Inspection on 13/01/09 for Carlton House Dispersed Scheme

This inspection was carried out on 13th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton House Dispersed Scheme 30/01/08

Carlton House Dispersed Scheme 27/02/07

Carlton House Dispersed Scheme 05/09/06

Carlton House Dispersed Scheme 04/10/05

Carlton House Dispersed Scheme 12/04/05

Carlton House Dispersed Scheme 04/08/04

Carlton House Dispersed Scheme 25/05/04

Similar services:

Larch Avenue

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Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Carlton House Dispersed Scheme 24 Wakefield Road Rothwell Haigh Leeds West Yorkshire LS26 0SF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dawn Navesey     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Carlton House Dispersed Scheme 24 Wakefield Road Rothwell Haigh Leeds West Yorkshire LS26 0SF 01132827110 01132887523 carlton.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): J C Care Ltd Name of registered manager (if applicable) Mr Robin Staincliffe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Carlton House 10 service users Carlton annex 5 service users The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Learning disability Code LD. To accommodate two named service users over pension age in the category of LD(E) Woodhouse Cottage 6 service users Date of last inspection Brief description of the care home Carlton House is owned by J C Care, which is a subsidiary of Craegmoor Health Care. The service is registered to provide care and accommodation for up to twenty-one Care Homes for Adults (18-65 years) Page 4 of 37 care home 21 Over 65 0 21 Brief description of the care home people with a learning disability and is spread over three properties. Carlton House has facilities for ten people, Carlton Cottage is within close proximity in the same grounds, provides additional accommodation for five people and Woodhouse Cottage is registered for six people. The one double bedroom, at Carlton House, is used as a single room. Therefore the maximum number of people living there is nine. Woodhouse Cottage is located three miles away and is staffed separately. The manager of Carlton House and Carlton Cottage retains responsibility. Carlton Cottage is purpose built, Carlton House and Woodhouse Cottage were previously family homes, which have been adapted. Carlton House and Carlton Cottage are situated in large grounds, a perimeter wall encloses these and the main gates are secured. Woodhouse Cottage accommodates people who are more independent and access is not restricted. Woodhouse Cottage has gardens to the front and rear. The homes are well served by public transport. Both sites provide car parking for visitors. The weekly fees for the home at the time of the site visit on 30th January 2008 ranged from 1426 pounds to 1885 pounds. Information about Carlton House/Carlton Cottage and Woodhouse Cottage, in the form of a statement of purpose, service user guide and the most recent inspection report published by the Commission for Social Care Inspection are available at the home. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care Inspection (CSCI) inspects services at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk One inspector carried out the visit and was at Carlton House from 10:40am until 7:50pm on 13 January 2009 and at Woodhouse Cottage from 9:40am until 11:45am Care Homes for Adults (18-65 years) Page 6 of 37 on 15 January 2009. The purpose of the inspection was to make sure the home was providing a good standard of care for the people who use the service. Before the inspection, evidence about the home was reviewed. This included looking at any reported incidents, accidents or complaints. This information was used to plan the visit. The manager of the home completed an Annual Quality Assurance Assessment (AQAA) before the visit to provide additional information. We looked at a number of documents during the visit and visited areas of the home used by the people who live there. We spent time talking with the people at the home, staff and the manager. Comments made to us during the day appear in the body of the report. Survey forms were sent to people living at the home, health professionals and staff. A number of these had been returned and information from them has been used in this report. Feedback at the end of the visit was given to the manager and business development manager. The last inspection of this home was 30 January 2008. What the care home does well: What has improved since the last inspection? At the last inspection of the home, the organisation was asked to look at how the homes operate and how they are managed as they are on separate sites and operate as two separate homes. They have done this and have now produced two individual statements of purpose, clearly outlining the aims and objectives for each service. A manager has been appointed for Woodhouse Cottage and we were told that it is the intention of the organisation to apply for separate registration of Woodhouse Cottage. There is a new service user guide. It is in an accessible format, including picture images, making it easier to read and understand. It also contains information on how to make a complaint and what the current costs of the placement are. One person told us they had received a copy of this and had found it Interesting. Some care plans have been developed to support people to develop their independence skills. One person has been supported to develop skills of independent travel and money management. However, further work is needed in this area to develop peoples living skills further. Care Homes for Adults (18-65 years) Page 8 of 37 There is now a food comments book, where staff record what food people have eaten and if it has been enjoyed. This makes sure that peoples nutritional needs can be monitored. Working with people who use the service and health practitioners, detailed behaviour management plans have been developed. This means that people who use the service