Inspection on 30/01/08 for Carlton House Dispersed Scheme

This inspection was carried out on 30th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton House Dispersed Scheme 13/01/09

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

Alderson Road 12

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 08/07/2008.

CARE HOME ADULTS 18-65 Carlton House Dispersed Scheme 24 Wakefield Road Rothwell Haigh Leeds West Yorkshire LS26 0SF Lead Inspector Carol Haj-Najafi Unannounced Inspection 30th January 2008 09:30 Carlton House Dispersed Scheme DS0000001432.V358581.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 Carlton House Dispersed Scheme DS0000001432.V358581.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. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton House Dispersed Scheme Address 24 Wakefield Road Rothwell Haigh Leeds West Yorkshire LS26 0SF 0113 2827110 0113 2887523 carlton.house@craegmoor.co.uk www.craegmoor.co.uk J C Care Ltd 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) Mr Robin Staincliffe Care Home 21 Category(ies) of Learning disability (21) registration, with number of places Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. The maximum number of service users who can be accommodated is: 21 Carlton House 10 service users Carlton annex 5 service users Woodhouse Cottage 6 service users To accommodate two named service users over pension age in the category of LD(E) 27th February 2007 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: 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 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. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 5 The weekly fees for the home at the time of the site visit on 30th January 2008 ranged from £1089 to £1839.93. Information about Carlton House 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. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care (CSCI) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.csci.org.uk The last key inspection was carried out in February 2007. Before this unannounced inspection visit on the 30 January 2008 evidence about the home was reviewed. The manager completed an annual quality assurance assessment (AQAA) and we used this to help us decide what we should do during our inspection. Surveys were sent out to people who live at the home, their relatives, staff and health care professionals. Twenty surveys were returned. Comments from the surveys have been included in the report. One inspector was at the home over two days, on the first day from 9.30am to 5.45pm and the second day between 9.30am and 2.00pm During the inspection, time was spent looking around the homes and talking to people who live and work there. We also spoke to a healthcare visitor. Interactions between staff and the people who live at the homes were seen. Care plans, risk assessments, healthcare records, meeting minutes, and staff recruitment and training records were looked at. Feedback was given to the registered manager and the acting business support manager at the end of the visit. What the service does well: We talked to eight people who live at the homes and it was clear people were happy and felt well cared for. One person said, “This suits me just fine, I like it here”. Another person said, “It’s alright, I’ve settled in”. People talked about going out with staff and spending time with staff when they are at home. In a survey one person wrote, “Staff there are all good to me”. One person said, “They are good, I always talk to them”. Another person said, “The manager is fair, staff are fair”. People’s needs are properly assessed before they move into the home so everyone can be sure that the person is moving into the right home and their needs can be met. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 7 Keyworkers organise regular reviews making sure people’s changing needs are identified quickly. People are encouraged to make choices about their lifestyle. Eight surveys from people who live at the home said you can do what you want on a weekend. One person said, “You can sleep in on a Saturday and Sunday morning”. Another person said, “I like it very much”. Good systems are in place to make sure people’s general healthcare needs are met. A healthcare professional said, “I have confidence in the Carlton House team and have no major concerns around the home”. Relative were positive about the care provided at Carlton House and Carlton Cottage. Comments included, “They have a good life at Carlton, they do plenty of social things.” “When we visit the home or telephone the staff are always polite and friendly.” “We have found the care home to be the best thing that has happened to (name of person).” What has improved since the last inspection? What they could do better: The aims and objectives for each service should be reviewed because sometimes two units operate as one unit and at other times they operate as separate units. This is confusing for people who live and work at the homes. The management arrangements at Woodhouse Cottage must be looked at because currently the home does not have a manager. This can leave the home vulnerable because there is no one accountable for managing the service on a day to day basis. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 8 People should be given more opportunities to develop their independence skills because this will help them lead a more independent lifestyle. Some people who live at the homes have very specialised needs. More can be done to make sure these specialised needs are met. Care plans should have some additional information and staff should have training to make sure people understand how these specific needs should be met. Staff said they would benefit from having training in the following areas; learning disabilities; understanding challenging behaviour; mental health; autism and diabetes. At times staffing levels are low and this has resulted in some people not being able to go out as often as they would like. A person who lives at the home said, “I would like to have more chances to go out”. A staff member said, “The majority of the time the staff team support people very well but this can slip during stressful times i.e. staff shortages”. One person had recently missed a day at college because there were not enough staff to go with him. Good safeguarding procedures are in place but during the site visit we witnessed a staff member responding inappropriately to a person who lives at the home when he was trying to raise a concern about another member of staff. This type of practice does not protect people because people cannot openly express their views. Carlton House and Carlton Cottage would benefit from having more laundry facilities so they don’t keep getting a backlog of dirty washing. This will help the control of infection. As a result of this inspection 13 requirements and 4 recommendations were made. These can be found at the end of this report. 