Inspection on 25/04/05 for 1a Garth Brow

This inspection was carried out on 25th April 2005.

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

Other inspections for this house

1a Garth Brow 26/06/07

1a Garth Brow 17/05/06

1a Garth Brow 28/09/05

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 25 April 2005 09:00 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 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 Stationary 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 F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 1A Garth Brow Address Kendal Cumbria LA9 5NN Telephone number Fax number Email 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 The Oaklea Trust Mrs Carol Ann Pounder Care Home 4 Category(ies) of Up to 4 users in the category LD Learning registration, with number Disability of places Up to 4 users in the cagtegory LD(E) Learning Disability over 65 years of age 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1 November 2004 Brief Description of the Service: 1A Garth Brow is owned by Fairoak housing and operated by 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 disabilitiaes some of whom may be over sixty-five. 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. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9am and 5pm on 25th April 05. There was one resident present during the inspection. Time was spent talking with the resident as he went about his daily activities. The manager was present for the inspection, in addition three care staff and a senior care staff were also spoken to. Care plan files and other records required by regulation for the running of the home were examined. What the service does well: What has improved since the last inspection? What they could do better: Information provided to new residents is in need of review to ensure it is up to date, accurate and contains the relevant information. New management arrangements have been put in place, which affect the on-call support service. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 6 The operation of this service must also be reviewed to ensure the safety of residents and staff. The registered person’s responsibilities in relation to the supervision and management of the home have not been carried out as required by the care home regulations and must be addressed. Consultation with people using the service could also be strengthened, ensuring residents needs and views are influencing the management of the home. 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 F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 5. The information supplied to prospective residents was not adequate as it was out of date and did not reflect the current situation in the home. The initial assessment of needs and ongoing monitoring of individual and specialist needs was good. EVIDENCE: The statement of purpose and service user guide must therefore be reviewed. Although residents had been issued with new contracts, which had been agreed, signed and held on file as required, they did not contain detailed information with regard to the terms and conditions of residence, particularly in relation to what the fees paid will cover e.g. decoration, furniture etc. Detailed care plans were in place for all the residents, which had been compiled with input from families and other professionals such as the community health team. Review dates had been set for annual review meetings. This level of information was good and guided staff in providing a personalised service. The Trust had introduced a new assessment to collate information regarding individual’s abilities and to identify the level of risk attached to particular activities, therefore safeguarding residents. In addition there were specialist assessments held on file, examples being occupational therapy and psychology assessments, which had been requested in response to specific issues. Through this ongoing review process and close working with relevant health 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 9 professionals, it was evident that resident’s needs and aspirations were being met. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 10 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 standard(s) 6, 7, 8, 9, 10. The home has good systems in place to ensure individual needs are assessed and recorded and incorporated into a personalised plan of care. Staff spoken to had a good awareness of individual preferences and provided appropriate support to promote an independent lifestyle. EVIDENCE: The review of two care plans was now overdue, however the manager explained that reviews had been planned for May, with all significant parties. All the residents care plans were examined, they were comprehensive and reflected personal needs and preferences. They also contained detailed guidelines to assist staff in responding to difficult and challenging behaviour. These strategies had been compiled with input from a range of health professionals, such as the community nurse, psychologist and psychiatrist. Health care needs were also well documented with the introduction of individual health action plans, with detailed information in place regarding known conditions. A new risk assessment format had been introduced with staff reviewing all risk assessments in place. Staff training had also taken place in relation to completing risk assessments. It was evident that resident’s needs were well documented and were being responded to appropriately. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 11 The home has appointed key workers who work closely with their allocated resident, to ensure their needs and aspirations are recorded and responded to. Residents are involved in all aspects of home life, with regular house meetings taking place where any pertinent issues can be discussed. Agreements were held on file which residents and their representatives sign to agree their care plans, thus ensuring they are making informed choices in their lives. One resident although aware of the dangers of smoking, chooses to continue to smoke, after advice from his GP he has agreed on an amount to smoke each day, which staff then support him with. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 12 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 standard(s) 11, 12, 13, 14, 15, 16. The residents were being encouraged and supported to lead fulfilling lives both in the home and in the community. EVIDENCE: One resident has effectively retired from formal education and vocational activities, however he does attend two social clubs each week. This gives him the opportunity to maintain and develop friendships in the community. Through the week staff support him to pursue his interests and hobbies. This ranges from a sedentary craft activity in the home, to day trips to a place of particular interest to him or alternatively accessing the local amenities of the town. The other two residents attend a local day service for five and four days respectively. This provides them with a range of developmental and leisure opportunities. When they are not at the day service staff support and facilitate activities in the home and in the community. Recent examples included visiting town for personal shopping, a day trip to an annual scarecrow festival and attending a local social club. One resident had been rehearsing a part in a play at the club and was looking forward to the forthcoming performance. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 13 It was evident staff support and encourage residents to keep in touch with friends and family, a record of significant contacts was maintained on personal files and residents wishes also recorded. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 14 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 standard(s) Resident’s needs and preferences regarding personal and healthcare support were well documented ensuring a good and consistent quality of care. EVIDENCE: The home was in the process of introducing health action plans, which is a personal record of all health and personal care related information. It is recorded in an accessible format, including pictures and symbols. This is used to record and monitor all health interventions and provides health professionals with detailed information ensuring a good continuity of care. Staff were seen to provide unobtrusive support and encourage independence. A long standing resident had recently died, based on discussions with staff, theirs and the resident’s emotional needs were respected and all aspects of the illness and death were handled sensitively. Counselling support was provided and people appropriately involved in the funeral, enabling them to grieve in their own way. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 15 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 standard(s) The home has good systems and policies in place to safeguard residents and ensure their views or concerns are listened to. EVIDENCE: There have been no recorded complaints since the last inspection, the home has an appropriate policy and procedure in place that is issued to residents in an audio and typed format, making it accessible and more meaningful to them. Through induction and NVQ training, staff receive appropriate training enabling them to recognise and respond to suspicions of abuse. Staff spoken to were aware of their responsibilities and the reporting procedures. Refresher training is provided periodically. Individual financial records were maintained and checked, which safeguarded residents from potential abuse. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29, 30. The home provides a safe and well-maintained environment, which meets the individual needs of residents. Garth Brow is comfortable and has a homely feel. EVIDENCE: Since the last inspection the home had carried out routine decoration as required. The exterior paintwork had been completed and the hall, stairs and landing had been decorated. The patio and paths had been pressure washed and there were plans to “plant up” the border in the front garden. A new suite has been purchased for the lounge, in addition to a specialist chair, on the advice of the occupational therapist, to meet one individual’s needs. These ongoing repairs and renewals really do make a difference and were appreciated by both residents and staff. The home has made minor adaptations, such as handrails and grab rails on the recommendation of the occupational therapist. One outstanding issue is the steps to the rear garden from the conservatory and kitchen. It is recommended a timescale for improving access be agreed with the relevant parties. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 17 Staff had recently received training in infection control, which had resulted in good practice procedures being introduced to the home. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36. Staff were well informed as to the individual needs of residents and the strategies that were in place to support them. Supervision of staff was good. Core and specialist training was provided, however refresher training in some subjects was overdue. EVIDENCE: The manager undertakes all formal supervision of staff on a regular basis. Records confirmed sessions taking place on a six-week basis, covering appropriate subject areas to monitor and maintain good practice. Staff described supervision and support as “good”. Through the regular supervision, the manager discussed and monitored training needs. Individual training records were examined. Although there were good levels of training in both core subjects and specialist areas, some refresher training was now due, such as manual handling. Recent training undertaken by staff included risk assessment, autism and health and safety. All new staff had completed the LDAF induction and foundation courses in addition to an induction to the home. Three staff had completed their NVQs with two others working towards the award. This level of training and support has a positive effect on staff, with evidence of good morale and high levels of motivation in the team. Care staff felt the training was appropriate and were aware of how to request specific courses. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 19 It was evident the induction of senior care workers, to their new roles and responsibilities was minimal. Particularly in relation to their responsibilities for the management on-call service. The home was now operating with a full compliment of staff with all vacant posts filled, including the introduction of a 20 hour senior care post. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42, 43. Management support in the home was good. Resident’s needs were well documented and they were safeguarded by the home’s policies and procedures. On-call management arrangements were inappropriate and not able to respond appropriately to emergencies. The senior management arrangements were not clear. EVIDENCE: The Trust has recently implemented a management restructure, which has resulted in the manager only being responsible for the one home, on a twentyfive hour contract. In addition the home has a senior care post for twenty hours each week. It was evident the home was benefiting from having a consistent manager and staff team, with good continuity of care. The manager however had not been formally supervised since December 04 and their had not been a regulation 26 management visit since January 05. On the day of the inspection the new Operations manager for the Trust’s 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 21 registered properties, Mary Brownlow, visited the home and met with the manager. A letter was on the resident’s personal files explaining the appointment of the new operations manager. The content of this letter was contrary to a letter forwarded to the Commission regarding the restructure. The management arrangements within the Trust must be clarified ensuring their statutory responsibilities are appropriately met. Two senior managers from the Trust had completed a Quality Audit of documents and systems in October 04. Consultation and quality monitoring within the home was discussed with the manager, with the conclusion being that consultation regarding the quality of services could be strengthened, through the use of specific user satisfaction questionnaires. Staff were aware of the on-call management arrangements and reporting procedures and shared their experiences of the service. It was apparent from these discussions that some senior care staff operated the management on-call service, whilst on-duty, at both care homes and when providing Domiciliary Care. This is totally inappropriate, as this will take them away from their primary duties. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 2 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1A Garth Brow Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 2 3 2 F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 23 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 1 Regulation 4&5 Requirement The home must review the content of the statement of purpose and service user guide, ensuring they are up to date and accurate. The contract of terms and conditions must contain the relevant information as described. Senior care staff must receive appropriate induction and training for their role. Monthly management visits must take place in the required timescale. The on-call management arrangements must be reviewed to ensure the safety of service users. The registered person shall ensure the manager of the home is appropriately supervised. Timescale for action 30th June 05 2. 5 5 31st July 05 3. 4. 5. 35 41 43 18 26 13 & 18 31st July 05 1st May 05 1st July 05 6. 43 18(2) 1st May 05 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 Good Practice Recommendations F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 24 1A Garth Brow 1. 2. 3. 4. Standard 29 35 39 20 It is recommended the home agrees a programme of improvement for access to and from the rear of the home. The need for refresher training must be identified and appropriate training provided. It is recommended consultation regarding service quality be strengthened with the use of user satisfaction surveys. Medication record charts should only be completed using the appropriate codes. 1A Garth Brow F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 25 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 F58 F10 s22689 1a garth brow v216857 250405 ui stage 4.doc Version 1.30 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!