are getting a more consistent approach from staff to help them manage behaviours that challenge others. All staff now complete an accredited medication handling course. The manager has also introduced competency checks that are carried out before any staff can administer medication. This makes sure staffs practice is safe. Staff have now received training in some of the medical needs of people who use the service. They said they had recently completed training in autism and borderline personality disorder. This means they have a better understanding of the effects of these conditions on people. Further training is also planned. The manager said he has reviewed the response to safeguarding matters and introduced measures to protect people better. These should however be kept under review to ensure people are kept safe. An extra communal lounge has been created at Carlton House. This means that people can spend time comfortably in shared areas of the home. The repairs and refurbishments that we said, at our last inspection, were needed at Woodhouse Cottage have been completed. This has made the home more comfortable. The home now has improved the laundry facilities, which means a reduced risk of the spread of infection. Minimum staffing levels have been maintained to make sure there are sufficient staff to meet the needs of the people living at the home. What they could do better: Work should continue on the person centred care planning process. People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This should include likes/dislikes, independence skills and future aspirations and goals. This will ensure that they receive person centred support that meets their needs fully. Some consideration should be given to developing more structured plans to support people to develop their independence skills. This will make sure peoples needs are met more fully. Recording systems must be put in place to show how homely remedies are managed. This will make sure systems are safe and errors can be avoided. Care Homes for Adults (18-65 years) Page 9 of 37 Records must show that staff have been appropriately trained to administer all medications, including insulin. This will make sure that only staff who are properly trained can carry out this procedure. Peoples support plans on how to manage incidents where restraint or physical intervention is needed must show how these have been agreed. This will protect peoples rights and interests. The organisation should consider providing staff with training that will help them give consistent support to help people who live at the home to further their independence. Some consideration should be given to extending the distribution of quality assurrance questionnaires to health and social care professionals. This would give an opportunity for these people to comment on the service provided and to comment on any improvements to be made. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: At the last inspection of the home, the organisation was asked to look at how the homes operate and how they are managed as they are on separate sites and operate as two separate homes. They have done this and have now produced two individual statements of purpose, clearly outlining the aims and objectives for each service. A manager has been appointed for Woodhouse Cottage and we were told that it is the intention of the organisation to apply for separate registration of Woodhouse Cottage. In the AQAA, the manager said, We have a statement of purpose that is displayed in the entrance of the home. We have a service user guide that informs service users, family and professionals about our service. The manager also said the service user guide had recently been revised. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: We looked at the new service user guide. It is in an accessible format for people with learning disabilites, making it easier to read and understand. It also contains information on how to make a complaint and what the current costs of the placement are. One person told us they had received a copy of this and had found it Interesting. There have been no new admissions to the home since our last inspection. The people who currently live at the home have had their needs re-assessed through the person centred care planning process the home has introduced. Peoples needs have also been assessed and reviewed with health care practitioners to make sure their needs are being properly met. In the AQAA, the manager said. We try to ensure that this is the most appropriate environment for the service user to live. We do this by gathering as much information as possible about the person by carrying out a personal assessment. From this information a decision is made as to whether the Service User is suitable for the Service and whether the Service can meet their needs. We have received a high number of notifications regarding conflicts between people who live at the home. Some leading to assaults of people. Since the last inspection of the service, there have been over twenty reported incidents of service users hurting each other and resulting in a safeguarding referral. We asked people who live at the home how they felt about this. They said they felt supported by staff during any incidents and spoke about the part they may have played in these incidents. One person said, I have outbursts and people sometimes fall out with me, staff talk to me and advise me to help me calm down. In the AQAA, the manager said he wanted to make improvements to the service and to review peoples needs to see if this service is right for the people living there. He said, To listen to service users regarding their choice of home whether it be within our service. More importantly for those service users who express a wish to live elsewhere we would support them in their decisions. Peoples comments on whether they liked the home were mixed. They included the following, I am very happy with this home the people in it are very nice I like them and they like me. (with