Inspection on 09/08/07 for Caldicott

This inspection was carried out on 9th August 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Caldicott 16/03/07

Caldicott 03/01/06

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 Field Unannounced Inspection 9 and 13 August 2007 09:30 th th Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 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.V343833.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 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.V343833.R01.S.doc Version 5.2 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.V343833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only adults (aged 18 -64 yrs) with learning disability may be accommodated. 16th March 2007 Date of last inspection Brief Description of the Service: 4 Caldicott Avenue is registered to provide personal care for 3 adults with a learning disability. Alternative Futures Limited, a registered charity operating in the North West, operates the home. Alternative Housing Association owns the premises. 4 Caldicott Avenue is a detached dormer bungalow, situated in a quiet residential road. On the ground floor there are two single bedrooms. There is a large lounge and a separate dining room. There is a domestic style kitchen, off which are a separate laundry area and an office. A walk in shower room/WC is also available on the ground floor. On the first floor there is a single bedroom and a further bathroom /WC with a whirlpool bath. There is a stair lift to access the first floor. To the rear of the home is a garden, which can be accessed by wheelchair. There is car parking at the front of the home. The home is located close to shops and supermarkets and there is access to public transport. The home provides a minibus, which gives residents the opportunity to go out individually or together. At the time of the inspection, the weekly cost for the service is £1366.62. Items not covered by this fee includes chiropody, television licence (if television in own bedroom), haircuts, presents, toiletries and confectionary and some activities. A service user guide and a statement of purpose, which describe the services offered at Caldicott, are available for potential residents and their relatives and social workers to refer to. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on two site visits to the home, information received about the service since the last inspection and by questionnaires completed by the manager and by a relative. During the first site visit to the home time was spent in the office looking at a sample of records and policies and procedures and talking to the manager. A tour of the home was undertaken. A second site visit was made to speak to staff and make further observations of the care being delivered to the residents. What the service does well: What has improved since the last inspection? Since the last inspection there has been a further improvement to the decoration of the premises. The way medication and toiletries are stored has been reviewed and safer arrangements for this have been made. Staff and the manager have undertaken additional training around the management of medication. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 6 Changes have been made to the recruitment practices to ensure that these fully safeguard residents. 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. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 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.V343833.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process would ensure that the service is only offered to individuals whose needs can be met at the home. EVIDENCE: No new residents have come to live at the home since the last inspection. The current residents have lived at the home for over 5 years and in this time the assessment process has changed. The assessment process that would be used for new residents would ensure a thorough assessment of an individuals needs and ensure that the service would only be offered to individuals whose needs can be met at the home. Potential residents would be assessed by the manager for the home and by the service manager. Visits would be made to potential residents where they are living. Information would be gathered from the residents’ carers, health service professionals and any other relevant agencies. The initial assessment process indicates that the assessment process covers all of a residents’ needs including their communication, religious and cultural needs. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 9 Opportunities for potential residents to visit the home to see if it is right for them would be made available. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The health and personal care needs of residents are well met and staff have the written information they need to appropriately support them. EVIDENCE: The care plans provide guidance to staff around the support residents need with their care and health. Daily records are made in each resident’s file, which, show the wellbeing of the resident. The care plans contain information around goal setting but the steps to be taken to achieve these goals could be made clearer. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 11 There was evidence of reviews taking place of care plans. At the last inspection it was reported that residents could be better supported by the arrangements for reviewing their care plans as there was no written evidence to show that family members, social or health professional from the placing authority or an advocate had been invited to attend a review or asked to comment on the residents current care plan. At this inspection this is in the process of being addressed and dates for these reviews have been arranged. A relative who completed a questionnaire said that the home always meets the needs of their relative. The records and a discussion with staff indicated that residents are assisted to make decisions about their lives in accordance with their abilities. Communication guidelines assist in this process. These guidelines need some further development. The manager and staff are working with a speech and language therapist around this. Records of residents likes and dislikes, routines and preferences around daily living, such as what time they like to get up and the activities they enjoy also ensures their choices are respected. The staff spoken with were very knowledgeable about the needs of the residents and appeared to have a good relationship with them. Residents appeared relaxed and content when with the staff. Risk assessments are carried out for both personal and environmental risks. Staff spoken with were clear about the action to be taken to prevent risks to residents’ safety. It continues to be recommended that risk assessments around the use of bedrails are reviewed on a weekly basis and that the daily checks made by staff are recorded. The manager has been trained to use the bedrails by an occupational therapist. The manager has trained staff in the safe use of bedrails but there is no evidence to indicate that he has been assessed as competent to provide this. The manager reported that this has been addressed by arranging for staff to attend appropriate training in the next 3 months. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a lifestyle that meets their needs and provides opportunities for their social and personal development. EVIDENCE: The residents are encouraged to develop independent life skills such as preparing food and making choices. Programmes of suitable activities are in place to suit the residents’ choices and abilities. A daily diary report is completed for each resident, which, details what the resident has done each day. Records showed and staff spoken with said that the residents 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. Staff spoken with Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 13 described the residents as having lots of opportunities to take part in the local community. Family contact is promoted where this is possible. A relative who completed a questionnaire said that the home always helps their relative to keep in touch. Residents have a weeks holiday each year. Each holiday is tailored to the individual needs of the resident and reflects their interests. The records of menus showed that three meals a day are provided that are balanced, offer choice and variety and meet the residents’ cultural backgrounds. A record of residents likes and dislikes and dietary needs is available. Advice is obtained from a dietician if this is required. Residents 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; both provide homely and pleasant areas for residents to eat meals. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of residents are well met and they are supported by the home’s policies and procedures for dealing with medicines. EVIDENCE: There is clear information available for staff on residents’ personal care routines that indicate their preferences. The records seen provide information on the morning and evening routines of each resident. Observations indicated that staff promote the dignity of residents and that they are supportive and caring towards them. Staff interviewed were very aware of the support needs of residents. Residents have access to medical/health care professionals as needed. Residents are helped to access healthcare services. Procedures for managing Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 15 specific health needs are available. meeting specific health needs. Training is provided to staff around The home has a medication policy and procedure in place. Staff who administer medication have all received training around the safe handling of medication and have undertaken additional training since the last inspection. The home receives advice and guidance from the local pharmacy as necessary. The medication administration records and corresponding medication were inspected and were found to be accurately maintained. A review of the storage arrangements for medication has taken place since the last inspection. At this visit medication is stored appropriately. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place for managing complaints and adult protection matters ensure that the wellbeing of residents is safeguarded. EVIDENCE: Advocates have access to a suitable complaints procedure, which gives them a clear picture of how to raise a concern or complaint on behalf of a resident. There have been no complaints since the last inspection either at the home or to CSCI. The staff spoken with were aware of the content of the complaint procedure and how to respond to complaints. A clear and detailed adult protection procedure was available at the home. Records show that all staff working at the home have read this. In addition training around recognising signs of abuse and the procedure to follow when reporting an incident of abuse is provided to staff. The staff spoken with had a clear understanding of the adult protection procedure. Records available at the home showed that the finances of residents are appropriately managed. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 17 Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including visiting the service. The home is clean and well presented and provides a comfortable and pleasant environment for residents. EVIDENCE: The home was clean and tidy on the day of the visit. The home is well presented. In the last 6 months the home has been redecorated and new carpets have been provided in the hall and in some residents bedrooms. The kitchen worktops have also been replaced. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 19 The residents’ bedrooms are personalised to reflect their personality and interests. The bedrooms are comfortably furnished and provide enough space. Communal space is provided in a large lounge area and in a separate dining room. There is a ground floor bathroom and toilet within easy reach of these areas. The bathroom is on one level and is appropriately fitted with handrails. There is a shower chair available. Mobility equipment is provided as necessary. The manager ensures that residents are appropriately assessed when this equipment is required. Records and a tour of the home showed that steps have been taken to ensure the safety of residents at the home. Hot water temperature regulators have been fitted to the bath and shower. A consistent record should be made of checks of the water temperature as records showed this had not been recorded for 6 months. The water temperature did not appear to be too hot at this visit. All radiators seen had low temperature surfaces, apart from the one in the office, to which residents do not usually have unaccompanied access. The first floor windows open so as not to pose a risk to residents. Records show that the gas, portable electrical appliances and bath hoist are safe for use. The fire alarm and emergency lighting are serviced regularly and are tested by staff at the home to make sure they are working properly. Since the last inspection the manager has documented a risk assessment concerning the resident in the first floor bedroom accessing the stairs when staff are not available. A tour of the home showed that there were no hazards to resident’s safety. There are procedures for staff to refer to about hygiene and infection control. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from the training and support provided to staff and the numbers of staff available. 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 seven staff have obtained relevant social care qualifications. The remaining three staff are currently working towards this. In addition, Alternative Futures has a training development plan and training for staff around meeting residents’ needs is provided on an ongoing basis. Training around equality and diversity is provided to staff at the induction and during the NVQ. Staff spoken with could give examples of how to promote the rights of residents. Staff said and records showed that they have regular supervision. Staff spoken with said the manager is very supportive. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 21 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 several shifts. Staff interviewed said that the staffing levels meet the needs of the residents and enable residents to take part in group and individual activities outside the home. There are no staff vacancies. Relief staff and the current staff team cover staffing shortfalls. Staff spoken with said the same relief staff are employed, who know the residents and how the home works. Staff spoken to on the day of the visit said they enjoy working at the home and that the residents are well looked after and they get a good service. A relative who returned a questionnaire said that the staff always keep them up to date with important issues affecting their relative. One new member of staff has begun work at the home since the last inspection. The records of staff recruitment were seen and provided satisfactory information. The home has an equal opportunities policy available. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality assurance systems and management approach ensure that the best interests of residents are fully 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 resident-centred issues. The manager has completed an NVQ Level 4 in management and an NVQ Level 4 in Care. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 23 Staff spoken with said that their views regarding the running of the home are sought and listened to. The staff were very knowledgeable about the needs of the residents. They had a good understanding of the home’s policies and procedures and the general operation of the home. It was evident that there are a number of opportunities for communication between the manager and the staff. There are a number of quality assurance systems in place. Staff reported that regular supervision and staff meetings are held. The manager reported that he undertakes regular checks of the safety and presentation of the home. The service manager makes a monthly assessment of how the home is performing. Consideration should be given to formally seeking the views of stakeholders involved with the service such as health and social care professionals. Training around safe working practices is made available to staff as part of their induction. There is a rolling programme of training opportunities provided and refresher courses are undertaken when needed. There are policies and procedures and risk assessments available that promote safe working practices. Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 24 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 X 4 3 5 X 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 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 X 3 X Caldicott DS0000018973.V343833.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA9 Good Practice Recommendations It is recommended that the risk assessments around bedrails are reviewed on a weekly basis and that the daily checks made by staff around the safety of bedrails be recorded. A regular record should be made of the water temperature tests that are undertaken at the home. Consideration should be given to formally seeking the views of stakeholders involved with the service such as health and social care professionals. 2. 3. 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