CARE HOME ADULTS 18-65
All Saints Vicarage Church Road Eppleton Hetton le Hole DH5 9AJ Lead Inspector
Elsie Allnutt Announced Friday 19 August 2005 at 9.00 am 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. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service All Saints Vicarage Address Church Road Eppleton Hetton le Hole Tyne & Wear Dh5 9AJ 0191 526 6326 0191 526 6326 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) Autism North Limited Miss Sandra Douthwaite Care Home 5 Category(ies) of LD Learning Disability (5) registration, with number of places All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 4 February 2005 Brief Description of the Service: As the name suggests the house was previously a vicarage. It is a big old building in its own grounds with an extensive grassed area and mature trees, however currently there is building work going on in part of this area at the back of to extend the building. The building is next door to the church it used to belong to. On the other side is a children’s play area. Church Road is a quiet street which runs parallel to the main road through Hetton.The interior of the house retains many of its original features such as wooden shutters on the windows. The décor is bright and the furniture uncluttered, allowing freedom of movement. All of the service users have single bedrooms that are individually decorated. The extensive grounds are kept tidy by a gardener and the general repairs are addressed by a handyperson. The home is currently registered to provide care for five service users under 65 years all of whom have a learning disability and who have autism. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took 5 hours over one day in August 2005. The views of four service users and four members of staff were sought. Due to the needs of the service users their satisfaction of the service provided did not rely on verbal communication but it was interpreted through observations of body language, interaction with staff, discussions with staff and the examination of records. This process demonstrated that all were satisfied with the service and the care and support given by staff. The families of the service users also gave positive feedback in relation to the satisfaction of the service provided via surveys carried out prior to the inspection, however there were some comments in relation to the lack of information about the plans for the new building. As part of the inspection process a sample of service users’ care files and the homes records were also examined. What the service does well: This service provides accommodation of a good standard. It is well maintained and as a result of effective cleaning routines offers a clean and hygienic environment. On the day of the inspection the friendly interaction of service users and staff created a warm and welcoming atmosphere and by observing life in the home it was evident that service users are supported to live a full and active lifestyle. Some of the same staff have worked at the home for many years, and as a result positive relationships have developed with the service users. The staff have detailed knowledge of the service users’ complex needs and this enables a consistent approach. Staff work with respect and skill and aim to involve service users in making choices about what they prefer to do. A mutual respect was observed between staff and service users. Some comments made by relatives include; “The standard of care is very high. It is more than just a job for the staff,” “Our experience of the staff and care is that it is of the highest order …….. is very happy, healthy and well cared for.”
All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 6 Care plans are well documented, up to date and relevant, and record service users’ needs and how they are addressed, identifying, when necessary, areas of risk and minimising these with clear guidelines for staff to follow. This enables a consistent approach and protects the service user while at the same time assists them to be independent and develop. What has improved since the last inspection? What they could do better:
So that everyone with interests in the home and its service delivery are aware of the details of any changes in the service, communication, in particular in relation to the building plans, could be improved. So that service users/relatives are aware of the full fees incurred in the cost of individuals’ care, and how they are paid, this information should be included in individual service users’ contracts. As part of the recruitment process the home receives a check from the Criminal Records Bureau for each member of staff, to ensure the service users’ safety. So that the CSCI can make sure that this has been carried out the original document should be kept for examination at the nearest inspection. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 7 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. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.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 All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.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) 5 Each service user has a contract that confirms that the home can meet service users needs, clearly stating the terms and condition of their care, however this does not include the full cost of the fees to be paid or how they are to be paid. EVIDENCE: Records confirmed that each service user has a contract that is clearly set out detailing the terms and conditions of their stay at All Saints Vicarage. These are now signed by a representative on behalf of the service user, however of the sample examined, the space that is provided to insert the cost of the fees and how they are to be paid is blank. This was brought to the attention of the manager. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 10 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) 6,7,9 Service users assessed needs are reflected within their individual plans of care, which provide guidance for staffs’ care practice. So that service users remain safe and their rights and independence are promoted, they are supported to take risks within a risk management framework. EVIDENCE: Care plans reflect that service users assessed needs are met and their rights and independence are promoted. To ensure a consistent approach to the care of individual service users, all are allocated a key worker who is responsible for the monitoring of the care plan. Although all of the service users living at this home have Autism, service users individual difficulties relating to this are evident and recorded appropriately. The guidelines, that were evident in the care plan for staff to follow in relation to these, maintain the consistent approach. Information in the care plans demonstrate that service users are supported to take part in as normal a life as possible and the risks that may be involved in doing this are addressed and risk management plans put in place. These are an integral part of the care plan.