regard to Woodhouse Cottage). One said they wanted to move from the home, one said they wished they had been given more information before they moved in and another said they chose the home as they had more freedom here than at their last placement. Other comments included: Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: I love it here (Woodhouse Cottage) Better than my last place I get on well with quite a few people here I sometimes fall out with people but staff help me to sort it out It’s alright here I am thinking of moving but it’s hard because I like it here. Care Homes for Adults (18-65 years) Page 14 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make decisions about their lives and are involved in planning their care and support. Evidence: Following the last inspection of the home, the manager provided us with an improvement plan and told us that peoples care plans would be regularly reviewed to assess progress that people were making. We looked at care plan and risk assessment records for some people who live at the home. We found them, in the main, to be fairly person centred and individual to each person. People who use the service said they were involved in drawing them up. One person said, I wouldn’t sign them if I didnt agree with them. Some plans had clear and detailed instruction on how the needs of people who use the service are to be met. Some had good information about how people should be supported with personal care, and health needs. They also gave good detail on how behaviours that challenge others Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: can be positively managed for people who live at the home. Some care plans linked well to risk management plans. However, some care plans had vague information and guidance for staff. For example, one care plan said a person needed help and supervision with some personal care tasks. This does not describe the type of help the person needs and could lead to their needs being missed or overlooked. Some risk management plans had not been completed even though it was clear there were risks to people. This again could lead to needs being missed. Staff were however, aware of the risks and how they were to be minimised. On the day of the visit, staff from another home within the organisation were at the home, carrying out an audit of care plans. They said they would be putting a report together on their findings in order that care plans were improved. Some care plans have been developed to support people to develop their independence skills. One person has been supported to develop skills of independent travel and money management. However, some plans were again vague and did not give clear direction on the support people need. Plans asked staff to encourage people. There was no clear structure as to how people were to be encouraged or what particular skills they were wanting to learn. Staff could talk about the support they give but said they had never received training in how to develop peoples living skills. One said, We just use common sense. This could lead to inconsistencies in the support people get. In the AQAA the manager said, We have promoted further risk taking with service users. This is always though the process of formal review,CPA (Care Plan Approach) or consultation with the responsible psychiatrist or CTLD (Community Learning Disability) services. The manager had also identified that risk could be better managed for people, he said, We find that at times there must be a balance between service user choice, decision making and risk, both to themselves and others. In some cases we need to ensure that we are not being overly cautious on the grounds of safety and further develop risk taking. He said he was planning to improve the service and wanted To continue to help service users develop, especially in the area of risk taking. To continue to develop the person centred approach and to promote new skills. Staff were familiar with what was written in peoples care plans and could talk confidently about the support they give. New staff said they had found the care plans very useful when getting to know people who live at the home. Care plans are reviewed and evaluated regularly to make sure they are still relevant Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: for people. Key workers do this on a monthly basis with people who live at the home; this makes sure they are still meeting peoples needs properly. Also in the AQAA, the manager said, We have regular meetings between service users and key workers to promote the individuals choice and this is incorporated within the person centred care plan. We talked to people who live at the home about Your Voice meetings. They said they enjoyed these and felt confident to have their say. One person said they did the agenda for the meetings and also typed up the minutes. People who use the service said, I like going out on my own, I like being independent. However, another said, when asked if they can make decisions about what they do, I have to make the first move and sometimes staff wont let me out. I have to stay at home when I have been naughty. We asked staff what they thought the service does well, one said, Support service users to be as independent as possible, to promote own skills they have and improve where possible and to ensure each service user remains as an individual. Others said, Promote choice, independence and individuality and Independence is promoted and positive risk taking is encouraged as far as possible. A health professional said, They work with clients on choice and independence but need more on best interest and capacity. They also thought the service could improve saying they need, More training on behaviour. The manager told us that they are currently working with health professionals to develop a programme of training based on the needs of the people who live at the home. He said this would include behaviour management. Care Homes for Adults (18-65 years) Page 17 