to one basis with staff. The senior staff on duty said that there was a planned review of the staff hours/shift patterns to ensure they are being used effectively. The home has recently recruited a new relief member of staff to cover two forthcoming planned absences. Training records examined reflected that staff had completed appropriate induction and foundation training and that staff had attended other courses. Over 50 of staff had completed their NVQ qualification. It is recommended a training and development programme is developed to ensure all mandatory and refresher training is completed in the required timescales. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 18 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): 37, 38, 39, 42. Quality in this outcome area is good. The new manager is working in the home full time and is ensuring staff are appropriately supervised and supported and records relating the efficient and effective running of the home are maintained. This judgement has been made using all available evidence including a site visit. EVIDENCE: There is an acting manager in post, Ms Sally Arnold who is covering the longterm absence of the Registered Manager. She is currently taking part in a management development programme and working towards her NVQ 4. She is getting guidance and support from the operations manager. Since she has been in the post full time she has been able to address shortfalls identified previously. The home is operating with a full compliment of staff that said, “ They were getting the support they need and regular supervision”. They confirmed that they see the manager on a regular basis and that they can access on-call support in her absence. There are regular staff meetings, which are 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 19 appreciated by staff, these ensure a flow of information between management and staff and also monitor and maintain consistent practice in the home. The organisation issues an annual quality survey with the results being collated and made available to interested parties. The home has also completed a quality improvement plan, which will be due for review in August 06. This was in the form of a self-assessment against the National Minimum Standards. All the records examined were up to date and accurate. There is a house file that is used to record all routine health and safety checks. The fire record was also up to date and staff had completed relevant health and safety training. The manager has introduced a monitoring system to track staff supervision and team meetings ensuring they take place in a timely manner. The home’s insurance certificate displayed in the home was out of date and must be replaced. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 20 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 3 2 3 3 1 4 3 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 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 2 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 21 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. 1 Standard YA3 Regulation 14 Requirement The home must ensure it is able to meet the needs of new residents and they are within the registration categories of the home. The home is required to have a current certificate of insurance. Timescale for action 01/06/06 2 YA43 25(2) e 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations It is recommended the planned decoration of the bathroom and toilet is completed as soon as is practicable. 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 22 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 1a Garth Brow DS0000022689.V291195.R01.S.doc Version 5.1 Page 23 - 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. 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