CARE HOME ADULTS 18-65
North Paddock 22 North Paddock Court Lings Northampton NN3 8LG Lead Inspector
Sheila Smith Unannounced 13 September 2005
th 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. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service North Paddock Court Address 22 North Paddock Court Lings Northampton NN3 8LG 01604 412501 01604 412501 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) Mr Barrie Oldham, The Brain Injury Rehabilitation Trust, 1st Floor, 32 Market Place, Burgess Hill, West Sussex, RH15 9NP Mrs Gillian Taylor CRH 3 Category(ies) of MD Mental Disorder - 3 places registration, with number of places North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 1st February 2005 Brief Description of the Service: North Paddock Court provides care and support for three residents between the ages of 18 and 65 years who have a mental disorder, arising out of an acquired brain injury, excluding learning disability or dementia. The service is part of The Disability Trust Brain Injury Services. The Trust works in partnership with a number of clinical specialists to provide specialist assessment and rehabilitation programmes. However, health care professionals external to the Home meet therapeutic and health care needs. The Home is situated on a residential estate close to local amenities, with easy access to a range of community activities, and public transport from the centre of Northampton. The home blends in with others in the road. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Clients, and upon their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting one of the Clients and tracking the care they receive through review of their records, discussions with them, and with the staff, and observations of care practices. The inspection took place during an afternoon over a period of 4 hours and was carried out on an unannounced basis. Communal areas, and bedrooms were visited. A selection of care records, and essential records of the home were reviewed. All of the Clients were spoken to as part of the inspection process. The Registered Manager Mrs Gillian Taylor was present for most of the inspection. The Commission had received a number of comment cards from Clients and relatives prior to the inspection. The comments recorded were positive and praised the home and the staff for the way in which the care is provided. What the service does well:
North Paddock Court is a family home where the Clients live as a family and have full access to all areas of the house. Clients are encouraged to contribute ideas to the running of the home through meetings with the staff. The home is situated in a residential area of Northampton and is similar in style to other properties in the area. The home is homely, and comfortably furnished and there is a private garden at the rear of the home, mainly laid to lawn. The home was decorated to a reasonable standard and the Clients bedrooms that were inspected were personalised containing, personal items, and had been decorated in colours chosen by the residents. The home had a warm relaxed and comfortable feel to it, with a dining room bright and airy,
North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 6 overlooking the garden, and a cosy lounge, which contained comfortable furniture. The three Clients were very positive about the services provided which include meals, personal care, activities, and also about the support that they receive from the staff, to maintain their independence. On the evening of the inspection relationships between the Clients, the Registered Manager and the member of staff were observed to be very good. No new admissions have taken place since the last inspection, but the Registered Manager clearly demonstrated that a new admission would take place over a period of time, involving several visits and overnight stays. Residents have appetising and healthy food; the evening meal on the day of the inspection was prepared by the clients with support from the member of staff, and eaten as a family meal. What has improved since the last inspection? What they could do better:
In accordance with the Trust’s wider service provision, Clients move into this Home from one of the other Trust resources, and all previous assessments and rehabilitation plans are transferred into the Home. No new admissions have taken place since the last inspection, but assessments read during the inspection tended to focus on the clinical assessment rather than holistic needs. The clients would benefit from the home devising their own initial assessment documentation that would feed into the care plans, and complement the clinical assessment.
North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 7 The Registered Manager said that the concerns raised at previous inspections regarding the policy of lone working, preventing the clients being able to access individual hobbies and activities, had been addressed by clients being asked to state their preferences for activities in advance, and additional staff being brought in .In reality this means the Registered Manager working a split day to accommodate evening activities. Clients stated that there were not enough staff on duty, and one feedback from a relative also indicated that they felt that this was a problem. The downstairs shower is out of action due to water seeping through the tiles. One of the Clients who does not wish to take a bath is having to travel to Milton Keynes to one of the other properties operated by the Trust for a shower. 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. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 8 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 North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 9 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 Prospective residents have the required information to enable them to make an informed choice about the home. EVIDENCE: The statement of purpose was viewed as part of the inspection process. This document covered all of the areas outlined in schedule 1, and the information was informative to the reader. All of the clients were able to give feedback relating to this document, and all had a copy along with the Service User Guide, in their rooms. Prospective Clients are invited to the home for meals and to stay overnight where possible, in order that they may meet the other clients and assess if they will fit in with the group. The Clients are admitted from another home owned by the Trust, and assessments received by the home tend to be clinical in nature. The home should consider devising its own assessment documentation that includes all of the areas outlined in the National care Standards, to feed in to the care plan. All of the clients were very positive in their comments about the staff and the home, and said ‘ staff are fantastic’ and ‘being at this house has helped me to improve and to achieve my goals’ North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 10 A contract is in place for each client. This agreement clearly sets out the terms and conditions of occupancy, and had been signed by the client. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 11 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 Systems are in place that allow Clients to be involved in decisions about their own lives, informed about restrictions that have been imposed, and the running of the home. EVIDENCE: As stated previously all assessments are generated from the clinical multidisciplinary review processes. The Care plans known as a Supported living plans had been divided into the factors affecting progress towards independence, physical, emotional, cognitive and functional. This was followed by a functional goal, and a short-term goal, with clear directions to staff describing their actions to assist / enable the client to meet their goals. The plans tend to be written in a clinical manner and although they were informative, and clients had signed them, it was clear from discussion that they did not fully understand the contents. Clients indicated that they made their own decisions and choices, based on information given to them by the staff. One Client described the decisions that she was allowed to make in her work placement. House meetings take place on a regular basis, and there was evidence from the minutes that discussions were held about trips out, and about matters concerning the house.