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle. Social, educational, cultural and recreational activities meet most peoples expectations. They also benefit from a good, healthy and varied diet. Evidence: In the AQAA the manager said, We encourage and facilitate service users to use a wide range of local community facilities open to the public and to attend local colleges. We support those service users that need help to maintain links with family. We have a good degree of flexibility. We involve service users in the daily running of the home, involving them in all aspects of daily living skills. Since the last inspection of the service, we have received concerns raised through care management and health care colleagues that people who need more motivation and Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: encouragement to do more are not getting this. In the AQAA the manager identified what he thought the service could do better. He said, We could be more dynamic in helping service users who show little interest in education or specific activities to find something that they may enjoy or stimulate them. Activities pertinent to the needs of the service users should be organised on a more regular basis to include weekends and evenings. We spoke to the manager about how he was going to do this. He said, they had reviewed their recruitment policy and were recruiting people who had skills and interests that may match those of the people who live at the home. He also said they were involving people who use the service in the recruitment process more to make sure they were getting staff that people felt they could get on well with. He said they were also planning to look more at rehabilitation for people, concentrating on developing peoples skills to take on more responsibility and independence. He said they had found the use of planners to be effective in helping people to manage their time better. Staff said that some people who use the service have difficulties with their motivation and getting involved in activity. One said, We have to be persistent, persevere, keep offering people choices but respect at the end of the day when they clearly say no. Activity on offer to people includes, college courses, going out for meals, to the pub, gym, shopping, visiting family, parties and walks out. We noticed that levels of activity had increased recently for some people. Staff said they felt this was due to one person having a one to one worker and some new behaviour management plans that were in place to support people more positively. On the day of the visit, a number of people went out throughout the day. This was either to go shopping or attend a regular college placement. Staff said that they felt they had enough staff to support people with their activities. Also there was plenty of social interaction between the staff and people who use the service. It was clear that staff and people who use the service get on well. As mentioned in the individual needs and choices section of this report, a more structured approach is needed to support people to develop their independence and daily living skills. Staff said they would welcome training to enable them to provide this. We looked at menus at the home. These are planned around peoples likes and dislikes. Menus are discussed on an individual basis with people and also at the regular Your Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: Voice meetings. There is also a food comments book, where staff record what food people have eaten and if it has been enjoyed. Staff are sensitive to peoples needs and while encouraging healthy eating, make sure people have plenty of opportunity for treats. Due to health needs, some diets have been recommended for some people to follow. Staff have taken the advice from the GP (General Practitioner) of people who use the service. They are also following this up with referrals to a dietician. This is good practice and means peoples nutritional needs will be monitored well. Care Homes for Adults (18-65 years) Page 20 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, peoples general healthcare needs are well met and based upon their individual needs. Evidence: In the AQAA, the manager said, We endeavour to carry out any aspects of personal care subject to service user preferences. Some service users are encouraged/prompted to consider their own privacy and dignity. All service users are supported at healthcare appointments,the degree of support varies depending on need. We liaise well and have good relationships with professionals involved with service users. Staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live at the home looked well cared for, well dressed and groomed. A health professional said, Care service usually respects privacy but people dont have keys to their room. People we spoke to said they had keys for their rooms. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: Good records are kept of health appointments and their outcomes. Staff make sure that people are given support to attend appointments to meet their health needs. People are referred to health professionals when needed. Staff have identified and monitored health needs well. A health professional, when asked what the service does well said, Accessing community facilities and allows all professionals to be involved and welcoming. A health professional also said, Care service sometimes seeks advice. Healthcare needs are sometimes met. Dietary input is required. We have also received concerns from other Health professionals saying they feel staff have not been trained well enough to positively manage behaviours that challenge. As mentioned in the choice of home section of this report, the manager is currently working with health professionals to develop a training programme for staff that will be based on the individual needs of people who live at the home. This should be arranged as soon as possible and it should be developed as an ongoing programme to make sure new staff as they join the service are