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. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 9 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 Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 10 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): 1, 2 & 5 People who use the service experience adequate quality outcomes in this area. People’s needs are properly assessed before they move into the home so everyone can be sure that the person is moving into the right home and their needs can be met. The registration is not appropriate because the homes do not operate as one unit. Aims and objectives for each service are unclear which is confusing for people who live and work at the homes. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We spoke to two people who had moved into the home since the last inspection. They both said they had settled in and were happy living at the home. One person said they had made friends with other people who live at the home and the deputy manager had visited them at home before they moved in. They also said their parents were happy with the move. In the AQAA the manager said, “We try to ensure that this is the most appropriate environment for the service user to live. We gather as much Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 11 information about the person for the assessment as possible and we develop a comprehensive care plan. We have a service user guide that informs potential service users, family and professionals and others about our service.” During the site visit, two sets of admission records were looked at. Each person had assessments that identified the type of support they required. The manager or deputy co-ordinate any admissions and complete the preadmission assessments. One set of admission information was very detailed and in addition to the home’s assessment, information had been received from various people/agencies. This demonstrates that a very through assessment process was carried out on this occasion. People had copies of the terms and conditions in their file. The organisation has introduced new, easy read terms and conditions. In two of the units, the people who live at the home had signed the new contracts. In the other unit the new terms and conditions had not been signed. A senior worker said they were organising time with each person to go though the statements before they asked them to sign them. Five people had signed terms and conditions but in the old format; one person did not have a signed contact. Most people who live at the home would understand the contents of the terms and conditions, however, there is some uncertainty whether a small number of people would fully understand the contents. It was suggested that where there is any doubt about a person’s capacity to understand any information they are signing, a representative should also be involved. The registration is for Carlton House dispersed scheme, which covers three units. Carlton House, Carlton Cottage and Woodhouse Cottage. Carlton House has facilities for nine people, Carlton Cottage provides additional accommodation for five people and is in the same grounds. Woodhouse Cottage is three miles away and is registered for six people. The registered manager is responsible for all three units, although he spends very little time at Woodhouse Cottage and is not managing the home on a day to day basis. There is frequent telephone contact. Woodhouse Cottage operates as an individual unit and has separate staffing. A senior support worker is employed three days week and is responsible for the day to day running of the unit. Further information about the management of the homes is under the management section of this report. The inspection in February 2007 and this inspection confirmed that Woodhouse Cottage is a very different and separate service. It is not appropriate that the units are registered as one service. Since the inspection in February 2007, senior managers from Craegmoor have met with CSCI to discuss the registration and they are willing to register the homes separately. CSCI’s registration team are currently looking at this. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 12 Carlton House and Carlton Cottage are separate buildings and at each shift, one or two staff are allocated to work in the Cottage. The two units share laundry facilities and money is held in only one of the units. For the majority of the time they operate as individual units but other times they operate as one. There are inconsistencies and lack of clarity, which can be confusing for staff and people who live at the homes. This was identified as a problem at the last inspection but there was no evidence seen at this inspection to show that progress had been made to address the issues. Both units have the same menus and shopping is done together, and most evening meals for the Cottage are cooked at Carlton House, even though the Cottage has their own catering facilities. Lunch is usually prepared in each of the units. One person commented that when staff from the Cottage go to get food supplies from the main house, people often say, ‘you’re taking our food’. They also have joint ‘service user’ meetings. People from both units wander in and out of the units. Staff and management said that separation of the units would be beneficial but it would be a long process, and shared laundry and money facilities makes it difficult to separate. Certain progressive steps could be taken with relative ease. The manager and acting business support managers agreed to look at the operation and interaction of Carlton House and Carlton Cottage. This process should include reviewing aims and objectives of each home and producing appropriate statements of purpose and service user guides. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 13 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 & 9 People who use the service experience good quality outcomes in this area. People are encouraged to make decisions about their lives and are involved in planning their care and support. Independence should be better promoted to make sure everyone has opportunities to lead an independent lifestyle. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Six people who live at the home said you can always make decisions about what you do; one said sometimes; one said never. One person said “I always make my own decisions, sometimes it’s hard so I ask a member of staff to help me”. In the AQAA the manager said, “Service users participate in the development of their own care plan and its evaluation. We endeavour to listen to service users views as part of daily interactions. This would be apparent when visiting our service.” Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 14 Since the last inspection, a new ‘person centred’ care planning process has been introduced. Keyworkers have spent time with people to identify how their care needs should be met. Assessments are completed and then this information is used to develop a care plan. Staff had a good understanding of person centred care. People who live at the homes talked about their care plans and said they had been involved. One person said he had a care plan for when he went out shopping and how much money he spends. We looked at three people’s assessments and care plans. They all had information that showed how the person’s needs should be met. They had good information about how people should be supported with personal care, and when out in the community. For example one plan said, “Staff should monitor my dietary intake”. The person’s daily notes had details of food that had been eaten and weight was checked every two weeks. They also had detailed guidance to deal with aggressive and potential risky situations. Staff were familiar with what was written in people’s care plans. Each assessment has a section on independence. These sections contained very little information. One person’s was blank, another person’s only related to communication. No one had a care plan for independence. People do tasks in the home, which include cleaning, laundry, preparing and cooking meals. Staff talked about how people are involved around the home. For example, one person who lives at the home can change his own bedding, clean his bedroom without support and take his washing to the laundry. But none of this information is recorded. The care plans should be broadened to make sure everyone is clear about the amount of support people need. This was identified as a shortfall at the last inspection. A very good care plan review system is in place. Keyworkers look at daily notes to find out if there has been any changes in care needs. They then review care plans and produce a monthly report. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 15 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, 15, 16 & 17 People who use the service experience good quality outcomes in this area. People are happy living at the home and are able to make choices about their lifestyle. More opportunities for people to go out with staff support would further improve people’s lifestyles. The quality of meals are good but a lack of accurate food records means nutrition and variety are not properly monitored. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: We talked to eight people who live at the homes and it was clear people were happy and felt well cared for. People talked about going out with staff and spending time with staff when they are at home. One person said, “This suits me just fine, I like it here”. Another person said, “It’s alright, I’ve settled in”. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 16 In the AQAA the manager said, “There are a number of service users attending colleges and day facilities, they generally access specific sessions relevant to and chosen by them. Care plans will indicate how service users access the community.” People talked about going to the local shop. One person said they can now go out on their own and this has made a big difference. Some people said they would like to go out more. A person who lives at the home said, “I would like to have more chances to go out”. One relative raised concerns that some organised activities were missed because there was no driver available. One person had recently missed a day at college because there were not enough staff to go with him. Staff said the homes provide a good service and successfully meet people’s needs. They said people are happy and have a reasonably good lifestyle. Staff did say opportunities to go out are sometimes limited and this is because of staffing levels. One staff said, “People would benefit from going out more”. Another staff said, “More opportunities to take people to the shop would be better, we get one to one time with people in the house and it is seen as an important part of your job to sit with people”. The manager acknowledged there had been some difficulties in recruiting the right staff and this had had an effect on staffing levels but they were in the process of recruiting new staff. People who live at the home said they can visit relatives regularly and staff will help them organise the visits. Staff often take people fairly long distances to make sure they maintain regular contact. One staff said this was an area where the home provided very good support. Eight people who live at the home said you can do what you want