Inspection on 26/06/07 for 1a Garth Brow

This inspection was carried out on 26th June 2007.

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 17/05/06

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 26th June 2007 08:30 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 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 www.oakleatrust.co.uk The Oaklea Trust Vacant 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.V341539.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2006 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. 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 with the only additional charges being for personal sundry expenses. The inspection reports are discussed with residents and displayed on a notice board. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this inspection visit I met with three of the four people living in the home. I spent time talking to them whilst they relaxed in the lounge or in their own rooms. I met with the manager and three care staff that were on duty during the visit. As part of the inspection I also spoke to relatives and other professionals and received questionnaires from the people living in the home. What the service does well: What has improved since the last inspection? Staff meet with people to find out about them and also arrange for them to visit the home before moving in, to make sure that their needs can be met. An up to date insurance certificate is displayed in the home making sure that people and their belongings are safeguarded. Different parts of the home have been decorated and new furniture bought. Plans have been agreed for more rooms to be decorated. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 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 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment and admission process has been used effectively to make sure people’s needs are fully assessed and their move into the home has been a positive experience. EVIDENCE: Since the last inspection the Statement of Purpose has been updated and issued to relevant parties. It contains suitable information in line with the requirements of the National Minimum Standards, therefore ensuring people are aware of the services provided. A new person moved into the home recently, which had been a positive experience for them. They first of all made short visits to the home to meet people already living there. This involved having a meal and a talk to the people living there. This progressed to overnight stays the outcome of which was evaluated with all parties, allowing the person to make an informed choice and ensuring their needs could be met. People already living in the home were also consulted and their views taken into account. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 9 The person moving in was involved throughout the admission procedure with support from their relatives/representatives. A multi-disciplinary review meeting was held to agree the final placement. There was evidence of both Social Work assessments and the home’s own needs assessment being completed and used to develop a detailed plan of care. Other specialist assessments were also incorporated into the care plan, which focussed on the level of independence. Valuable information was gathered during the admission process, which gave staff an insight to the person and their individual needs and idiosyncrasies, which all contributed to a smooth transition into the home. Daily routines were quickly established based on the needs of the person, which has given them a real sense of belonging. A signed contract of terms and conditions explaining people’s rights and the rules about living in the home has been issued with a copy retained on each person’s file. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive care plans have been developed that guide staff in providing personalised support to individuals. People are consulted on and participate in all aspects of home life and enjoy a high level of independence in the home and in the community. EVIDENCE: Detailed care plans have been developed and agreed with all the people living in the home and their representatives. These have been kept under review with minutes of review meetings held on file. These recorded discussions about key aspects of people’s lives and any actions resulting from the discussion and who is responsible for completing them. The review meetings involved the person’s relatives/representatives and other agencies involved such as the Social Worker, Day Service staff and the Community Health Team, which is good practice. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 11 A comprehensive needs assessment, which is reviewed at least annually, is used to develop the care plans, as well as other specialist assessments and feedback from significant others. The assessment identifies the level of support people require for all aspects of daily living. This enables staff to identify if people are becoming more dependent or if their needs are changing. Based on the outcome of the assessment an action plan is agreed to make sure necessary adjustments are made. A good example of this is staff completing a monitoring chart for one person due to a change in their behaviour that was having a negative impact on their lives and could have had an underlying health implication. This also involved the home working closely with the relevant health professionals to evaluate the recordings and agree strategies for staff to support the person to maintain the person’s safety and welfare. Person centred care plans are being introduced for all the people living in the home. One person has started to develop their plan, which was recording relevant information in a format they could understand using pictures and diagrams. This was more meaningful to them as they recognised it as their document. Although there was very detailed information contained in the care plan files, some of the information was out of date, not signed and dated or no longer relevant, which can be confusing for staff. It is recommended the content of care plans are reviewed to make sure only up to date and relevant information is contained in them. A daily care record is completed at the end of each shift, which records choices made during the day, significant events and a record of any achievements (promoting independence). It was evident from this record that people are exercising choice in many aspects of their lives. There were also a lot of positive recordings that reflected people’s achievements and gave you an insight to their daily life. This included evidence of people being involved in various household chores as well as leisure activities in the home and in the local community. Recording positive events in people’s lives is good practice as often only negative events are recorded. As well as people working closely with a member of staff (key worker) to develop their care plans, house meetings are also held on a regular basis giving people an opportunity to be consulted and involved in all aspects of the running of the home. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 12 A new risk assessment format has been introduced, which identifies hazards under five main headings. The hazard is identified as well as individual control measures that will minimise or remove the risk and also who is affected. The areas assessed are wide ranging ensuring people are kept safe, while enjoying a fulfilling lifestyle of their choice. Personal and confidential information is securely stored at all times, with staff being aware of the importance of maintaining confidentiality when handling sensitive and personal information. 1a Garth Brow DS0000022689.V341539.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): 12, 13, 14, 15, 16, 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are being supported and encouraged to lead an independent lifestyle of their choice. They have a high degree of autonomy in choosing how they live their lives, which is respected by staff. They are involved in a good range of leisure activities both in the home and in the local community. EVIDENCE: Two people attend a local day service on three and five days each week respectively, the other two people are effectively retired from formal vocational and educational activities. Despite this they continue to have a busy and fulfilling lifestyle of their choice. One person is particularly independent and enjoys a busy social life. This includes being a member of a local walking club that goes out twice a week, attending college, a weekly social club, a dance class as well as relaxing at home or going out to the local pub for a drink, meal or game of pool. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 14 Everyone has now planned or is planning an annual holiday, which they are looking forward to. Staff are working closely with people to make sure they are making a meaningful choice about the type of holiday they choose and that it will meet their needs and preferences. For one person this includes the development of a picture board to help them understand their options and make their choice, which is good practice. In addition to holidays regular day trips are organised either locally or a bit further afield. During this visit people were busy planning a trip to a zoo that was requested at a house meeting. People have shared use of a car but also use local public transport to get around. Some staff also use their own cars to support people to attend appointments when the need arises. Review meeting minutes and a Social Work assessment review that I examined also confirmed that people are enjoying a “fulfilling lifestyle and participating fully in the home and the local community”. It described people helping to prepare meals, cleaning their rooms, being involved in menu planning and shopping and helping in the garden. One person took great pride in showing me round the garden pointing out the vegetables and flowers they had planted and cared for. There was a varied menu planned each week based on feedback from people and from known likes and dislikes. These included a good variety of fresh food including healthy options and fresh fruit. When asked people said, “the food was good”. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On the whole people’s personal and healthcare needs are well documented and staff have a good understanding of individual needs and ensure they receive appropriate services when required. Some records should be reviewed more frequently. EVIDENCE: Staff have a good understanding of residents’ personal and healthcare needs. They work positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain good health. Healthcare needs are well documented and records kept up-to-date, these are linked to care plans to alert staff on any changes, and include monitoring sheets and reports for specific issues and appointments. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 16 Everyone is registered with a GP of their choice and have access to other members of the Primary Health Care team. Other checks such as opticians, chiropody and dental checks are also recorded on Healthcare files including any actions required as a result of the appointment. Interactions were observed between staff and people living in the home. Staff were respectful and talked to people in a sensitive and understanding manner. I checked the medical record sheets against the medication held in the home. These were all up to date and accurate ensuring the safe administration and storage of medication. However records of medication held in care plan files and PRN medication guidelines had not been reviewed and updated. It is recommended care plan medication records and PRN guidelines are periodically reviewed and updated. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have good knowledge and understanding of policies and procedures to safeguard people and protect them from abuse. EVIDENCE: The service has a complaints procedure that is up to date, clearly written, and is easy to understand. It is made available in different formats such as audiotape, making it easier for people to understand and more able to complain or make suggestions for improvement. The policies and procedures regarding protection of individuals are clear and in line with local Adult Services policies and are regularly reviewed and updated. Staff were clear on their role and responsibilities in recognising and reporting incidents. Training of staff in the area of protection is regularly arranged by the training department, with the manager ensuring training is kept up to date. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Garth Brow is a safe, homely and comfortable environment that matches people’s lifestyle needs. EVIDENCE: The Home is close to the town centre of Kendal within walking distance of local shops and amenities. It is well maintained and has a private garden and patio area to the rear. The furnishings and decoration are of a good standard and homely in style. Since the last inspection the conservatory, lounge and hall, stairs and landing have been decorated and new furniture purchased. There is a planned programme of ongoing repairs and renewals that ensures the environment is well maintained, safe and comfortable. All areas of the home were clean and hygienic with staff supporting people to clean their rooms and communal areas. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a well-trained and knowledgeable staff team who provide a consistent and reliable service. EVIDENCE: Three part time posts are currently being advertised, these are currently being covered by the regular staff working additional shifts. There is a gender imbalance at present as all the staff are female and all the people living in the home being males. Hopefully this situation can be improved with the new appointments. There are sound recruitment policies and procedures in place that make sure people are safeguarded. It was evident from my observations and discussions that staff take a “pride in their work” in delivering a personalised service. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 20 I examined the staff files of the staff on duty, these included a record of training and course certificates, supervision notes, annual appraisals. There was also a training record (matrix) displayed in the office to enable the manager to monitor training needs and make sure refresher training was taking place at suitable intervals. Staff said the manager is “supportive and always available” they also said “personal development and training was encouraged”. Supervision records were up to date with actions agreed and signed by both parties, which is good practice. Although there were annual appraisals held on file these were now out of date and in need of review. It is recommended all staff have an annual appraisal completed with development targets agreed. All the staff have completed their NVQ training including the manager who has completed NVQ 4 and is working toward the Registered Manager award. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and staff work closely together ensuring the home is safe and well maintained and that good quality care is provided to people. EVIDENCE: Ms Arnold has completed her NVQ 4 and is working toward the registered manager award. She is managing the home effectively and efficiently and in the best interests of the people who live there. Regular meetings are held so that people can contribute to all aspects of the running of the home. In addition people are consulted both informally and formally on a regular basis. An annual quality assurance questionnaire is also issued to people to get feedback about all aspects of the service. Information from this is used in developing the home’s business and development plan targets for the year, which then reflect the thoughts and preferences of the people living there. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 22 The manager has a very ‘hands on’ role and will work a shift alongside the care staff, which is appreciated by staff but also gives her an understanding of staff issues. There are daily and weekly recording systems that help with the efficient running of the home and the maintenance of a safe environment. A daily diary record and weekly planner is used to coordinate activities and resources. This ensures staff are aware of their role during that shift and the support required by people to complete their daily and weekly routines. Routine health and safety checks are completed with staff checking at the handover if everything has been completed. In addition a monthly safety checklist is completed on a monthly basis, which records any potential or actual hazards and the action required. 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 23 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 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X 3 3 X 1a Garth Brow DS0000022689.V341539.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 2 3 Refer to Standard YA6 Good Practice Recommendations It is recommended the content of care plans be reviewed to make sure only up to date and relevant information is contained in them. It is recommended care plan medication records and PRN guidelines are periodically reviewed and updated. It is recommended all staff have an annual appraisal completed and agree personal development targets. 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