Inspection on 03/01/06 for Caldicott

This inspection was carried out on 3rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Caldicott 09/08/07

Caldicott 16/03/07

Caldicott 26/08/05

Caldicott 17/01/05

Caldicott 02/08/04

Caldicott 10/02/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Caldicott 4 Caldicott Avenue Bromborough Wirral CH62 6DJ Lead Inspector Beate Roth Unannounced Inspection 3rd January 2006 02:15p Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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 Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Caldicott Address 4 Caldicott Avenue Bromborough Wirral CH62 6DJ 0151 334 2122 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) Alternative Futures Limited Alan Meadows Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only adults (aged 18 -64 yrs) with learning disability may be accommodated. Mr Alan Meadows to complete an NVQ Level 4 qualification in management by 2005 and demonstrate that his existing qualifications are the equivalent of an NVQ Level 4 in Care. 26th August 2005 Date of last inspection Brief Description of the Service: 4 Caldicott Avenue is registered to provide personal care for 3 service users with a learning disability. The home is operated by Alternative Futures Limited, a registered charity operating in the North West. The premises are owned by Alternative Housing Association. 4 Caldicott Avenue is a detached dormer bungalow, situated in a quiet residential road, within walking distance from a small parade of local shops. There are two single bedrooms on the ground floor and one single bedroom on the first floor. Communal areas of the premises comprise a large lounge and a separate dining room. There is a domestic style kitchen, off which is a separate laundry area and an office. There is a walk in shower room/wc situated on the ground floor. On the first floor there is a further bathroom /WC with a whirlpool bath. There is a chair lift to the first floor. To the rear of the home is a garden to which there is level access. There is car parking at the front of the home. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during an afternoon. During the inspection time was spent in the office examining records and policies and procedures and talking to 4 members of staff. A tour of the home was undertaken. Staff were observed delivering care to service users. Following the inspection the manager was spoken with. What the service does well: What has improved since the last inspection? What they could do better: The way that the contracts/statement of terms and conditions are drawn up could better support the interests of service users. An improvement needs to be made to the risk assessments around the use of bedrails at the home. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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 Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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, 3 and 5 The assessed needs of service users are met. The contracts/statement of terms and conditions could better support the interests of service users. EVIDENCE: No new service users have come to live at the home since the last inspection. New service users would be assessed by the manager for the home and by the service manager. Visits would be made to a prospective service user where they are living. Information would be gathered from the service users’ carers, health service professionals and any other relevant agencies. An examination of an initial assessment pro forma indicated that all the information recommended would be gathered. There was a limited amount of information available about the lives of the current service users before they came to live at the home. The newly introduced “Successful Support” documentation covers this area and when completed should address this issue. Records show that the assessed needs of service users are met by close liaison with appropriate health and social care agencies. Comprehensive induction and foundation training is provided to staff. Staff are then encouraged to undertake an NVQ 2 in Care which includes training around caring for people with a learning disability. At present four staff have obtained relevant social care qualifications. The remaining staff are currently working towards this. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 9 There is written information available providing individual guidelines for This information is being further communication with service users. developed. Tenancy agreements with Alternative Housing and support agreements with Alternative Futures are in place. The support agreements (contracts/terms and conditions) have been revised and information around the actual cost payable is now available. However, the revised support agreements are not factually accurate as they refer to supported living arrangements being in place. Caldicott is registered with the Commission for Social Care Inspection as a care home and does not provide supported living. A support agreement seen, had been signed by a senior manager for Alternative Futures. Alternative Futures should demonstrate that each service user has had access to an individual independent of Alternative Futures who has assisted the service user to ensure that the contract/statement of terms and conditions is in their best interests. It continues to be recommended that service users be supported by family, friends and/or advocate as appropriate when drawing up the support agreement. It is understood that attempts to identify an appropriate advocate are ongoing. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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 the following standard(s): 6, 7 and 9 Care planning reflects the assessed and changing needs of service users. Some risk assessments need to be revised to better promote their well being. EVIDENCE: Since the last inspection the care plans have been revised with the introduction of new documentation called “Successful Support.” The care plans cover all the matters recommended in the National Minimum Standards and provide clear guidance to staff around the support service users require. Daily records are made in each service user’s file. Key workers are allocated to each service user. There was evidence of reviews having taken place of care plans. Behaviour management plans around managing the behaviour of service users who can display challenging behaviour are available. The records and a discussion with staff indicated that service users are assisted to make decisions about their lives in accordance with their abilities. Communication guidelines assist in this process. These guidelines are in the process of being developed further. Records of service users likes and dislikes and preferences around daily living, such as what time they like to get up and the activities they enjoy also ensures service users choices are respected. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 11 Risk assessments are carried out for both personal and environmental risks. Risk assessments around the use of bed rails are available. Since the last inspection consultation has taken place with an occupational therapist around the safe use of bed rails and guidance has been provided. The bed rail risk assessments are being reviewed on a 6 monthly basis. The risk assessments must indicate that the timescale for review is in accordance with the needs of the service user and the assessed risk. The risk assessments for the use of bed rails does not indicate who is to provide the instruction to new staff around the use of the bed rails, any changes to a service users needs that may effect the use of the bed rail and whether the service user continues to need the bed rails. It is suggested that the guidelines provided by the occupational therapist and the NHS guidelines available on risk assessing bed rails be used in order to produce a comprehensive risk assessment. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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 the following standard(s): 11, 12, 13, 15 and 17 Service users are provided with opportunities for personal development and appropriate activities that ensure they are part of the local community. The meals provided are balanced and meet the needs and preferences of service users. EVIDENCE: The records and observations indicated that service users are encouraged to develop independent life skills such as preparing food and making choices. None of the service users at 4 Caldicott Avenue attend day or training centres or go to employment projects. Programmes of suitable activities and holidays are in place to suit their choices and abilities. Records showed and staff spoken with said that the service users make use of community facilities such as local pubs, shops and public transport. The home is located close to shops and other community resources. The home has its own transport, which enables community participation. Service users make use of specialist swimming and riding facilities where this has been assessed as appropriate. Service users are provided with opportunities to establish friendships. Family contact is promoted where this is appropriate. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 13 The records of menus showed that three meals a day are provided that are balanced and offer choice and variety. A record of service users likes and dislikes and dietary needs is available. Advice is obtained from a dietician if this is required. Service users are helped to eat their meals and there are support guidelines for staff to follow around this. Meals are eaten in the kitchen or in the dining room, which has been redecorated since the last inspection, making this a more pleasant area to eat meals. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 and 20 The health needs of service users are well met and they are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: There is clear information available for staff on service users personal care routines that indicate service users preferences. The records seen provide information on the morning and evening routines of each service user. Observations indicated that staff promote the dignity of service users and that they are supportive and caring towards them. Staff interviewed were very aware of the support needs of service users. Visits to service users from medical/health care professionals take place in private. Records indicate that service users have access to medical/health care professionals as needed. Service users are helped to access healthcare services. Procedures for managing specific health needs are available. Training is provided to staff around meeting specific health needs. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 15 The home has a medication policy and procedure in place. Staff who administer medication have all received training around the safe handling of medication. The home receives advice and guidance from the local pharmacy as necessary. Medication is stored securely. The medication administration records and corresponding medication were inspected and were found to be accurately maintained. Where service users are not able to consent, it would be good practice to record the multi–professional decision to provide medication to a service user in the care plan. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 16 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 and 23 The systems in place for managing complaints ensure that service users views are heard and appropriate action taken. The practices at the home provide protection for service users. EVIDENCE: There is a complaint procedure that is more suited to the needs of service users with a learning disability. Staff reported that they elicit the views of service users in accordance with their abilities. Information is available to enable a complaint to be made on behalf of a service user by an advocate. The complaint procedure describes the stages of the complaint and the timescales for investigating complaints. The staff were aware of the content of the complaint procedure and how to respond to complaints. CSCI has not received any complaints about this service since the last inspection. A clear and detailed adult protection procedure was available at the home. All staff working at the home have signed to indicate they have read this document. In addition training around recognising signs of abuse and the procedure to follow when reporting an incident of abuse has been provided to staff. The 4 staff spoken with had a clear understanding of the adult protection procedure. