Inspection on 11/12/05 for 38 Sandgate

This inspection was carried out on 11th December 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

38 Sandgate 30/04/09

38 Sandgate 14/04/08

38 Sandgate 09/08/07

38 Sandgate 09/08/06

38 Sandgate 09/03/06

38 Sandgate 14/02/05

38 Sandgate 05/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 38 Sandgate Kendal Cumbria LA9 6HT Lead Inspector Ray Mowat Unannounced Inspection 11th December 2005 09.30 38 Sandgate DS0000036570.V262805.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 38 Sandgate DS0000036570.V262805.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. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 38 Sandgate Address Kendal Cumbria LA9 6HT 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 733465 Cumbria Care Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (2) of places 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Younger Adults by 1st April 2004. An application in respect of a registered manager for this home must be received by the National Care Standards Commision within 28 days of the date of this notice. A maximum of three younger adults with a learning disability (LD3) may be accommodated two of whom may be older with a learning disability (LD(E)2). The matters detailed in the attached schedule of requirements must be completed in the specified timescales. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. 14th February 2005 3. 4. 5. Date of last inspection Brief Description of the Service: 38 Sandgate is a registered care home for up to three people with learning disabilities. At present the home is operated and managed by Cumbria Care, an independent business unit within Cumbria County Council’s contract services group. There were two residents in the home at the time of the inspection. Due to the high level of assessed needs of one of the residents, there is an additional sleep-in staff required, who is using the third bedroom. The home is in a quiet residential area on the outskirts of Kendal town, it is close to a bus route and local amenities. The home is a semi-detached property with a small front garden and a paved patio area to the rear. All the rooms are single occupancy with the bathroom and communal areas of the home being shared. Suitable adaptations to meet the needs of service users were in place. 38 Sandgate DS0000036570.V262805.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 on Sunday 11th December 05. This enabled me to see a different aspect of life in the home at the weekend. I spent time with both the residents during the day and spoke to all the four members of staff on duty. I also spoke to the supervisor for the home, who was on duty at the nearby hostel. I also looked at records relating to the care of the residents and the safe running of the home. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5. Information relating to the terms and conditions of residence is poor. EVIDENCE: There was evidence on personal care plan files of input from a range of other professionals including specialist health care professionals. This included detailed assessments and specific strategies to guide staff. The home receives ongoing support from some specialist health services who are constantly monitoring and updating strategies and providing support to staff. Changes and other findings are incorporated into the care plan. The home has not yet produced contracts of terms and conditions as required at the previous inspection so this requirement will be repeated. The home has been purchased by Impact housing association who specialise in providing housing to people with disabilities. This was part of Cumbria Care’s corporate plan to de-register the small care homes. The home is still in the process of providing information to the commission relating to the application to deregister. However up until a decision is made the home remains a registered care home and must provide a service in line with the National Minimum Standards and Care Home Regulations. There is some confusion around who is responsible for replacing, repairing furniture and white goods and decorating the home. As far as the residents are concerned they are living in residential care and must receive that service in line with the care home regulations. Therefore they must be provided with a refund for the recent purchase of a drier and the new cooker that is required must be provided. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 8 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. Residents are enjoying a good quality of life with their needs and wishes appropriately responded to. EVIDENCE: The home has developed detailed care plans which are kept under review with input from other agencies and specialist health services and family. The care plans have evolved from the home’s own assessment and specialist assessments, when needs have been identified. It was evident from some of the reports from other professionals the “home is managing people effectively”. For one resident with complex needs a range of strategies have been developed, with multi agency input, to guide and support care staff. A good example of this is the “communication passport”, which records the meaning of particular gestures and words that the individual uses on a regular basis. This was developed with guidance from the speech and language therapist. Throughout the inspection residents were offered choices and their preferences were respected. One resident is very particular about routines. In response the home has developed and recorded a morning and evening routine for staff to follow. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 9 The home has now developed a comprehensive range of risk assessments to support and promote an independent lifestyle in the home and in the community. These were also kept under review which is good practice. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 10 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. Staff have a good awareness of individual needs and preferences and support residents in pursuing their chosen lifestyle. EVIDENCE: Care plan files contain detailed strategies that reflect individual needs and choices. Both residents attend the local day service five days each week, Monday to Friday. This provides them with a range of educational and leisure activities and community involvement. They are also able to socialise with their peers and develop friendships outside the home. They are involved in inhouse activities such as social and domestic activities, in addition to more active community activities, such as sailing, horse riding, day trips and visits to the amenities of the nearby town of Kendal. At home one of the residents enjoys a more sedentary lifestyle. In contrast the other resident is quite active and enjoys participating in community activities and will get involved with household chores. Since the last inspection the home has repaired the resident’s bicycle as required, which is a popular pastime they enjoy. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 11 On the day of the inspection one of the residents had enjoyed a relaxed start to their day, having a sleep in and a late breakfast, which they look forward to at a weekend and is something they valued. Both the residents have regular contact with their family and friends, with family and friends visiting the home or the residents going out to visit them. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 12 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. Personal and healthcare needs and support are well documented and the home is working closely with other agencies to ensure needs are met. EVIDENCE: The home has clear recording systems to monitor the personal and healthcare needs of residents. Key workers take a lead role in arranging appointments and coordinating check ups to ensure a continuity of care is maintained. A record of all health related interventions is held on personal files including the outcome of appointments and any resulting strategies. There were recent reports on file from specialist services. Residents were also registered with a local GP. One resident was undergoing an assessment regarding going up and down stairs. This has become a high-risk activity which has resulted in a change to how staff provide personal care. Appropriate referrals have been made by the home to look at aids and adaptations, including a stair lift, which will remove the risk and improve the resident’s quality of life. Medication records were up to date and in order. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 13 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. The home’s policies, procedures and practice ensure residents are safeguarded at all times and that their views will be listened to and acted upon. EVIDENCE: There were no recorded complaints since the last inspection. The complaints policy had been issued to all service users in the service user guide and was also displayed in the home. The home had appropriate policies and procedures in place regarding mistreatment and abuse of vulnerable adults that are based on current good practice. Staff I spoke to during the inspection were aware of what constitutes abuse and their role in reporting any issues. Staff receive training at induction and also through NVQ training. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Much of the décor and furnishings are in a poor condition and in need of attention. EVIDENCE: It was noted at the last inspection that the décor of the home and some furnishings were in need of attention. A requirement was made at the last inspection regarding the production of a programme of repairs and renewal. This was not available at this inspection. With the home now being owned by Impact housing association it is imperative that the home produces a programme of repairs and renewal. The flooring in the kitchen has ripped and is a trip hazard, this must be replaced within the stated timescale. The cooker is also in need of replacement. These issues are subject to a requirement. The suitability of the environment for one resident is being assessed, with a view to providing a stair lift, to eliminate the risk when going up and down stairs and improve access to the toilet and bathroom, which will promote independence. Residents have personalised their rooms to their own tastes with their own belongings. Although much of the décor is ‘tired and dated’ the home was clean and hygienic. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36. The home is maintaining appropriate levels of suitably trained staff to meet the needs of residents. EVIDENCE: Due to ongoing disciplinary investigations the home has two vacant posts, which are being covered by both relief staff and regular staff, who are working extra hours. The relief staff being used are fully inducted to the home and familiar with the residents and their routines enabling a continuity of care to be maintained. In the absence of the acting manager staff files were not available. However, staff spoken to said they got “good support and supervision”, which is provided by the supervisor for the home. They also said they got “suitable training that helped them in their role”. This included core training such as moving and handling as well as specialist training such as breakaway and restraint. Staff have developed good relationships with and an understanding of residents needs and preferences which has resulted in them both enjoying a ‘settled period’. Staff had a good awareness of their role and responsibilities and the reporting procedures of the home. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. The management support was inconsistent with the supervisor taking responsibility for the day-to-day running of the home. EVIDENCE: The home has not currently got a registered manager. The post has been vacant for some time, initially due to the absence of the acting manager, Ms Dixon and subsequently because of the pending application to de-register. It was evident that Ms Dixon, who is also managing the nearby hostel is not spending sufficient time in the home. This has resulted in the supervisor, Mr Shaw, who has 10 hours of supervisor time when he is not on “hands on care”, to carry out the management duties for the home. This situation must now be addressed and an application to register a manager must be forwarded to the Commission. Despite this lack of formal management support, the staff felt well supported and received regular supervision from Mr Shaw and this resulted in a consistent service for the residents. However there are several management issues relating to the terms and conditions and the maintenance of the environment that must be addressed. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 17 The home has conducted a consultation exercise regarding the proposed deregistration to a ‘supported living tenancy’. This process was on hold due to a legal challenge regarding de-registrations of care homes. For the application now to be considered the portfolio of supporting evidence must be updated. I met with the acting manager, Ms Dixon, on the 20th September 05, to clarify the information that is required to enable me to process the application. Earlier in the year a satisfaction survey was completed regarding all aspects of life in the home. Risk assessments have been developed to promote and support an independent lifestyle and maintain the safety of staff and residents. The assessment for supporting one of the residents up and down stairs is under review and must be monitored closely. The fire extinguishers were overdue for inspection. However, this had been noted by the supervisor and action taken to remedy this. 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 18 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 X X 1 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 1 3 2 2 3 1 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 X 3 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 38 Sandgate Score 3 2 3 X Standard No 37 38 39 40 41 42 43 Score 2 2 3 X X 3 X DS0000036570.V262805.R01.S.doc Version 5.0 Page 19 Yes 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 YA5 Regulation 5 Requirement The home must issue an up to date contract of terms and conditions that reflects the changes within the home and incorporates the requirements of the Care Home regulations and National Minimum Standards. This must be issued to and signed by service users or their representatives. (The original timescale of 1st May 05 was not met) The home must produce a programme of repairs and renewal prioritising work to be carried out. (The original timescale of the 1st May 05 was not met.) The cooker must be repaired or replaced. (The original timescale was not met of 1st May 05) The kitchen floor covering is ripped and must be replaced. A registered manager must be appointed and registered with the Commission. Timescale for action 01/02/06 2 YA24 23(2) 01/02/06 3 4 5 YA24 YA24 YA38 23(2) 23(2) 8 01/02/06 01/02/06 01/03/06 38 Sandgate DS0000036570.V262805.R01.S.doc Version 5.0 Page 20 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 Standard Good Practice Recommendations 38 Sandgate DS0000036570.V262805.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. 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