also given the training. This will make sure peoples needs are properly met. Staff said, they had received training in some of the medical needs of people who use the service. They said they had recently completed training in autism and borderline personality disorder. They also said how the training had given them a better understanding of the effects of these conditions on people. Staff said they had also received training from a district nurse in the administration of insulin. We looked at records and could not find any records to show this training had been done. The manager said he would ask the district nurse, who gives this training, to provide certification to show that staff are trained in this procedure. In the AQAA the manager said the service had improved in the last 12 months. He said We have become more conscious of the need to enter details of healthcare appointments within the designated part of the PCCP.(Person Centred Care Plan) We have introduced Health Action Plans. We have regular medication audits We have completed self medication assessments. All staff have completed administration of medication training. The home uses a monitored dosage pre-packed system for medicines. There are good ordering and checking systems in place. We checked some medication administration records (MAR) sheets. These were found to be in good order. Staff said they did not administer medication unless they had been trained to do so. There were no systems in place to show how homely remedies were managed. This must be rectified to make Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: sure systems are safe and errors can be avoided. Care Homes for Adults (18-65 years) Page 23 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people are protected. However the large number of events that affect peoples welfare and safety need to conyinue to be closely monitored. People are confident that they will be listened to and that appropriate action will be taken when necessary. Evidence: In the AQAA, the manager said, We take all complaints and concerns seriously. We act quickly when potential issues of abuse are detected. We share information with the appropriate authorities and individuals. We have robust policies which deal with concerns,complaints and safeguarding.Referrals to local safe guarding adults team are made immediately. All concerns or critical events are reported immediately to the Area Manager and advice given is followed and well documented. Health professionals have raised concerns at the number of safeguarding issues and concerns that staff are not supervised or trained properly to deal with these. In response to this the manager said he has reviewed the response to safeguarding matters and introduced the following: -Closer working with health professionals to develop behaviour management plans. -Making sure all staff are trained in how to follow the plans. -Reviewed the compatibility of people living at the home and made some changes to Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: rooms which people occupy in different parts of the scheme to try to reduce the number of altercations that take place between people. -Put measures in place to protect people who live at the home from the behaviour of others. This has included increased staffing levels for some people and individual activity. -Introduced safeguarding as an agenda item in team meetings and staffs supervision to make sure staff understand their responsibilities clearly. -Started to arrange service specific training to be delivered by health professionals. (as mentioned in choice of home section of this report). Since the last inspection of the home there have been over 20 reported incidents involving physical or verbal abuse between people who use the service. There have been 5 incidents involving physical or verbal abuse from staff to people who use the service. All these staff have been dismissed following the homes investigation into them. There have also been over 40 reported incidents where restraint was used when people who live at the home were displaying behaviour that challenges others. A health professional said, All clients are in progress of getting behaviour programmes especially regarding MDT (Multi- Disciplinary Team) decision of using restraint. ?? techniques used currently without care plan. Records showed that some people had plans in place on how to manage incidents where restraint or physical intervention was needed but did not always show how these had been agreed. In the AQAA, the manager said, All staff attend POVA (Protection of Vulnerable Adults) traning and training in the management of violence and aggresion and We use physical intervention as a last resort and document this no matter how minor the intervention is. Staff also undertake training in the safe use of restraint and records show that they document this anytime it is used. Staff talked of the importance of keeping people safe during any incident where physical intervention is needed. They said the training they received was good and equipped them well. All staff were very clear on restraint being used as a last resort and could give good examples of the deescalation techniques they use to avoid the use of restraint. The incidents mentioned above have led to a large number of safeguarding adults referrals since the last inspection. We have been informed of these through the home using the proper procedures. People who use the service said they felt safe. Some people talked about the number of arguments that take place between people who live at the home. Comments Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: included: (name of person) is always interfering but staff help us sort things out (name of person) gets on my nerves sometimes. Staff have received training in safeguarding adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. The home has an easy read complaints procedure that is readily available to people. The complaints procedure is regularly discussed in the home at Your