Inspection on 28/09/05 for 1a Garth Brow

This inspection was carried out on 28th September 2005.

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 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 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 28th September 2005 05:30 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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.V249699.R01.S.doc Version 5.0 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.V249699.R01.S.doc Version 5.0 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 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.V249699.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/4/05 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. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place at 5.30pm on 28/9/05. The inspector met with all three residents whilst they relaxed in the lounge and also joined them for a house meeting. There was one member of staff on duty who the inspector spoke with. There were no visitors to the home during the inspection. The registered manager is currently on sick leave and the acting manager was not on shift. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure all medical record sheets are completed in line with good practice guidelines, currently codes are being inappropriately used, which could cause confusion. Ongoing staffing problems have affected the quality of the service provided and must be addressed as a priority. A period of stability in the management role will be beneficial to the home. It is also recommended the acting managers hours are recorded on the house rota, to enable the management input to the home to be assessed. The terms and conditions of residence must be clarified, ensuring residents are issued with all relevant information. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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.V249699.R01.S.doc Version 5.0 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): 1, 2, 3, 4, 5. The admissions process for the home is thorough and allows people to make informed choices, however the customer agreement in place must be reviewed, ensuring it contains all relevant information relating to the contract of terms and conditions. EVIDENCE: There have been no new admissions to the home since the last inspection, however people had visited the home with a view to moving in. On the evening of the inspection, a member of staff facilitated a house meeting with the three residents. They discussed plans for a prospective new resident to visit the home in the near future. The member of staff explained the arrangements for the visit and reassured individual residents about the purpose of the visit and gaining their agreement to it. Involving and consulting with residents in this way is good practice and ensures their rights and privacy are respected. A new customer agreement (2005 version) has been issued to and signed by residents. The document refers to “terms and conditions of the occupancy/tenancy agreement, between the customer (resident) and the housing provider”. This agreement was not available for inspection, in addition although the home is required to issue a contract of terms and conditions, there should be no agreement between the housing provider and the resident, as this would constitute a tenancy. The agreement should be between the housing provider and the residential care provider. This must be clarified with all residents and their representatives, so they understand all the terms and conditions of their residence. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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. Resident’s individual needs and preferences were well documented, with clear guidance for staff, to support them in leading an independent lifestyle. EVIDENCE: Comprehensive care plan files were in place for all the residents. The organisation has recently introduced a “needs assessment/service user plan”, which have been completed for all the residents. This includes assessments relating to personal support, household and domestic tasks, lifestyle, culture, communication and healthcare. Based on the outcomes from the assessments, care plans are updated and monitored, ensuring needs are acknowledged and responded to appropriately. Specific strategies had also been developed to support residents and guide staff, in response to specialist needs and challenging behaviours. These are referenced in the care plan and held on personal files. They were compiled with advice and guidance from a range of specialist health services, such as the behaviour intervention team, a psychiatrist and psychologist and the community nurse team. There was evidence of these being monitored and reviewed on an ongoing basis. There was evidence residents were making everyday choices in their lives with support from staff or their representatives. In addition to support on an 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 10 individual basis, house meetings were also used to discuss issues affecting their lives. A good range of risk assessments were in place, ensuring residents could safely pursue an independent lifestyle. A good example of this was two residents who had recently chosen and planned a holiday to France. The staff on duty described how staff supported and facilitated the process, taking on an enabling role and encouraging independence but ensuring the safety of residents. Based on discussions with the residents they had thoroughly enjoyed all aspects of their holiday. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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. Residents are encouraged to lead independent lifestyles, both in the home and in the local community. Opportunities for pursuing leisure activities have been restricted on occasions by shortages of staff. EVIDENCE: Two of the residents continue to enjoy attending a local day service for four and five days each week respectively. This provides them with a good range of both educational and social activities. The other resident is effectively retired and enjoys a more sedentary lifestyle, attending an older adults day service one day each week and a lunch club and social club on other days. Staff take on an enabling role, to support people in pursuing their hobbies and interests, which are recorded in the care plan. However the availability of staff to do such activities has been affected by staff shortages, resulting in limited opportunities for residents. The staff on duty was aware of these issues and had been liaising with the acting manager, to obtain new resources for the home that would enable them to provide a greater range of alternative activities and interests in the home environment. The inspector spoke with two residents who had recently returned from a holiday in France. They had obviously enjoyed the experience and took great 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 12 pride in showing the inspector their holiday photographs and talking about their experiences. It was evident the holiday had been well chosen and planned around the preferences of the residents, with one of them describing it as a “grand holiday”. The menus for the home and a record of meals provided were examined. These reflected individual tastes and choices and provided a well balanced diet. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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. On the whole personal and healthcare needs of residents were well documented and being responded to appropriately, however medication records were inconsistent. EVIDENCE: Personal and healthcare needs continue to be well documented, with clear guidelines in place in the care plan and a detailed record of all healthcare interventions maintained. There was evidence of a wide range of health professionals being involved in residents care as needs arise, with multi-disciplinary strategies being developed to guide and support residents and staff. The contents of the medication cupboard were checked against records and found to be up to date, however inappropriate completion of the medical record sheet (MAR) for one residents weekend medication, could cause confusion. This was highlighted to the staff on duty and must be reviewed. It is also recommended that all staff responsible for administration of medication sign all current PRN medication guidelines, in line with the home’s policy. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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 These standards were fully assessed at the last inspection and met. EVIDENCE: There have been no recorded complaints since the last inspection. The home has developed some individual strategies to safeguard residents, which are kept under review. These will need to be monitored and reviewed with the introduction of a new resident to the home. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 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, 27, 28, 29, 30. Garth Brow provides a safe and comfortable environment that meets the needs of the current group of residents. EVIDENCE: All communal areas of the home inspected on this occasion were furnished and decorated to a good standard. As the inspection took place in the evening the exterior of the home was not inspected. The conservatory is a designated smoking room and has a fan fitted to ensure a smoke free environment in the other rooms of the home. Residents are happy with the arrangements and respect the rights of other residents. There is a small laundry and utility room, which was well ordered and contains suitable equipment for the size of the home. There was evidence on personal files of the home liaising with other professionals to ensure appropriate aids and adaptations are in place, when needs are identified, to maintain and promote independence. All parts of the home were found to be clean and hygienic. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 16 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): 32, 33, 34, 35, 36. Staff shortages continue to have a negative impact on life in the home and are placing existing staff under pressure on a frequent basis, by working additional shifts. EVIDENCE: The home has continued to struggle to maintain adequate staffing levels, due to the turnover of staff and other staff absences. The rota for week ending 2.10.05 reflected this situation, with shifts not covered and the use of agency staff. The chief executive of the Trust has acknowledged the problem faced by the organisation across the homes in the Kendal area and has written to staff, explaining the planned responses to improve recruitment and retention of staff. This includes internal and external adverts, interviews planned for September, continued recruitment to the relief bank and a recruitment fair planned for the 29.9.05. These staff shortages directly impact on the quality of life of residents and the continuity of care they receive and are subject to a requirement. There was only one member of staff on duty throughout the inspection who the inspector spoke to at length. In the absence of the manager staff files were not available for inspection, however the staff spoken to during the inspection confirmed that they were receiving regular supervision. They also stated that “they felt confident with the support available and being able to access support when required”. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 17 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, 41, 42. The home has experienced continued disruption due to management changes and a period of stability is required, to establish and nurture a consistent and reliable staff team. EVIDENCE: As described previously the existing manager is on long term sick leave, which the Trust has responded to by appointing a temporary manager, Ms Sally Arnold, who is an experienced senior support worker from a nearby home. She is working twenty hours in the manager’s role in Garth Brow and is working the remainder of her hours, in her substantive post, as senior support worker in the other home. Ms Arnold is on the Trust’s management development programme and is working towards her registered manager award. It is recommended Ms Arnold’s management hours in the home be reflected on the house rota. If the absence of the registered manager continues consideration should be given to Ms Arnold transferring all her hours to the home, to improve the continuity of care and give her more time to establish herself in the role. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 18 The regulation 26 management visits were now taking place as required, which were examined by the inspector. All other records relating to the management of the home and monitoring of health and safety, examined on this occasion were up to date and accurate. Both individual and general risk assessments were in place, with the staff on duty having a good insight to their responsibilities in maintaining a safe environment and safeguarding residents in the community. 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 19 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 3 3 3 3 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 2 13 2 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 2 X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1a Garth Brow Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 2 X X 3 3 2 DS0000022689.V249699.R01.S.doc Version 5.0 Page 20 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 20 Regulation 13 Requirement All medical record sheets must be completed at the point of administration, in line with good practice guidelines. The home must ensure adequate numbers of suitably trained staff are on duty at all times. Timescale for action 09/10/05 2 33 18a 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 5 20 Good Practice Recommendations It is recommended all relevant information relating to terms and conditions of residence are clarified and issued to residents. It is recommended that all staff responsible for administration of medication, sign all current PRN medication guidelines, in line with the home’s policy. It is recommended Ms Arnold’s management hours in the home, be reflected on the house rota. 3 43 1a Garth Brow DS0000022689.V249699.R01.S.doc Version 5.0 Page 21 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.V249699.R01.S.doc Version 5.0 Page 22 - 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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