CARE HOME ADULTS 18-65
Callum House 26 The Drive Coulsdon Surrey CR5 2BL Lead Inspector
Claire Taylor Unannounced Inspection 3rd November 2005 2.45pm Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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 Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Callum House Address 26 The Drive Coulsdon Surrey CR5 2BL 020 8660 4379 020 8660 4379 no email 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) Oregon Care Limited Ms Kim Louise Yeoman Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow one specified service user over the age of 65 to be accommodated. 18 & 19 May 2005 Date of last inspection Brief Description of the Service: Callum House is a detached seven-bedded care home registered to provide social care to seven adults who have learning disabilities and some associated mental health needs. The home provides a specialised service that caters for the needs of service users who display behaviours that may challenge the care services that they require. Located in a residential area of Coulsdon, the home is well placed for access to local transport links and amenities. Communal areas consist of a spacious lounge, dining room, kitchen, “leisure room “ and utility room. There are sufficient numbers of bathroom/shower and toilet facilities located throughout the home to meet service users needs. The large rear garden is set out over two levels, with a barbeque area and patio. The home has its own car that is used to facilitate a wide range of outings and activities. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second inspection for the year and was unannounced. It took place over an afternoon and lasted three hours. The focus of this visit was to confirm the general health and welfare of the service users as well as monitor compliance with previous requirements and recommendations. The home received a positive report for the previous inspection (May 2005) and has once again showed consistency in its application of the National Minimum Standards as well as a commitment to improve upon standards. Inspection time was spent examining records, talking to service users, one staff, meeting with the home manager and touring the premises. There have been no new admissions to the home and the manager reported that there have been no significant changes since the last inspection. All those who contributed to the inspection process are thanked for their time and for sharing their views about the home. All key standards were assessed at the home’s previous inspection in May 2005 and the reader is therefore referred to that report should they require any further information. What the service does well:
The home continues to be well managed with a stable staff team who know the needs of the service users. The manager is knowledgeable and experienced and provides good supervision, support and leadership. Record keeping in the home is well organised. The plans of care and intervention are well created, and reflect very closely the needs of the specific person. Service users are treated with respect as individuals and offered choices. Some service users may present behaviours that challenge the services they require and the home demonstrates an ability to meet their specialist needs. Detailed behaviour management strategies and interventions are in place for those who may behave in a way that puts themselves or others at risk of being physically harmed. In addition, the home has good systems in place to make sure that staff have the necessary training and skills to support the service users. Staff spoken to confirmed that the team works well together in a friendly run atmosphere. There are many social activities offered in a variety of ways to service users that are based upon their needs and choices. Service users spoken to gave positive comments and appeared relaxed and comfortable in their home. Individuals were complimentary about the staff and good activities provided such as parties and outings. Callum House provides a pleasant and homely environment for the people who live there. The home is well furnished and the premises continue to be maintained to a very high standard. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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.
Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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 Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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): X None of these standards were assessed on this occasion. Standard 2 was assessed as met at the May 2005 inspection. EVIDENCE: Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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 the following standard(s): 6, 8 and 9 The care planning process is well managed and ensures a very personalised and consistently high level of service provision for the people living in the home. Staff encourage service users to make decisions about their lives that maximises their involvement and opportunities to contribute to the operation of the home. Service users are provided with the necessary support to take risks so that independence is maximised as far as possible. Standard 7 was assessed as met at the May 2005 inspection. EVIDENCE: Comprehensive care plans are generated from initial and ongoing assessments and liaison with relevant specialist services as needs were identified. This provides staff with detailed information that enables a continuity of care to be maintained. On examination of the care plan files there was evidence of regular reviews involving residents and other significant parties. Pictures, widgit symbols and photos are included to make them more accessible to those service users who have limited verbal communication. This is good practice, making the care plan more meaningful to them and valuing their input to it. Records show that staff encourage and promote independence
Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 10 in all aspects of people’s lives. Staff have a good awareness of their role and responsibilities in taking on an enabling role when supporting residents. There were examples of specific programmes that had been developed to guide staff. Support is often given on a one to one basis, offering service users quality time with their key worker staff. Person centred planning continues to progress further and each service user now has a health action plan booklet. Through regular house meetings with residents, relevant issues are discussed relating to all aspects of life in the home and in relation to individual needs; recent examples including choice of meals and preferred activities. Detailed risk assessments are in place to ensure the activities people take part in, do not put them at unnecessary risk of harm, whilst protecting their individual rights and choice. e.g. use of the kitchen, accessing the home / wider community, and managing behaviours that are likely to challenge the service. Detailed guidelines for some service users concerning aggression and self-harm are in place that provide staff with clear management strategies/ techniques to diffuse potential incidents. These are reviewed as changes occur together with associated risk assessments. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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 the following standard(s): 13, 14 and 16 Service users are benefiting from a fulfilling lifestyle both within the home and local community that is planned around their needs and preferences. Staff treat people who live in the home with respect, value their individuality and promote their individual rights. Standards 12, 15 and 17 were assessed as met at the May 2005 inspection. EVIDENCE: Most of the daily activities offered are through local college courses, day centres and local community resources. These activities are reviewed regularly to ensure they meet the changing needs of the service users. Records also showed that staff work hard to provide the service users with stimulating activities that are organised according to individual choices. The home informs service users about activities via meetings, informal discussions and the use of a notice board. A flyer about a forthcoming pantomime was posted on the office door for service users to make their preference. Service users had recently enjoyed a party with fireworks and a Halloween theme. One service user spoke about their recent 50th birthday celebration, as well as other hobbies including football and music. Another service user celebrated her
Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 12 birthday with a fancy dress party earlier in the year. Both service users spoke favourably about these events and gave positive comments about the activities provided in the home. It was clear that staff work closely with each individual, their family and significant others, such as the day service, to ensure their preferences are responded to appropriately and the people important to them are involved with social events. Service users also spoke of their recent holiday to Butlins which they had clearly enjoyed. Service users regularly access public transport including buses, trams and trains and the home has its own car to facilitate activities and outings. Indoor entertainment includes TV, music centre, videos, board games, magazines and art and craft activities. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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 the following standard(s): 18 and 19 The support provided is flexible to offer sufficient time and care to individual service users. Promotion of health is well observed. Service users welfare is closely monitored to ensure that their physical and emotional needs are met. Standard 20 was assessed as met at the May 2005 inspection. EVIDENCE: Service user plans are informative and clearly outline the ways in which the staff team will work with the individual to support them. Where support is required with personal physical care, this is identified and guidance is available on how specific tasks should be undertaken. Several service users have specific goal plans to help them develop their personal care skills. Daily routines and house rules promote independence and individual choice for service users. Times for getting up/going to bed are flexible, as are mealtimes. The home encourages service users to be responsible for housekeeping tasks, which is specified in their care plans. Information relating to personal and healthcare needs including both routine and one off health interventions were well recorded. Care plans and specific strategies identify individual and specialist needs, which also reflect any changing needs. Detailed records were in place and involvement with specialist services highlighted. A good example of this was the records maintained in relation to one service user who was receiving physiotherapy treatment for a recent leg injury. This included specific
Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 14 guidance for staff to support the person. The home was in the process of transferring all health related information onto “Health action plans”, which were being introduced for all the service users. Staff had attended training on completion and use of the plans. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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 the following standard(s): 22 and 23 Arrangements for dealing with complaints are well managed to ensure that service users feel listened to and their views are acted upon. There are procedures and systems in place regarding the protection of vulnerable adults and prevention of abuse. EVIDENCE: The complaints procedure contains all of the relevant and necessary information and is readily available to the people who live there, their relatives and other visitors. Records showed that the home deals with complaints seriously and takes prompt action to address any concerns or complaints. Service users spoken to were confident about whom they should speak to if they were unhappy. Since the last inspection two more staff have attended formal training on the protection of vulnerable adults. Training is planned for other staff as courses become available. The induction process for staff includes training in identifying and responding to mistreatment and suspected abuse. Callum House accommodates service users who may present behaviours that challenge the services they require and the home generally demonstrates an ability to meet their complex needs. To maximise safety however, staff are still in need of refresher training to deal with physical aggression and this requirement is therefore repeated under staffing standards. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 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 the following standard(s): 24 and 30 Callum House is homely, bright and clean, and provides the service users with safe, comfortable surroundings in which to live. Standards 24, 26, 28 and 30 were assessed as met at the May 2005 inspection. EVIDENCE: Service users bedrooms were not viewed on this occasion and a brief walk round the home took place. Communal areas are well furnished, bright, clean and decorated to a high standard. Well-kept records for the ongoing maintenance and redecoration of the premises are in place. Furniture and fittings are of good quality and in meeting with the needs of the service users. A new leather sofa suite has been purchased since the last inspection. The standard of cleanliness and hygiene throughout Callum House remains well maintained. To enhance independence, service users are encouraged to participate in household cleaning tasks on a daily basis and each have a “home day” to clean and tidy their bedroom. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 17 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, 34 and 35 Service users benefit from a competent and knowledgeable staff team, who are provided with the necessary training and guidance to support their needs. Recruitment practices are securely managed to maximise protection for the service users although two references must be obtained before a new employee starts work. This ensures that staff have been fully vetted before working with vulnerable adults. EVIDENCE: Valuably, staff turn over at the home remains low resulting in stability and consistency of care for the service users. The home’s allocation allows for two to three members of staff on each day shift and one waking night. Three staff have been appointed since the last inspection and all three files were examined. Each file contained a detailed induction pack whereby an experienced staff supervises and supports the new worker. Learning topics include the particular needs of the service user group, the worker’s role in the home and general principles of care. Recruitment procedures ensure that staff are vetted correctly so that service users are safeguarded from people who should not be working there. With the exception of one however, records confirmed that all staff have undergone appropriate checks. Only one job reference was available for one of the new recruits and it was reported that the home was awaiting the other. Before a new staff commences work, two satisfactory job references must be provided. This includes keeping records of
Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 18 any verbal references obtained. A list of all the current and three new employees CRB and POVA checks was verified at this inspection. As recommended, a nominated deputy has been appointed since the last visit meaning better consistency for when the home is run in the absence of the manager. Staff spoke highly of the manager and felt that the team works well together in a friendly run atmosphere. Service users feedback on staff was very positive and several commented that they liked the new staff members. Regular staff meetings are held to ensure information is cascaded to all staff and they have an opportunity to discuss any issues. Staff continue to work towards their NVQ qualification level 2 in care with the deputy studying for the next level. As previously required, staff have yet to receive appropriate refresher training in dealing with physical aggression. This requirement is therefore repeated due to the needs of this service user group. In addition, more training that is specific to the needs of the service users has yet to be arranged. I.e. on autism and management of challenging behaviours. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 19 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): 42 Good safe working practices ensure that the home aims to promote and protect the health and welfare of service users at all times. Standards 37 and 39 were assessed as met at the May 2005 inspection. EVIDENCE: The home is good at making sure that the premises is kept in a good state of repair and health and safety guidelines are well observed. Servicing and maintenance records were viewed at the last inspection and up to date. Details about fire evacuation practices have been improved to include who was involved and the length of time taken to carry out the drill. Service users spoken to confirmed that they took part in regular fire practices. Key health and safety training for staff continues to be well organised and planned so that staff update their skills and knowledge at appropriate intervals. The manager keeps accurate records for staff training. Any accidents or incidents are recorded appropriately in a book and significant events are now reported promptly to the Commission in accordance with regulation 37 of the Care standards act. As previously required, the manager had undertaken a risk
Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 20 assessment of the premises to identify potential hazards. More information is needed however to ensure that the health, safety and welfare of people living and working in the home is fully safeguarded. I.e. each risk must be individually recorded on a plan. Any required actions to minimise the risk of potential harm should be recorded in more detail. Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 21 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 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 2 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Callum House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000025759.V265709.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES -1 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 YA34 Regulation 19(4 b) (5 d) Timescale for action Staff records must contain all the 31/12/05 details listed in schedule 2 of the regulations. Two satisfactory employment references must be obtained before staff commence work. The registered provider is required to ensure that all staff receive appropriate training in dealing with physical aggression. (Timescale of 30/09/05 not met) 31/03/06 Requirement 2. YA35 12(1)(a) 18 19 Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 23 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 YA35 Good Practice Recommendations Further training is recommended that is specific to the needs of the service users. i.e. for staff to develop a better understanding/ refresh their knowledge of autism and challenging behaviours. (Repeated from May 2005 inspection) Risk assessments for safe working practices and the premises should be expanded upon. I.e. each risk must be individually recorded on a plan. Any required actions to minimise the risk of potential harm should be recorded in more detail. 2. YA42 Callum House DS0000025759.V265709.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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