CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
7 Newgate Lane Fareham Hampshire PO14 1BQ Lead Inspector
John Vaughan Unannounced Inspection 10th January 2007 10:10 X10029.doc Version 1.40 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 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 7 Newgate Lane Address Fareham Hampshire PO14 1BQ 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) 01329 667041 www.c-i-c.co.uk. Community Integrated Care Mrs Lin Cowdrey Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4), Physical disability (4) of places 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: 7 Newgate Lane is a care home that offers care for up to four people who have a learning disability and sensory disability. The property is owned by Knightstone Housing Association and is managed by Community Integrated Care. The home is situated in a residential area near to the town of Fareham and the village of Stubbington. The home has easy access to local recreational and health care facilities. The placement fee for this service is currently £1028.51 per week. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector met with service users, staff members and the manager of the home during the visit to the home, which took place over one day. During the visit the inspector spoke to service users about their experiences of the home, observed service users and staff, sampled records, interviewed staff and toured the home assisted by the manager, staff and service users. In preparation for this visit the inspector also examined information obtained about the service including incident reports, regulation 26 reports and the most recent inspection reports on the home. What the service does well: What has improved since the last inspection?
The home now has a ramp to the front door to improve access to the service. This also improves the safe evacuation from the service. New furniture has been purchased for the dinning room. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practice of the service ensures that residents have a full assessment before moving into the home to document and respond to their needs. Residents and their representatives are encouraged to visit and see the home to help them make a choice about where to live. EVIDENCE: The inspector examined a sample of two service user’s records during the visit to the home. An assessment of need was in place for both individuals and copies of care manager’s assessments were also seen on record.
7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 9 The practice of the home is to complete an assessment of the individual before offering a place in the home. Service users and their representatives are supported to visit the home before choosing to live in the service to tour the home and meet other service users and the staff that will support them. Intermediate care is not provided by this service. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by care plans that generally document their needs and how these needs should be responded to. Some work is required to ensure support strategies for managing challenging behaviour are in place. Medication administration practices need improving to fully demonstrate that they protect service users. The practices of the home demonstrate that service users are treated with dignity and respect.
7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 11 EVIDENCE: Both service user’s files had a care plan. The care plan contained support information covering areas of personal care, health, mobility, communication and likes and dislikes. A new format was introduced to the home in August 2006 and this was completed on the files seen by the inspector however in the section on “support needs- action to meet these needs” the majority of these areas say see care package. The manager explained that they have been told that they can use the older formats already in place. This means that a number of formats are now used in the home and the files are very full. The manager agreed that this needed to be looked at to make sure it remains useable and meaningful. One service user is currently receiving support to manage their challenging needs and the inspector saw evidence of input from the community learning disability team, consultant, GP and care manager. Guidelines were seen on utilising distraction and redirection techniques. The inspector did not find any guidance on how to manage incidents when the service user is assaulting others or damaging property and staff explained that they have had to escort the individual from other service user’s rooms. Staff have had training in nonviolent intervention and break-away techniques. The manager was advised that they must put clear guidelines in place to address this and link to the current agreed practices. The home’s medication administration practices were examined. Medication is stored securely in metal drug cabinets and a monitored dosage system is used to store and dispense medication. When exploring the administration practices with a member of staff some anomalies were found that on further examination confirmed that the wrong dose of medication had been given to a service user. An error had occurred outside the control of the home however staff had not spotted the mistake and continued with the reduced dose of medication supplied by the pharmacy. When this was reported to the manager they took immediate action to obtain the correct medication and arrange for a new prescription to be sent. Throughout the visit to the home staff members were observed interacting with service users making positive comments, discussing activities and offering choices about meals and activities. Staff knocked on doors and explained to service users what they were doing when assisting them with their needs.
7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to have an active life enhanced with contact from family members and staff practices that treat service users with respect. A balanced and varied diet is offered to service users meeting their needs. EVIDENCE: 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 13 Service users were involved in a range of activities during the day of the visit to the home. One service user returned from his trip out with a community activity worker. They told the inspector that they had been to the library to take out some talking books. Another service user returned for a day service in the afternoon and said that he had enjoyed the activities he had taken part in. Two service users went out on a trip in the local community supported by staff. The inspector confirmed that activities are planned and three of the four service users have a documented activity plan, which includes a variety of activities such as hydrotherapy, sensory suite sessions, gardening, music groups and local community trips. The inspector found conflicting information for one person within their person centred plan as it states that a it is important for this person to have a structured activity plan and this is not in place. This was discussed with the manager who confirmed that a more day-to-day approach to activities is taken to be successful in supporting this person. The inspector saw evidence to confirm that this person is engaged in regular activity however the manager will need to ensure the care plan actively reflects this approach. Care plans document individual choice interests and wishes, the decorating of service users rooms reflects individual choices and personalities and through taking to staff the inspector could see that individual choices are supported and encouraged. These plans also contained information on important relationships and staff confirmed that there are no restrictions on visitors to the home and service users are encouraged to maintain important relationships. A menu plan is in place demonstrating a varied and interesting diet is offered to service users and staff members confirmed that service users are supported to make choices about what they want to eat. Lunch was offered in a flexible manner and service users were not hurried or rushed in any way. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home can demonstrate that the views and concerns of service users, their families and representatives would be documented and acted upon. The practices within the home mean that service users are protected from abuse. EVIDENCE: A complaints log is in place and the manager reported that they had not received any complaints. A policy and procedure is in place for responding to complaints within the home. The inspector spoke to staff about the actions they would take to raise concerns and they were all aware of how to make the manager and senior staff aware of concerns, complaints and allegations. The inspector confirmed that staff members have received training in adult protection and preventing abuse.