Voice meetings. People who live at the home said they knew what to do if they were unhappy about anything. They said they would See the staff and the manager if they were unhappy about anything. Most people said staff listen to them and act on what they say. We looked at the complaints records in the home. Records have been kept of any complaints and their outcome. Records are kept of the finances of people who live at the home and their monies are kept safe. Care Homes for Adults (18-65 years) Page 26 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is homely, comfortable and in the main, safe for people who live at the home. Evidence: In the AQAA, the manager said, We maintain the homes to a reasonable standard. We do experience some property damage at the home from time to time. Mainly at Carlton House. This is due to some of the behaviours displayed by some of the Service Users living at the home. We do our best to repair the damage as quickly as possible .We encourage service users to take responsibility for their own rooms/laundry and will give staff support as required. Most people said they were happy with the cleanliness of the home. One person said Sometimes it smells. We noted an offensive smell in the toilets and bathrooms of Carlton Cottage. The manager said he would obtain some cleaning agent that could remove the odour. A tour of Carlton House, Carlton Cotttage and Woodhouse Cottage was carried out. Communal areas, bathrooms and bedrooms were visited. At the last inspection of the home we said there must be adequate communal areas in Carlton House to make sure Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: people can spend time comfortably in shared areas. A room that used to be used for meetings has now been decorated and new comfortable furniture is on order to create a second lounge in the home. This will give people a choice of lounges and has increased the shared space available to people. People said they were happy with their bedrooms. They had been supported to personalise them and said they got the support they needed to keep them clean. To further improve the service, the manager said in the AQAA, We have an improvement list of work we feel is or will be needed around the home. We plan to commence a refurbishment project for Carlton House/Cottage which will incorporate the review of facilities within the service. The manager said that a proposal had been put forward to the organisation for this refurbishment and looking at dividing Carlton House into two separate units. The repairs and refurbishments that we said, at our last inspection, were needed at Woodhouse Cottage have been completed. The home has now improved the laundry facilities which means a reduced risk of the spread of infection. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. Care Homes for Adults (18-65 years) Page 28 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are, in the main, trained, skilled and in sufficient numbers to support people who use the service. Evidence: In the AQAA, the manager said the service has improved, saying, Our training in all statutory areas has significantly improved. We have organised and had delivered specialist training which reflects the specific needs of the service user group. We have recruited additional staff after a number of recruitment initiatives. We looked at recruitment records These showed that recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. Also in the AQAA, the manager said, Staff complete an induction programme within three months of employment. We have an induction pack for new staff to complete, and an assigned mentor supervises the work. Training is usually arranged for new starters soon after commencement of employment. Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: Some people said their induction covered most of what they needed to know. Other comments included: Currently working observing other members of staff and gone on a few training sessions. I think a solid week of training before starting work would be more beneficial I feel that Craegmoor induction that is completed on the first day of employment contains too many points about Craegmoor as a company and not enough service specific information The induction programme that is to be completed within three months of starting covers more of the important aspects of the job Most staff we spoke to were positive about other training that had been provided. One said, Its great, very good training. One staff said they needed more training and guidance in dealing with conditions such as anxiety, depression, bi-polar disorder and diabetes. Another said, I feel that funding for staff to attend courses is often an issue. As mentioned in the individual needs and choices section of this report, a more structured approach is needed to support people who use the service to develop their independence and daily living skills. Staff said they would welcome training to enable them to provide this. The organisation should consider providing this type of training so that staff can give consistent support to help people further their independence. As mentioned in previous sections of this report, concerns have been raised through care management and health care professionals that staff are not trained well enough to meet peoples needs. As also mentioned, the manager has recognised there are shortfalls and has put plans in place to address training needs with the arrangement of courses to cover the individual needs of people who live at the home. Staff said they were often short staffed. They said, I find it difficult to do jobs well when we are short staffed (which is all the time), Problems getting enough staff and staff that are suitable to work in this environment, I feel staff in the home (including management) work very hard to meet the needs of service users, although due to human resources the needs are not always met. When we asked staff what they thought the service could do better, they said, Employ more staff. The manager