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 The home is clean and generally well presented and provides a comfortable and pleasant environment for service users. EVIDENCE: In general the home is well maintained. Since the last inspection the dining room has been redecorated. It is understood that the flooring is to be replaced which will further enhance the appearance of this room. There are small holes in the flooring where the dining room table was secured to the floor. The service users bedrooms are well decorated and suitably furnished. Bedrooms have been personalised to reflect the personality and interests of the service uses. Steps have been taken to ensure the safety of service users at the home. Hot water temperature regulators have been fitted to the bath and shower. Records show that regular tests of the water temperature are undertaken. All radiators seen had low temperature surfaces, apart from the one in the office, to which service users do not usually have unaccompanied access. The first floor windows open so as not to pose a risk to service users. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 18 A tour of the home showed that the home was in general clean. There was areas of staining to the carpet in the hall and the lounge. The staff reported that this is due to be professionally cleaned. There are procedures for staff to refer to about hygiene and infection control. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 19 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, 33 and 35 Service users benefit from the training provided to staff. There are sufficient numbers of staff to meet the needs of service users. EVIDENCE: Comprehensive induction and foundation training is provided to staff. Staff are then encouraged to undertake an NVQ 2 in Care which includes training around caring for people with a learning disability. At present four staff have obtained relevant social care qualifications. The remaining staff are currently working towards this. In addition, Alternative Futures has a training development plan and training for staff around meeting service users needs is provided on an ongoing basis. This training is provided following consultation with staff. This plan is subject to continuous review. The staffing rota showed that there is a minimum of two staff on duty during the day and evening with a third member of staff available for some shifts. Staff interviewed said that the staffing levels meet the needs of the service users and enable service users to take part in group and individual activities outside the home. There is currently one staff vacancy. Relief staff and the current staff team cover staffing shortfalls. Staff said the same relief staff are employed, who know the service users and how the home works. No new staff have been recruited to work at the home since the last inspection. The records of staff recruitment were not available at this Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 20 inspection as the manager was not on site and these records are only accessible to the manager. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 39 The quality assurance systems and management approach ensure that the best interests of service users are supported. EVIDENCE: The manager has a number of years experience at a senior level in a care setting. He has undertaken numerous internal training courses in management and service-user-centred issues. The manager has completed an NVQ Level 4 in management and has recently completed an NVQ Level 4 in Care. 4 members of staff were spoken with. The staff reported that they consider their views regarding the running of the home are sought and listened to. The staff were very knowledgeable about the needs of the service users. They had a good understanding of the home’s policies and procedures and the general operation of the home. It was evident that there is clear and effective communication between the manager and the staff, which can only benefit service users. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 22 The views of service users are ascertained in accordance with their abilities. A complaint procedure is available. An equal opportunities policy is available. There are a number of quality assurance systems in place. Staff reported that regular supervision and staff meetings are held. The manager undertakes regular checks of the safety and presentation of the home. The service manager undertakes Regulation 26 visits. Audits take place of medication and finances. Dates of policies show that policies and procedures are regularly reviewed and up-dated to meet the requirements of legislation and the needs of service users. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 23 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 Standard No Score 1 X 2 3 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X X X Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5, 17 Requirement Timescale for action 03/01/06 2. YA9 13 The registered persons must ensure that the service users contracts/statement of terms and conditions reflect the actual service provided. A comprehensive risk 03/01/06 assessment must be available for the use of all bed rails. A review of the risk assessments for the use of bed rails must take place in accordance with the needs of the service user and the assessed risk (previous timescale not met). 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 YA5 YA9 Good Practice Recommendations It is recommended that service users be supported by family, friends and/or advocate, as appropriate when drawing up the contract. It is recommended that the NHS guidelines on risk assessing bed rails that are available at the home be used DS0000018973.V276013.R01.S.doc Version 5.1 Page 25 Caldicott in order to produce a comprehensive risk assessment. Caldicott DS0000018973.V276013.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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