on a weekend. One person said, “You can sleep in on a Saturday and Sunday morning”. Another person said, “I like it very much”. Four relatives said the care home always meets the needs of their friend or relative; one said sometimes. Four relatives said the care home always help their relative to keep in touch; one said usually. Additional comments from relatives included: • Everything is well organised and the carers do a brilliant job • They have a good life at Carlton, they do plenty of social things • When we visit the home or telephone the staff are always polite and friendly • We have found the care home to be the best thing that has happened to (name of person) Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 17 The following suggestions were made to improve the service: • To be kept more informed on any serious difficulties that relate to their relative • To ring back when they say they will; this rarely happens • Get more staff People who live at the home said the food is generally good. One person said, “The food was ‘nice and healthy’.” Another person said, “The meals are tasty”. People who live at the homes and staff go shopping to the local supermarket for provisions. It was clear from discussions people enjoy this. One person was seen to ask for some specific foods, and these were added to the shopping list. People are involved in preparing and cooking the meals, and again people said they enjoy this. One person said, “We all help in the kitchen, it’s everyone’s job”. Another person said, “Staff help me in the kitchen and help me with my room”. The menus are varied and people said they have a good choice of meals. People can have alternatives to the menu. On the first day of the inspection, some people chose a different lunch. The menu at Woodhouse Cottage states ‘alternative’. Alternative meals are not recorded so it is not possible to get an accurate picture of what people have eaten. As stated in the Choice of Homes section, Carlton House and Carlton Cottage share the same menu and use the same kitchen. Meal and mealtimes could be improved for people if the units operated separately. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 18 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 & 20 People who use the service experience good quality outcomes in this area. People’s general healthcare needs are well met but some people’s specialist needs have been overlooked. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: A healthcare professional said individuals’ needs are always met. They also said, “Carlton House fills an important niche in that it manages challenging personalities in a firm but fair way. I have confidence in the Carlton House team and have no major concerns around the home”. Another professional said, the care service “promotes positive reinforcement and assists people to see their actions from a third party perspective”. They said the home could have “better correspondence over service users’ care plans”. A healthcare professional was visiting one of the homes. She said staff have always been friendly, offered drinks and is aware she is coming. Staff make Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 19 sure they have privacy during her visits. She said she has no concerns about the home. In the AQAA the manager said, “All service users are supported at healthcare appointments, the degree of support varies dependant on need. We liaise well and have good relationships with professionals involved with service users.” Each person has a health action plan, and care plans and assessments cover personal and healthcare needs. All appointments are recorded on a healthcare sheet. One care plan identified that the person should have special shampoo and moisturiser for their hair and skin. These products were in the person’s bedroom. Several people at the homes have very complex and specialised needs. Healthcare professionals are involved with people who live at the home and are consulted when staff want guidance and advice. Care plans have information about medical and specialised needs but there were some gaps. For example, one person has a mental health diagnosis and his mental health has an effect on his daily life. There was a general information sheet but no specific care plan. Another person is autistic and displays typical autistic traits but care plans did not identify this in enough detail. Records and discussions with people showed that there have been several incidents between some people living at the home and it is thought these might have been triggered because of how relationships have been developing. Care plans did not have any information about emotional needs or sexuality. The manager agreed to explore appropriate support for this group of people. The medication system is a Monitored Dosage System. Medication records were looked at and they had been completed correctly. Medication storage was well organised. Staff said they carry out regular medication checks. On the second day of the inspection staff were attending a medication training course. The manager confirmed that, at Carlton House and Carlton Cottage, two staff are always present when medication is administered, one of whom must have completed medication training. At Woodhouse Cottage, all but one staff have completed medication training, although the person who has not attended training has been administering medication. It is important to make sure medication is only administered by people who are appropriately trained to reduce the risk of errors being made. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 20 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 & 23 People who use the service experience adequate quality outcomes in this area. Overall people are protected. People are confident that they will be listened to and that appropriate action will be taken when necessary. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Staff said they know what to do if a person living at the home or their relative has concerns about the home. Eight people who live at the home said they know how to make a complaint. Four relatives said they know how to make a complaint. One person who lives at the home wrote, “I know I can speak to many people if I’m unhappy”. In the AQAA the manager said, “We take all complaints and concerns seriously. We have robust policies dealing with concerns, complaints and protection. We make service users aware that they can speak out when they feel unhappy about something that has happened to them and how to do so.” The AQAA said the homes had received six complaints since the last inspection. We looked at the complaints record. The complaints were recorded and there was good detailed information to demonstrate that they had been investigated thoroughly. One healthcare professional said, “Any issue raised is given proper attention”. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 21 In care planning records very detailed risks assessments have been carried out on people who can be aggressive and actions have been put in place to minimise risks to the person and others. One person who lives at the home said, “I get angry. Staff help me but I still get angry and take it out on people. Staff and my consultant have tried different things, relaxation, music and a diary”. Staff said they felt they had received proper training and were confident when dealing with volatile situations. Staff records confirmed all staff have received training on how to deal with people whose behaviours challenge services. Daily records had very specific information if incidents had taken place. Staff had clearly described what had taken place and any relevant details. Where needed an incident form had also been completed. The recording system to monitor incidents is good and staff write down minor incidents. The homes have informed CSCI if serious incidents have taken place. However, one person who lives at the home talked about an incident that had occurred several days before the inspection. There was no record of the incident. The manager spoke to staff who described the event as ‘horseplay’ rather than an aggressive incident. The manager acknowledged that the person had perceived it differently and agreed to discuss this with staff. Staff and management have attended training in the protection of vulnerable adults and were familiar with the adult protection procedures. They were able to say what action they would take if they suspected abuse or if someone made an allegation of abuse. They were also able to describe the different types of abuse. One person who lives at the home talked about a concern that related to a specific staff member. During the discussion a senior staff member’s response was inappropriate. The staff member was obviously unhappy that the person was raising a concern and told the person what they alleged did not happen. This did not enable the person to openly express their views and does not safeguard people. The manager, who was also present, identified this was an unacceptable response and agreed to reassure the person who lives at the home and address the issues with the staff member. We looked at personal allowance records. All financial transactions were recorded. Two people’s records were looked at and the hand written sheets corresponded with the computerised records. People were observed receiving money from the office. Staff said they write out a receipt and complete the balance sheet every time they give out money. They were seen to count the money with people, point to the amount written on the receipt and ask people to sign. One person said they always sign for the money and staff always show them how much is written on the receipt. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 22 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, 28 & 30 People who use the service experience good quality outcomes in this area. People live in a comfortable environment that is generally well maintained. The home is hygienic but insufficient laundry facilities could spread infection. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: On the days of the visit the homes were clean and tidy. Decoration, furniture and furnishings were of a reasonable standard. Six people who live at the home said the home is always clean and fresh; one said sometimes; one said never. Several people were happy for us to look at their bedroom, which are clearly seen by others as the person’s own space. Each bedroom was personalised and people said others only came in when they are invited. One person said they Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 23 would like some more storage space and a replacement fridge and another person said they would like a new computer desk. The manager agreed to discuss these requests with people and help them purchase appropriate items. A good system is in place for monitoring maintenance around the homes. Management and staff carry out checks and any problems are recorded. A maintenance worker covers all three units and carries out work as and when required. He was tiling a bathroom during the visit. One window at Woodhouse Cottage was broken and boarded up, and bits of broken glass were visible. A record of the broken window was made in October 2007 but this had not been repaired by the end of January. This is an unacceptable timescale for a repair and must be attended to promptly. The inspection in February 2007 identified that the main unit, Carlton House, does not have a quiet communal area that people who live at the home can use. Several years ago, a small lounge was converted to an additional bedroom. It was said that this was a facility that is greatly missed. The high number of incidents and feedback from staff and people are strong evidence that there are not adequate communal rooms. This issue has not been addressed. One person said they had recently had problems with another person who lives at the home and this often occurs in the lounge. They said staff advise them to go to their bedroom because there is not another room available. The manager has a programme to replace furniture and carpets as they become worn, and this appears to work reasonably well because communal areas were in a satisfactory condition. The