North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 12 Case records evidenced that risk assessments are undertaken to a good degree and strategies of management were in place to eliminate or minimise risk, including behavioural management strategies. Client’s comments and observations made during the inspection evidenced that staff provide support, guidance and training to assist them to manage their own personal safety. Clients were able to explain why they were not allowed to do something and the reasons why, and one Client also said that she would question restrictions. Another Client said that she was not allowed to go near flashing lights as it may affect her epilepsy. Clients indicated that they were well aware that the home keeps records about them. Records were seen to be kept securely in the office. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17. Clients are given opportunities for accessing the local community, given opportunities for placements in the community, according to individual skills, encouraged to make friends and maintain family relationships, which leads to a fulfilling lifestyle. EVIDENCE: Clients confirmed that they had opportunities to increase their practical life skills and were encouraged to do things for themselves, and to help with household tasks such as helping to keep their bedrooms clean, setting and clearing tables, washing up, assisting with their own laundry, and cooking the meals. On the day of the inspection one Client was cleaning and hoovering her room, and later others made the evening meal assisted by the member of staff on duty. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 14 Two of the Clients work voluntary in local charity shops, and another helps in a local café for two mornings a week. All of the Clients were enthusiastic in their comments about their placements and obviously enjoyed them. The Registered Manager confirmed that the home has a positive relationship with the local community. Local amenities are available and used by Clients, such as the local supermarket, restaurants, and pubs. One Client said that she enjoyed picnics, visiting local garden centres, because she enjoyed gardening, and going to the theatre. She commented that she would like to go out to the theatre and cinema more often if staff were able to take her.(This is the subject of a requirement) All of the clients spoke about a regular walk through Ling’s wood each week and said how much they enjoy it. Clients confirmed that they could receive their visitors where they wish, whether this was in their own rooms or the communal lounges. Clients are encouraged to maintain close contact with their families and on the day of the inspection one client had returned to the home, after spending a few days with her family. Residents were positive in their comments about the food provided. The meal on the day of the inspection consisted of King Prawn Saganaki, garlic and feta cheese, which was prepared by the clients assisted by the member of staff Clients were rightly proud of their efforts and enjoyed their meal. Fresh fruit is available at all times. The Clients prepare the menu and have three meals a day, of which one is a cooked meal, alongside snacks and drinks. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19, 21 The arrangements for planning care in this home are good ensuring that health personal and social care needs of people living in the home are fully met. EVIDENCE: The Clients need little help with their personal care but confirmed that their privacy was respected at all times. One Client said ‘staff always knock on my bedroom door before coming in ‘ Clients said that they were taken to see the Doctor if they were unwell, and although were given the opportunity of seeing the doctor alone would rather the staff accompany them as they had problems with their memories and would not remember what was said. Through the Trust Clients have access to specialist support such as a Clinical Psychologist, Occupational Therapist, and a Speech and language therapist, who monitor their progress towards meeting their individual goals. There was evidence that Clients had been asked whether or not they wished to discuss their wishes in the event of terminal illness or death. If the client was willing to talk then their wishes were recorded. There was evidence that this subject was treated competently and with sensitively.