7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a generally well maintained and comfortable home enhanced by individually personalised private rooms. EVIDENCE: 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 16 The inspector toured the home assisted by staff and service users. The home is clean, tidy and free from any unpleasant smells. Service users allowed the inspector to view their private rooms. These rooms were decorated to their personal tastes with pictures, posters and personal items. A service user said that they were very pleased with their room and had everything that they need including a number of items related to their favourite football team. Another room seen by the inspector contained lights sensitive to music and a staff member explained that they have established that the service user responds positively to these lights and during the day the service user was observed listening to his music enhanced by a number of flashing and pulsing lights. The home is well maintained and had good quality furniture in the communal areas. The home has a small garden and patio to the rear of the home. Staff reported that they have just received new furniture for the dinning room that included a new table and chairs and the old chairs were worn out. The kitchen is looking worn out and has been repaired on a number of occasions in the past. Some consideration will need to be given to planning for replacing this to maintain the good image and safety of the service. A ramp has been installed to the front door to improve access for service users who have limited mobility. This improvement also ensures safer exiting in an emergency such as fire. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well-trained and supervised staff members support service users and they are protected by recruitment practices that demonstrate a thorough recruitment procedure is followed in the home. EVIDENCE: The inspector met with the staff team and engaged in a group discussion about their collective experiences of working in the home, how they support service users and their training and support to carry out their roles. The team commented that they feel well supported and have regular supervision with the manager. An appraisal system is used in the home to
7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 18 monitor performance and one member of staff is nearing the end of their probation period which links into this process. Staff demonstrated a sound knowledge of service users needs and were able to tell the inspector how they use the documented care planning information on each person to help meet these needs. Induction and training records were available to demonstrate that staff have completed mandatory training in health and safety, first aid, moving and handling, food hygiene and principles of care. Staff told the inspector they have been trained in non-violent crisis intervention to support service users who challenge the services provided for them. Records also confirm that the staff team have undertaken training in protecting people from abuse. The organisation provides support for staff to obtain a National Vocational Qualification (NVQ) in care. One staff is currently completing an NVQ at level 3 and three staff have obtained an NVQ at level 2. Three staff recruitment records were examined and found to be satisfactory, containing an application form, two written references, proof of identity and evidence that Criminal Records Bureau (CRB) and Protection of Vulnerable Adults register checks have been completed. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 20 Service users are supported by a service, which is managed in an effective and open manner. The service can demonstrate that a system is in place to develop the service with views from service users and their families included in this process and the home’s equipment is maintained and serviced to keep people safe. EVIDENCE: The manager of the home has a qualification in the care field and is currently undertaking her Registered Manager’s Award (RMA). The manager explained that they are now working on a short timeframe to complete this award. A service user and stakeholder survey is undertaken by the organisation on an annual basis and feedback is provided to the service. The manager told the inspector that they are currently completing a business plan for the home. Monthly regulation 26 visits arte made to the service and a report is completed for these visits and held in the home. Service users are supported to express their views about the home and are encouraged to make choices for themselves about day-to-day events. The inspector observed this during the visit. The manager reported that family members actively support service users and advocate on their behalf. The inspector confirmed by examining the homes servicing records that the alarm system has been serviced regularly. Weekly alarms tests are completed, a fire drill was carried out in December 2006 and staff training in fire safety took place in the same month. Records examined also confirmed that the heating, electrical and hot water systems have all been inspected and serviced this year. 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 3 6 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 ENVIRONMENT Standard No Score 19 3 20 3 21 X 22 X 23 3 24 X 25 3 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 22 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 OP7 YA6 Regulation 15 Requirement The registered person must ensure that guidelines are agreed and put in place to demonstrate how staff will intervene to support a service user when assaulting others. This must include specific instructions on how staff support the service user to leave areas of the home that they have no access to. The registered person must ensure that staff receive updated training in the safe handling of medication to ensure medication is correctly checked on receipt and any inaccuracies are rectified. Timescale for action 07/03/07 2 OP9 YA20 13 07/03/07 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 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 23 7 Newgate Lane DS0000012363.V324821.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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