All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 11 The manager explained that the risk assessment provides useful information as to whether a service user would be safe taking part in a particular activity, for example whether swimming should take place in a public pool or whether a specialist pool is needed. For one person the latter is needed and guidelines for staff to follow support the service user to successfully take part in an activity that they enjoy. Although it was evident when reading care plans that the likes and dislikes of individual service users are clearly recorded, it is acknowledged that due to their complex needs offering choices can cause anxiety. Staff explained that to avoid this choice is often limited, and often the choice of two options is given, or in some cases the choice is made for the person by staff. It was explained that this is achieved by using the knowledge recorded about the service user both in the care plans and the homes Choice and Consultation file. Records confirmed this. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 12 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) 12,13,14,15 Service users are assisted to lead active and fulfilling lifestyles by having a regular community presence and by accessing a range of leisure facilities. This assists service users to lead a full and enjoyable life. EVIDENCE: Due to the complexity of their needs none of the service users take part in paid employment or attend college. A recent assessment for someone recently leaving school confirmed this for one service user. However positive work by staff has resulted in each service user taking part in a varied activity programme. Staff and records confirmed that most of the activities that service users are involved in involve physical activity. However one service users care plan recorded their great enjoyment of the cinema and another listening and playing music. Other activities recorded include swimming, 10 pin bowling horse riding and walking. On the day of the inspection all service users were involved in a variety of activities, two went out for lunch and then 10 pin bowling, others went for a walk through a local park, while one person stayed at home listening to music and another went out with relatives. Staff confirmed that, as well as taking
All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 13 part in community-based activities service users use the facilities at Gorse House on a planned basis. The manager confirmed that the home maintains positive relationships with service users families and endeavours to keep them informed of any changes in the lives of their relatives, and any changes to the service. The manager confirmed that letters were sent out to the relatives in relation to the current building work. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 14 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) 18,19,20 Service users personal and healthcare needs are met in a flexible, but consistent manner, and the medication arrangements are managed in a safe way, appropriate for the needs of service users. EVIDENCE: Staff support service users to address their individual healthcare needs by assisting them to visit local GPs and attend hospital appointments. The outcomes of such visits are recorded in the care plans. Through observing the interaction of staff with service users it was evident that personal support continues to be delivered in a discreet and respectful manner. Staff were observed offering support sensitively and appropriate to the needs of the individual service users. Locks on toilet and bathroom doors promote individual service user’s dignity, however when one service user failed to use this facility staff were observed promoting their privacy and dignity by closing the door for them. Staff confirmed that they have received training in relation to the administration of medication and observation on the day confirmed that the procedures were appropriately followed.
All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 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 standard(s) 23,24 Satisfactory arrangements are in place to help protect service users from abuse and a comprehensive complaints procedure ensures that concerns and complaints are taken seriously. EVIDENCE: Staff confirmed that they have received awareness training regarding abuse and adult protection, as well as training in relation to handling verbal and aggressive behaviour. In discussion staff were able to appropriately describe what action to take in a situation where they witnessed abuse. There were no complaints recorded since the last inspection. The complaints procedure has been developed in picture format in an attempt to make it accessible to service users, however it is not clear how much is understood. Staff explained that they would be able to recognise when someone is unhappy about something by observing their reaction and behaviour and this would be recorded and addressed directly. Records confirmed this. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 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 standard(s) 24,25,28,30 Considering the current building work taking place the overall standard of the environment, including service users individual bedrooms is good, clean and hygienic, however there are areas of the home that need attention due to the work in progress. Effort has been made to maintain the safety of the service users. EVIDENCE: As found at previous inspections the standard of the environment at this home is good even though building work is in progress. The furnishings are of a good quality and reflect the needs of the service users. The large rooms and high ceilings provide the space needed for five young adults to, sometimes awkwardly, move around safely without restriction. The manager confirmed that the areas of the building showing signs of wear and tear are to be addressed on completion of the current building work. The manager explained that the extension is to provide additional space to the dining and lounge areas on the ground floor, and two additional rooms on the first floor. This is to provide separate living facilities for an additional service user, the plans of which have been discussed with the CSCI.
All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 17 Effective cleaning routines reflect a hygienic and clean environment and staff confirmed that they had received training in relation to infection control. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 18 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) 32,33,34 The home employs a competent and qualified staff complement via robust recruitment and selection processes, which means that service users are effectively supported and protected by staff. EVIDENCE: The examination of staff rotas confirmed that an adequate number of staff are on duty each day to address the needs of the service users. The examination of staff files provides evidence that good recruitment procedures are in place including the request of two references and clear CRB checks. When examining one of the files, although there was evidence that the CRB check had been made, the document number only was available. The manager was advised that the actual CRB document needed to be kept, until examined by the CSCI, during the inspection nearest to the recruitment of the member of staff. Staff discussed the needs of the service users with respect and understanding. When observing staffs’ social interaction with service users, their response, and the way they addressed service users’ needs, it was evident that positive relationships have developed between them.
All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 19 86 of staff are now qualified in NVQ, although this was lower to that found at the last inspection, this was due to staff moving to other positions within the company, however this remains a good achievement. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 20 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) 42 The health and safety of the service users is promoted by a well managed staff team. EVIDENCE: The home has comprehensive health and safety policies and procedures that are clearly recorded in a health and safety file. The manager confirmed that a health and safety audit, being carried out by an outside agency, is currently in process and the outcome will result in a review of the health and safety procedures within the home. It was clear that the health and safety of the service users had been considered when planning the current building work. The manager confirmed that the builders working on the site had been consulted about the safety of the service users prior to the building work starting, and the builders’ daily plans are shared with the manager. Observations of the work in progress confirmed that acceptable safety measures were in place and the necessary
All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 21 plans have been shared with the appropriate agencies. All of the areas where builders were at work were restricted to service users, although service users could observe the work in progress from a safe place. The staff team were observed to work with health and safety issues in mind and confirmed that they had attended training in relation to moving and handling and first aid. The fire log and accident books were up to date and recorded appropriately. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 22 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 x x 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 4 4 x 3 3 4 Standard No 31 32 33 34 35 36 Score x 4 3 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
All Saints Vicarage Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 23 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. 2. Standard 5 24 Regulation 5(1)(c ) Requirement The amount of fees to be paid must be included in each service users Contract. The areas of the building showing wear and tear must be addressed on completion of the building work. Inidividual CRB certificates must be kept in the home until they have been examined by the CSCI during the nearest inspection. Timescale for action 3. 34 17(2) 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 15 42 Good Practice Recommendations Further attempts should be made to ensure that service users and their families are kept up to date of any planned changes in the service being delivered. The safe practices observed to be carried out during the inspection process, in relation to the building work, should continue throughout the building process. All Saints Vicarage B52-B02 S15776 All Saints Vicarage V194228 190805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Baltic House Port of Tyne South Shields Tyne and Wear NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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