Inspection on 28/06/05 for Bleak House

This inspection was carried out on 28th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

Bleak House 13/08/07

Bleak House 17/08/06

Bleak House 08/12/05

Bleak House 06/01/05

Bleak House 22/07/04

Bleak House 29/01/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Bleak House High Street Patrington East Yorkshire HU12 0RE Lead Inspector Sarah Sadler Unannounced 28 June 2005 09:40 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. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bleak House Address High Street Patrington East Yorkshire HU12 0RE 01964 630383 01964 631243 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) Bleak House Limited Mrs Christine Linda Allen Care Home 19 Category(ies) of LD Learning disability 19 registration, with number of places Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6.1.05 Brief Description of the Service: Bleak House is a care home providing care and accommodation for up to 19 people of either sex under the age of sixty-five who have learning disabilities.It is a privately owned home. The home is on the main street in the village of Patrington,close to local amenities and within easy access to public transport.The home has been registered for a number of years and consists of a large two-storey Tudor style building. Internally the home retains many of its original features including a large wooden fireplace and panelled living room. There are a number of communal areas including the dining area, smoking area and large rear gardens. There are seven single rooms and six double rooms, none of which are en-suite. There is not a stair lift or hoist in the home.Car parking is on the adjacent main road or visitors may use the adjacent Church car park. Service users are supported with personal care and health needs by the staff team,with other agencies, for example, the community team learning disabilities accessed as necessary. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by one inspector Sarah Sadler over one day. The inspection was part of the routine inspection year April 2005 to March 2006. What the service does well: What has improved since the last inspection? What they could do better: Staff training and supervision could be better. Quality assurance systems require development and implementation. Some of these issues are outstanding requirements from previous inspections and must now be addressed. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 6 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. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 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 standard(s) 2,5 Service users are assessed to ensure that the home can meet their needs. Service users are provided with a contract that informs them of the expectations for living in the home. EVIDENCE: Two of the service user files examined contained an assessment completed within the home and one contained a copy of the Community Care Assessment and Care Plan completed by the Local Authority. All contained service user plans that indicated the service users’ needs, the goals to be achieved and how this was to be achieved. All service user files examined contained a copy of the contract/statement of terms and conditions of residing in the home. All of these had been signed by the service user to confirm that they agreed to the contents. The contract covered the majority of the required areas, for example, it included the fees to be paid. One of the areas it did not include was a copy of the service user plan that the home works to in order to meet the needs of the service user. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 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 standard(s) 6,8,9 Service users are supported in having their needs met by adequate care planning and reviewing systems. Service users are enabled to take risks in their lives. Service users are consulted on some aspects of the home. EVIDENCE: Service user files included a service user plan, that detailed the needs of the service user. Two of the files examined included risk assessments which detailed the restrictions placed upon service users in their everyday lives. Where possible service users had signed to agree to the risk assessments. One service user confirmed “I’ve got a file” when asked if they had a care plan. When necessary the plan also included any support work required to assist service users in managing their behaviours. Service users discussed their key workers and how these had all recently changed. Service users confirmed that they were happy with these changes. Service user files included daily reporting on each area of the care plan, a monthly review within the home and copies of annual care management reviews. Minutes are kept of service user and staff meetings. A representative from the service user group is elected by the service users and attends the staff Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 10 meeting. The representative feeds back the minutes of the service user group to the staff meeting. The registered manager confirmed that the quality assurance systems are continuing to be developed within the home. There is a missing persons policy and a basic details form for other professionals should a service user become missing. The registered manager discussed a recent incident were a service user had become missing and the actions taken with this. The registered manager and staff had taken appropriate actions and the service user had returned to the home. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 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 standard(s) 12,13,14,15,16 Service users are able to take part in activities, their local community, and maintain relationships. Service users’ nutritional needs are met. EVIDENCE: Discussions with the staff and service users confirmed that different service users attend different Adult Education centres throughout the week. One service user confirmed that they go to a local Day centre “ Wednesday, Friday and Tuesday”. Staff confirmed that activities commenced prior to entering the home could be continued with. The staff confirmed that this had occurred with a previous service user. Service users do not attend further education. Service user notes reflected that they go for walks in their local community and access local facilities such as pubic houses. Service users confirmed “ We go to pub with Chris and Sheila on a Wednesday”. Another service user confirmed that “ I used to go to the bakers, but it is closed now”. Service users were observed to go for walks in the village. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 12 Service users stated “ Sometime in July we are having a Barbeque”, “I go bowling”, “We have a baking group”, “ I aren’t going on holiday, I am going out for days, I don’t want to go away for a week” and “It’s alright here.” Another service user confirmed that they get to go out “lots”. A staff member confirmed that on a Monday an activities person normally attends and completes movement to music. However this person would not be attending this Monday due to illness. She also stated that the priority of the afternoon shift is to complete activities with the service users. Some of these included trips out, discos and games. She confirmed that on a morning service users have little jobs which are part of their care plans, for example cleaning their rooms. One service user confirmed this “I do jobs everyday”. Service users were sat in the lounge for long periods of time. During this time some service users were sat reading, some were listening to music and some were asleep. All of the service users were able to come and go as they pleased, which some other service users did, entering and leaving the lounge. Service user files did not detail the level of activities that staff and service users confirmed occurred. For example, one service users’ notes reflected that they completed only 6 activities in one month. Service user files reflected that they are able to visit, telephone and receive telephone calls from family members. One service user confirmed that they visited their family home regularly. Staff were observed to knock prior to entering a service user’s room. Service users’ rooms are all lockable. Staff were observed talking positively with service users. For example, as a staff member was leaving the room a service user followed her, she quietly asked them “ Are you alright? Did you want something?”. The staff member stood and waited until the service user had managed to say all that they wanted to. Service users were observed to be able to access all communal areas of the home, with service users utilising the gardens and different lounge areas. Service users eat their meals in a dining room. The tables were set with flowers and condiments. Meals were observed to be relaxed and unrushed with staff eating with service users. There is a four week menu that has recently been amended to include more service user choices. Individual food choices that deviate from the planned menu are recorded. Two of the three service user files contained an individual nutritional assessment. All files contained weight monitoring charts, only one of these was up to date. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 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 standard(s) 19,20 Service users’ health needs are met. EVIDENCE: Service user files include records of visits to and by GP’s and other health professionals. Details of a health review were included in one service user’s file. Another had been referred to the GP due to illness and the reasons for this with the outcomes were clearly recorded. Service user files reflected regular input from the nurse from the Community Team Learning Disability in supporting a service user with their health needs. A service user confirmed that if they were sick they would “ pull the cord “ for staff support. They also confirmed that if they needed to go to the doctors someone from the home would take them. There is a medicines policy that details to staff how to handle medicines within the home. Also to retain medicines for a minimum of seven days should a service user pass away. Records of administration of medicines were up to date, with records kept of any reasons for a service user not receiving their medication, for example if they declined it. Staff confirmed that there is a fridge available, should any medicines require to be kept cool. Staff have not yet undertaken accredited medication training. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Service users are able to complain, their complaints would be acted upon. Service users are from protected from abuse. EVIDENCE: There is a complaints policy which details the actions to be taken, including timescales. It also the contact details of the Commission for Social Care Inspection should the complainant wish to raise the matter with the Commission. No complaints have been made to the home. There is a copy of the Local Authority’s procedure ‘The Protection of Vulnerable Adults’ held in the home. This is complemented by the home’s own policy for handling issues of abuse. There is not a policy for the handling of physical or verbal aggression. Service users’ finances are handled by the home, with service users being provided with all personal allowances. Records for the income and outgoing of personal monies are kept with appropriate receipts. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 Serviced users live in clean and well maintained home. EVIDENCE: The home continues to be maintained to a high standard. The home was clean throughout with no offensive odours. Furnishings remain of a good standard. The home has a planned maintenance programme with major works being planned for later this year. There continues to be a separate laundry area with walls and floors that are cleanable and impermeable. There are policies and procedures in place for the control of infection which include the use of Personal Protective Clothing. The staff confirmed that the home meets the requirements of the Water Supply (Water Fittings) Regulations 1999, with regard to the hygiene in the home. However no documentary evidence was available of this. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 16 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) 35,36 Service users are not supported by a trained and supervised staff team. EVIDENCE: The registered manager confirmed that there is a training programme that has been established for the staff team as a whole, but that this is not yet implemented due to staff accessing other courses. The registered manager confirmed that all new staff undertake Learning Disability Award Framework training. Records of staff training were not available at the inspection. The registered manager confirmed that staff supervisions are being undertaken and that she is working to the requirement of a minimum of six supervisions a year. Staff appraisals have not yet been undertaken. Supervision records were not available on the day of the inspection. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 17 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) 39,40,42 Service users’ Health and Safety needs are met. Service users are not involved in quality assurance. The home is not fully audited to ensure that service users’ needs are met. EVIDENCE: The registered manager confirmed that the quality assurance system is continuing to be developed and therefore was not available at the inspection. A professional management system is now in place, which provides the home with a range of policies and procedures. Staff files included some details of training in Fire Safety and First Aid. There is a cupboard for the storage of hazardous chemicals and some product data information is available within the home. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 18 A fire procedure and risk assessment was available, alongside an annual and weekly checklist of the competency of the fire equipment, emergency lighting and monthly fire drills. There was a Health and Safety at Work Policy, Food Hygiene information and procedures for the recording and reporting of any accidents. The registered manager confirmed that Portable Appliances (PAT), the Electrical Wiring and Gas Safety systems have been checked and comply with any requirements to ensure service users’ safety. Risk assessments for safe working practices are not yet in place. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 19 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 3 x x 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 1 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 2 3 1 3 3 x Standard No 31 32 33 34 35 36 Score x 2 x x 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bleak House Score x 1 1 x Standard No 37 38 39 40 41 42 43 Score x x 1 3 x 1 x J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 20 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 8 Regulation 24 Requirement The registered provider must ensure that service users are involved in the quality assurance in the home.This is an onging requirement with a previous compliance date of 21.2.04. The registered provider must ensure that service users receive an annual holiday as part of the basic contract price of residing in the home. This is an ongoing requirement with a previous compliance date of 29/5/04. The registered provider must ensure that accurate monitoring records are kept of service users weights. The registered provider must ensure that staff undertake accredited medication training. This is an ongoing requirement with a previous compliance date of 22/10/04. The registered provider must provide evidence that the home complies with the Water Supply (Water Fittings) Regulations 1999. The registered provider must ensure that there is a staff training and development Timescale for action 28.8.05 and ongoing. 2. 14 4,5,12,16 28.8.05 and ongoing. 3. 19 12 28.8.05 4. 20 18 28.8.05 and ongoing. 5. 30 13 28.8.05 and ongoing. 28.10.05 6. 35 4,10,12,1 7,18,19,2 4,26 Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 21 7. 8. 36 39 18 (2) 17,24,26 9. 42 18 10. 42 23 programme that meets the Sector skills council workforce training targets. This is an ongoing requirement with a previous compliance date of 21/2/04. The registerd provider must ensure that staff are appropriately supervised. The registered provider must ensure effective quality assurance monitoring systems. This is an ongoing requirement with a previous compliance date of 21/2/04. The registered provider must ensure that all staff should be trained to the TOPPS specifications. This is an ongoing requirement with a previous compliance date of 21/2/04. The registered provider must ensure that risk assessments for safe working practices are in place. This is an ongoing requirement with a previous compliance date of 6.4.05. 28.8.05 and ongoing. 28.8.05 and ongoing. 28.8.05 28.9.05 11. 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. 3. 4. Refer to Standard 5 12 14 23 Good Practice Recommendations The service user contract should include all of the areas recommended in the National Minimum Standard 5. Service users should be offered opportunities for further adult education. Appropriate records should be kept of the activities which service users enter into. A policy for the handling of physical and verbal aggression should be in place. J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 22 Bleak House 5. 6. 32 36 50 of staff must hold an NVQ 2 or above in care by 2005 The registered provider must ensure that staff receive an annual appraisal. Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit 3 First Floor Hesslewood Country Office Park Ferriby Road Hessle East Yorkshire HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI Bleak House J53_s19649_Bleak House_v224365_280605_stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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