North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 16 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) 22. Complaints are handled objectively and Clients were confident that their concerns would be listened to, taken seriously and acted upon. EVIDENCE: Out of two relative / visitor comment cards received one relative confirmed that they are aware of the homes complaints process, but had not had course to use it. Another relative commented that they sorted out problems with the Registered Manager. The pre-inspection questionnaire indicated that there had been one complaint within the last 12 months, but this did not directly concern the home. The Service User Guide kept in the Clients rooms contained the complaints procedure. Clients indicated that they would contact the staff or the Registered Manager if they had any complaints or problems and were confident that they would be resolved it in a professional way. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 17 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) 24,30 The standard of the décor within the home is reasonably good, and the standard of hygiene was high, so that the residents have a homely place in which to live. EVIDENCE: The Home is close to a local shopping centre, and accessible by public transport from the centre of Northampton. It offers a family styled environment for the Clients and is in keeping with the local community The Home is suitable for its stated purpose and provides Clients with appropriate living space. The premises were generally well maintained, comfortable, bright, and cheerful. The clients were looking forward to the delivery of new carpets shortly. Standards of domestic and hygiene maintenance were appropriate at the time of inspection. The kitchen area was tidy, with work surfaces clean, and all perishable foodstuffs appropriately refrigerated. Kitchen equipment, such as the cooker, refrigerator, and freezer were suitable in capacity for the needs of the Clients.
North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 18 Problems with the downstairs shower means that one of the clients, who prefers not to have a bath, is escorted to Milton Keynes for a shower. The Registered Manager is experiencing some problems with the Housing Authority, who owns the house, in correcting the problem. (This is the subject of a requirement) The Clients were pleased to show their rooms, which were found to be clean, comfortable, appropriately furnished and personalised. The Clients confirmed that they were happy with their rooms. One of the Clients was proud of the small garden, at the rear of the property, where she enjoyed growing flowers and tomatoes. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34,35 The numbers of staff employed do not allow the individual and the collective social needs of the residents to be met, thus potentially causing frustration amongst the residents. EVIDENCE: This small home has a total staff team of 4 including the Registered Manager, who is part of the rota. Concerns have been raised at previous inspections regarding the inflexibility of the rota that provides one person on duty, being able to meet the individual needs of the Clients outside of the home. The Clients commented that they were not able to go out as much as they might wish to because of the lone working policy. They gave very positive comments about the Manager, but also commented that ‘she had a lot of paperwork to do’. The member of staff on duty said she would always contact the Registered Manager or the person on call if she was concerned about a problem. She said ‘Although we are on duty alone we do not feel so, as there is always someone to talk to if there is a problem’. The home has a procedure for contacting the person on call but did not have a risk assessment for lone working. (This is the subject of a recommendation) North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 20 The member of staff on duty, demonstrated throughout the inspection, a good understanding of individual Clients needs and interacted with them in a positive manner. The General Social Care Council’s standards of conduct and practice have been made available to all staff. One staff file was checked during this visit. The file demonstrated that there is a robust recruitment procedure used in this home. All staff have an enhanced criminal records bureau check. Training provided since January 2005, has included First Aid, Control of substances hazardous to health, Manual Handling, Fire, Food hygiene, epilepsy, Brain injury rehabilitation training. Staff do not hold a National Vocational Training qualification. (This is the subject of a requirement) It was evident that the care provided by staff is based on a sound plilosophy and values that promote enable and encourage the Clients to work towards their own goals and live a live as full as possible. The member of staff said that she had spent some time recently travelling on local public transport with one of the clients, to help develop her confidence to be able to travel alone. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 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 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) 37,42 The registered Manager manages the home efficiently and ensures the Client’s rights are protected. EVIDENCE: The Registered Manager is competent and shows warmth and commitment to the Clients and staff. Training undertaken includes National Vocational Qualification at level 3, but she has not yet taken a Management qualification (This is the subject of a requirement) The member of staff commented that the Manager was easily accessible to her, and willing to discuss issues and guide her in practice by example. Discussions with Clients indicated that the Manager was visible and very much a part of the team. The home had a relaxed atmosphere and both staff and Clients commented on their opportunities to voice their opinions. North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 22 A sample of records was examined which included Fire records, Risk assessments, Boiler service, Gas and Electrical testing records, and accident records. All the records that were seen were accurate and up to date with the exception of a risk assessment for lone working. (This is the subject of a recommendation) North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x x Standard No 22 23
ENVIRONMENT Score 3 x 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 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 2 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
North Paddock Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 24 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 14, 33 Regulation 18 Requirement To review staffing levels and deployment having regard to the Clients assessed individual needs, of support to pursue their own interests and hobbies.(This was a recommendation at the previous inspection ) The shower must be repaired Staff must be enrolled for National Vocationa Training The Registered Manager must enroll for a Management qualification Timescale for action 30/11/05 2. 3. 4. 24 33 37 23 18 9 31/10/05 31/10/05 30/11/05 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. Refer to Standard 2 Good Practice Recommendations Prospective clients would benefit from assessment documentation which is specific to the home, and covers the criteria in standard 2.3 of the National Care Standards Act. A risk assessment for lone working should be available. 2. 42 North Paddock 20050913 North Paddock Court X00022 UN Stage 4 S12873 V243804 C51.doc Version 1.40 Page 25 Commission for Social Care Inspection Newland House, First Floor Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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