said there had been problems in recruiting and retaining staff. He said they had tried a new approach which seemed to have been more successful. This includes involvement from the people who live at the home. We looked at rotas in the home and saw that minimum staffing levels are maintained. The manager also said that a number of new staff had recently been recruited to cover some of the vacancies. He said that the current staff team worked overtime to fill the gaps of the vacancies and that regulars from an agency were occasionally used. Staff Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: said they were looking forward to new staff starting and hoped they would stay. People said they got on well with the staff and felt there was always enough staff around to help them. Comments included: Always somebody here for you Very happy with staff and the new ones we have got lately I have a great key worker Staff are kind and help me. Staff said they felt well supported by the ongoing support they receive from their manager and the training they have done. Records showed that staff receive regular supervision where they get the opportunity to review their role. They also spoke highly of the de-briefing sessions that have been introduced to support them when they have been involved in any incidents where people who live at the home have displayed behaviour that is challenging. One said, It is a good learning opportunity and gives you time to reflect. There is a commitment from the organisation for staff to complete their NVQ (National Vocational Qualification) in level 2 or above. Half of the staff team have an NVQ, or are due to start when they have finished their induction. This will give them the opportunity to further develop their skills. Care Homes for Adults (18-65 years) Page 31 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, the interests of the people who use the service are seen as important to the manager and staff and are safeguarded. Evidence: A separate manager has now been appointed to manage Woodhouse Cottage and take responsibility for its day-to-day management. The registered manager continues to oversee both services at the moment. It is the intention of the organisation to apply to register Woodhouse Cottage as a separate service to Carlton House and Cottage. The registered manager of the service has now commenced the RMA (registered managers award) which will make sure he is suitably qualified and has the knowledge and skills to manage the service. Staff were positive about the support they receive from the manager. They said, I gain a lot of support from staff and management, I feel quite comfortable in going to the manager with any problems and Staff are well supported by the manager. Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: The area manager conducts monthly provider reports with detailed requirements for improvement. The manager receives regular supervision from the area manager to support him in his role. In the AQAA, the manager said, We complete regular audits for the homes and are regularly audited by clinical governance. Action plans are completed with quality improvement points which need addressing to achieve compliance. On the day of the visit an auditor from the organisationss head office was in the home carrying out an audit and discussing improvements to be made at the home. The home also sends questionnaires out to people who use the service and their relatives to ask them their views on how they can improve things. An analysis of these is carried out and improvements are made accordingly. The manager said a new vehicle for the home had been purchased in response to suggestions made in the past. Some consideration should be given to extending the distribution of these questionnaires to others such as health and social care professionals. This would give an opportunity for these people to comment on the service provided and to comment on improvements to be made. Records we looked at showed that regular health and safety checks are carried out. In the AQAA the manager said relevant health and safety policies and procedures were in place, and reviewed. He also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. The organisation provides a comprehensive manual of policies and procedures for staff to refer to. Staff said they used these on occasions they needed to look something up and found them useful. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Recording systems must be put in place to show how homely remedies are managed. This will make sure systems are safe and errors can be avoided. 13/02/2009 2 20 13 Records must show that 13/02/2009 staff have been appropriately trained to administer all medications, including insulin. This will make sure that only staff who are properly trained can carry out this procedure. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This should include likes/dislikes and future Page 35 of 37 Care Homes for Adults (18-65 years) aspirations and goals. This will ensure that they receive person centred support that meets their needs fully. 2 11 Some consideration should be given to developing more structured plans to support people to develop their independence skills. This will make sure peoples needs are met more fully. Peoples support plans on how to manage incidents where restraint or physical intervention is needed should show how these have been agreed. This will protect peoples rights and interests. The organisation should consider providing staff with training that will help them give consistent support to help people who live at the home to further their independence. Some consideration should be given to extending the distribution of quality assurrance questionnaires to health and social care professionals. This would give an opportunity for these people to comment on the service provided and to comment on any improvements to be made. 3 23 4 32 5 39 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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