CARE HOME ADULTS 18-65
54 Darlington Road Hartburn Stockton-on-Tees TS18 5EN Lead Inspector
Jackie Herring Announced Inspection 21st September 2005 09:30 54 Darlington Road DS0000039039.V251794.R02.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 54 Darlington Road DS0000039039.V251794.R02.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. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 54 Darlington Road Address Hartburn Stockton-on-Tees TS18 5EN 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) 01642 806448 01642 866433 bryan.cutter@choicescare.com Choices House Mr Bryan Paul Cutter Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2005 Brief Description of the Service: 54 Darlington Road is a seven bedded care home providing personal care to adults with learning disabilities. The level of disability is high and all of the residents are very physically dependant with communication needs. The home is a converted property, with seven single spacious bedrooms, one of which had an ensuite facility. There is a very spacious, nicely presented garden, which is accessible to all residents. The home is situated close to the centre of Hartburn, very close to a parade of shops, public house, community centre and church. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an announced inspection and was carried out in one inspection day, six inspection hours in total. A number of records were examined, including resident’s files, staff records, menu and medication record. Staff and relative interviews were undertaken and there was indirect observation throughout the day with staff and resident interactions being noted. 54 Darlington Road offers personal care to the maximum of seven people who have learning disability needs. It should be acknowledged that all of the current six residents have extremely complex needs and as such, due to cognitive and communication difficulties it was not possible to seek their views during this inspection. What the service does well:
A very high level of personal, social and emotional care is delivered the residents of 54 Darlington Road by a dedicated and well trained staff team who have a clear understanding of residents needs, within a very warm and homely environment. Relatives stated, “People who live at Darlington Road have not got a voice to be heard. But it their right as human beings to be cared for as best they can be. The care and quality of life is the best they can get from such a team of dedicated carers. If they could speak they would say, “I am happy living here”. Other relatives stated, “all of my loved one’s needs are fully met, they provide good social care and I am kept informed of GP visits and any changes”, “the residents deserve the right to the best care they can get and they get it here”. “Very caring staff with an understanding of individual patients needs”, “the staff meet my loves ones needs in every way”. Staff are happy and feel very supported in their job role, one staff member stated, “this is the best place I have ever worked, you just know you are making a difference to the residents lives”. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 6 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. 54 Darlington Road DS0000039039.V251794.R02.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 54 Darlington Road DS0000039039.V251794.R02.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): 2 The pre admission process is extremely detailed and robust and needs of residents are determined prior to admission. EVIDENCE: During discussion with the manager, it was confirmed that a copy of the Care Management assessment is always obtained prior to any admissions to the home. The admission process was described as being a very detailed, well planned process in which there is involvement from Consultant Psychiatrists, Social workers, residents/relatives and all other significant parties. It was also confirmed through discussion with the manager that a number of visits are made to the home by the prospective resident and family members prior to the actual admission to the home. 54 Darlington Road DS0000039039.V251794.R02.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, 9 Each resident has an individual plan and staff are fully aware of the needs of the residents. Although a wide range of information is contained in the plan, there may be too much additional detail, which deflects from actual plans outlining specific goals and interventions of care and may prevent these plans from being used as the main source to deliver care. EVIDENCE: Three sets of residents records were randomly selected to examine, although, only one was fully examined in detail. The records contained copious amounts of information both within the historic file and individual plan. During discussion with the manager, it was identified that there was potentially too much information, which could make the individual plans overly cumbersome and not as active and live a plan of care as it could be. These particularly related to the numerous risk assessments in which there was a risk assessment and plan in place for all plan of care activities. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 10 Due to cognitive and communication difficulties, it is not possible to fully involve the residents in their individual assessment of need and plan of care. It was confirmed through discussion, that much consultation was completed with relevant individuals such as families and also in collaboration with other social and health care professionals. It was very clear from having discussions with the manager, staff, relative and through indirect observations that the individuals needs of the residents were paramount and staff were able to positively describe their relationships with residents and describe how they encouraged choice and decision making through body language and non verbal communication. 54 Darlington Road DS0000039039.V251794.R02.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): 12, 15, 16, 17 Residents are provided with a range of activities, which lead to them having fulfilled life. Residents are provided with good quality meals, which meet their dietary needs. Contact with family members is encouraged. EVIDENCE: During discussion with staff they gave a detailed account of the type of activities residents were involved in. This included details of individual activities such as personal shopping as well as more planned activities including hydrotherapy and disco nights. During the inspection, individual activities were also observed to take place, such as snozelin therapy for two of the residents and relaxation to music for another resident. During discussion with staff, they confirmed that relationships with friends and family was important to the residents and said that this was always encouraged. A relative was interviewed during the inspection who said that they visited on a regular basis and that they were kept well informed of changing needs. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 12 A relative said, “the staff take their responsibilities seriously, they treat my relative with respect, very much as an individual, more like royalty”. Staff spoke of the flexibility of life in the home, one staff member said, “there is no particular routine, it very much depends upon how individual are at any given time”. The meals were described as excellent and there had recently been a new cook appointed. The inspector sampled lunch during the inspection, which was delicious. Copies of the menu’s were submitted with the pre inspection questionnaire and detailed nutritious and healthy meals. 54 Darlington Road DS0000039039.V251794.R02.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 Staff are able to demonstrate a knowledgeable understanding of residents individual needs and residents receive consistent support from staff to ensure needs are met. The written medication procedures need to reflect local arrangements and include procedures for controlled drug management. EVIDENCE: The residents who live at Darlington Road have very complex physical and medical needs. Due to cognitive and communication difficulties, it was not possible to engage residents in discussions about life within Darlington Road and to determine whether their full range of needs were met. Through observation during the inspection and discussion with a relative, staff and the manager it was clear that the resident’s needs were intimately known by all. Staff spoke about the importance of individuality and demonstrated knowledge of the residents they were keyworkers for. They were able to describe preferences in regard to activities and other life style needs and talked of the importance of understanding residents through non-verbal communication. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 14 Staff also described a weekly objective meeting, in which individual residents were discussed, as were their needs and wants for the week ahead. These were then planned for and included such matters as taking individual residents shopping for new clothes. There is a good range of specialist equipment to ensure that physical needs are promoted and met, such as tracking hoists, specialist beds and chairs. Staff also said that, “the residents are cared for fantastically”. Relatives said, “the staff recognise the needs of residents, they provide real hands on care by touching – holding hands and cuddling”, “all of my loved one’s needs are met, there is good social care and I am kept informed of GP visits and any changes”. A relative said, “the residents deserve the right to the best care they can get and they get it here”. Although the medication system was not fully examined, it was confirmed that the outstanding requirement from the previous inspection had been addressed. Also during an examination of the policies and procedures, it was identified that they required review and updating and they did not fully relate to the procedure in place at Darlington Road and did not include procedures for the management of controlled drugs as they only related to the use of Temazepam. Relatives through inspection comment cards stated, “very caring staff with an understanding of patients individual needs”, “Darlington Road is my loved one’s home in every sense, she has hands on care every day, tasty food and a good social life. This is how everyone in care should be looked after, the staff meet my loved one’s needs in every way”. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Whilst resident’s communication skills are very limited, arrangements are in place through the complaints process to promote safety and offer protection. EVIDENCE: Although resident’s views could not be obtained during the inspection, staff spoke of how they would take any concerns forward, they were clear about the complaints procedure and the need to act on behalf of the residents. One relative said, “if there were any concerns I would speak to the manager about them”. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards had been inspected at the last inspection. EVIDENCE: The environment at 54 Darlington Road continues to be most certainly conducive to meeting the needs of the residents. It was observed to be clean, odour free, bright, airy and extremely homely with sufficient internal communal space. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 17 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, 34, 35 Residents are in competent safe hand with their care needs being met by a well-trained staff team. Training records could be developed further and there is the need for competency records for more specialist tasks. The recruitment procedures are robust, however records were not fully up to date for more long serving staff. EVIDENCE: Training was discussed with the manager and individual training records were made available for examination. It was agreed with the manager that having a detailed training matrix enabling training to be effectively planned and monitored could further enhance the training records. During discussion with staff they believed that training was well delivered and the training enabled them to deliver effective care to the residents. As well as mandatory training being delivered there was more specific training such as specialist feeding techniques. During discussion with the manager, it was identified that there was the need to ensure where specialist techniques were being completed that certificates of competence be obtained. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 18 Relatives through discussion and though the inspection comment cards believed that there was a competent staff team. One relative stated, “the staff are brilliant, they recognise a lot of things that I have not seen”. A random sample of new staff files was examined and contained the required information. The pre-inspection questionnaire was discussed with the manager, which contained some details of Criminal Records Bureau checks. It was identified that these had not been completed for a number of staff who had transferred across from the previous organisation. Immediate action was taken by the manager to address this. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 19 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, 39, 41 Residents benefit from a well run home, which provides consistently high standards with sound leadership. The policies and procedures are in need of review to ensure they reflect the service and contain details of any local arrangements. EVIDENCE: Darlington Road continues to be a very well run home, which is described as a very friendly home with a very approachable manager and excellent staff team. Staff spoke of the approachability of the manager, the support that was given and also the fact that the environment was one of inclusion, with everyone having a voice and being valued. A relative inspection comment card stated, “People who live at Darlington Road have not got a voice to be heard. But it is their right to be human beings to be looked after as best they can be. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 20 The care and quality of life is the best they can get from such a team of dedicated carers. If they could speak, they would say, “I am happy living here”. Due to cognitive and communication problems, it was not possible to take the views of the residents. Staff were able to explain how they engaged with the residents through non-verbal communication and through their knowledge of them as individuals and how views of relatives would be taken. Policies and procedures were examined, which were not service specific and did not reflect local arrangements. Details of this, was that many of the policies and procedures were not relevant to care homes and contained details of supported living, domiciliary care and day care procedures. 54 Darlington Road DS0000039039.V251794.R02.S.doc Version 5.0 Page 21 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 X X 3 X X Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X x LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 x 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
54 Darlington Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 2 X x DS0000039039.V251794.R02.S.doc Version 5.0 Page 22 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 YA20 Regulation 13 Requirement The policies and procedure in respect of medication must be updated, reflect the procedures that are carried out by the home and include policies and procedures for the management of controlled drugs. Where staff undertake more specialist care tasks such as gastric feeds, there must be evidence of training a competency assessments. Criminal Records Bureau checks must be in place for all staff. Timescale for action 01/12/05 2 YA 32 18 01/12/05 3 YA34 19 21/09/05 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 YA32 YA41 Good Practice Recommendations Consideration should be given to developing the training records further, to include a training matrix/checklist enabling quick reference to staff training. It is recommended that the policies and procedures be updated and include for general use only those relevant to
DS0000039039.V251794.R02.S.doc Version 5.0 Page 23 54 Darlington Road 3 YA6 the service to aid access and use. There is also the need to ensure that they contain any local arrangement that may exist. It is recommended that the individual records and plan of care be reviewed as they contain copious amounts of information, which may deflect from the actual information needed to deliver and evaluate care. Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk
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