manager had identified that dining chairs need replacing in all the units and a request for replacing them had been submitted. The dining carpet in Woodhouse Cottage was faded and badly stained and needs replacing The grounds of Carlton House and Carlton Cottage had been cleared. Staff said it was better since some rubbish had been cleared away. One person who lives at the home said, “I like looking after the grounds and have done a good job cleaning them”. The manager said the shed had been cleared and people can use it for storage. The home does not have a call system. Each staff member carries a two way radio at all times. Staff said they never work without having a radio. They said the system works well and they always feel safe. Carlton House and Carlton Cottage share a laundry. Woodhouse Cottage has a separate laundry. Both have industrial washing and drying equipment. Fourteen people from Carlton House and Carlton Cottage share the laundry in Carlton House but it only has one washer and one dryer. During the visit there Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 24 was a lot of dirty washing piled up just outside the laundry. Staff said they sometimes get a backlog of washing and they sometimes have a problem with the dryer. Apparently people put in wet a quilt which causes the dryer to breakdown and it takes several hours to dry out. Senior managers from Craegmoor carry out visits to their homes to make sure they are providing a satisfactory service. Reports from September and October 2007 identified that there had been excessive dirty washing. There were appropriate hand washing and hand drying facilities in all areas of the home. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 25 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, 33, 34 & 35 People who use the service experience good quality outcomes in this area. People who live in the home are supported by a caring staff team. On occasions, there are not enough staff and this affects the quality of the service because people cannot go out as often as they would like. Staff are skilled but a broader training programme would make sure staff could meet people’s specialist needs. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Seven people who live at the home said staff treat them well; two said sometimes. Seven surveys said carers always listen and act on what they say; two said sometimes. One person wrote, “Staff there are all good to me”, another person wrote, “I very nearly feel like I am not listened to, I feel like they have not got time for me”. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 26 People who live at the home were complimentary about staff. One person said, “They are good, I always talk to them”. Another person said, “The manager is fair, staff are fair”. One staff member said there are usually enough staff to meet the individual needs of the people who live at the home; three staff said sometimes. One staff member said, “We have a high turnover of staff and are often working understaffed. This puts a strain on the staff who are working”. Another staff said, “The majority of the time the staff team support people very well but this can slip during stressful times i.e. staff shortages”. One healthcare professional said, “Staffing levels may at times restrict options”, another professional said, “Lots of staff turnover affects the continuity of care”. One relative said. “At times they are short staffed”. As stated under the lifestyle section, sometimes people have not gone out as often as they would like because of staffing levels. Staff also said sometimes there are not enough staff. The manager said they have not had a high turnover of staff but they have had some difficulties because of staff sickness and general recruitment. We looked at Woodhouse Cottage staff rota. Management said there should be three staff on duty when everyone is at home. There were several weekend and evening shifts when only two staff were on duty. Staff said they are being given training which is relevant to their role. One staff member said, “ We don’t have training about mental health issues even though some people suffer with these problems”. One staff member said their induction covered everything they needed to know; two said mostly; one said partly. One person said, “It felt a little rushed”. During the site visit staff said they would benefit from additional training. They identified the following areas; learning disabilities; understanding challenging behaviour; mental health; autism and diabetes. Staff training records confirmed that staff have attended mandatory training courses, which include health and safety, moving and handling, infection control, basic food hygiene, equal opportunities and primary intervention. NVQ training records confirmed of the twenty six staff that work at Carlton House and Carlton Cottage, three staff have completed NVQ level 2 and seven are working towards the award; six have completed level three and five are working towards the award. In the AQAA the manager said, “We have an induction pack for new staff” and they are “assigned a mentor.” “Training is usually arranged for new starters soon after they start employment and is generally done in block. NVQ is Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 27 offered and with those currently training we will be over minimum compliment when they complete.” We looked at the recruitment process for three people that had started working at the home since the last inspection. The files had all the relevant information to confirm these recruitment processes were well managed, which included application forms, interview notes, references and CRB (criminal records bureau) checks. We talked to two staff about the recruitment process. Staff said they thought it was very good. They said before they started work, the management team had prepared them because they had talked about management expectations of staff and the type of work they would be engaged in. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 28 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, 39 & 42 People who use the service experience adequate quality outcomes in this area. Management is good at Carlton House and Carlton Cottage but the absence of a registered manager at Woodhouse Cottage leaves the service vulnerable. This puts people at risk as there is no-one accountable for managing the service on a day to day basis. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The registered manager has worked at the home for over eleven years. People who live at the home and staff said they thought the management of Carlton Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 29 House and Carlton Cottage was good. The manager has recently enrolled on the Registered Manager’s Award. An assistant manager works alongside the registered manager at Carlton House and Carlton Cottage. A senior support worker has been managing Woodhouse Cottage on a day to day basis since June 2007. The management team at Woodhouse Cottage should consist of one assistant manager and three senior support workers. Recently it has been operating with only one senior support worker. There has not been an assistant manager since June 2007. Two of the three senior support workers from Woodhouse Cottage had not worked at the home for some time. One person had been temporarily transferred to another Craegmoor home; one person was absent from work because of ill health. As stated under the choice of homes section, the management of Woodhouse Cottage is not sufficient because the registered manager does not have day-today responsibility for the running of the home. The management arrangements were identified as inadequate at the last inspection, and even though the registration of the homes is being reviewed the registered provider must still make sure proper management arrangements are in place. In the AQAA the manager said, “we complete regular audits for the homes” and “our audit results have been gradually improving”. At least once a month Craegmoor must organise a visit to the home to make sure everything is satisfactory, these visits are called Regulation 26 visits. The area manager or acting business support manager has visited the home at least monthly and produced a report on the conduct of the home. The reports are detailed and demonstrate the visits are an effective system for monitoring the quality of the home. At Woodhouse Cottage, relatives and people who live at the home had returned several questionnaires to the organisation in March 2007. These were kept in the office. Some concerns had been raised but there was no evidence to show these had been addressed. CSCI surveys for people who live at Woodhouse Cottage, their relatives and staff were on the top of the office filing cabinet, which indicates that they had not been given out. A senior support worker said they had not been given to people who live at the home. This does not give everyone an opportunity to say what they think about the service. People who live at the home can attend regular ‘service user meetings’. Three had been held in the last four months and people had discussed, holidays, outings, cleaning and transport. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 30 People who live at Carlton House and Carlton Cottage have joint meetings. People could benefit from having meetings that are specific to each home so they can talk about any specific issues. In the AQAA the manager said relevant policies and procedures were in place, and many were reviewed in the last two years. He also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. Dates for servicing portable electrical equipment and fire equipment were verified at the inspection. We looked at fire testing, fire servicing and emergency lighting records at Woodhouse Cottage. These were all up to date and confirmed that regular health and safety checks take place. Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 31 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 1 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 3 X Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 32 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4, 5 Timescale for action The registered persons must look 30/04/08 at how the homes operate and how they are managed. The services and facilities must be reviewed and clear guidance of how they will operate must then be produced. This should be in the format of a statement of purpose and client guide. Timescale of 30/09/07 not met People must have a signed contract/statement of terms and conditions. Where there is any doubt about a person’s capacity to understand any information they are signing, a representative should also be involved. This will make sure the person signing the agreement understands the contents. People who live at the home must have an individual plan that identifies how they should be supported with daily living tasks to help promote their independence. This will make sure their individual needs are met. DS0000001432.V358581.R01.S.doc Requirement 2 YA5 5(1)(b) 31/03/08 3 YA6 15 30/04/08 Carlton House Dispersed Scheme Version 5.2 Page 33 4 YA17 16 5 YA19 15 13 6 YA20 13 7 YA23 13 8 YA24 23 Meals provided must be accurately recorded. This will make sure nutrition and variety can be properly monitored. People must have individual plans that identify how any emotional and specialist health needs should be met. This relates to relationships, sexuality, mental health and autism. This will make sure people’s individual needs are met. Medication must be administered by staff who are appropriately trained. This will help make sure people receive the right medication. Staff must respond appropriately to any allegations made by people who live at the home and encourage people to report their concerns. This will help make sure people are safeguarded from abuse. The window in the small lounge must be replaced to make sure people live in a safe environment. (Woodhouse Cottage) The dining carpet must be replaced to make sure people live in a pleasant environment. (Woodhouse Cottage) There must be adequate communal areas to make sure people can spend time comfortably in shared areas. (Carlton House) Timescale of 30/06/07 not met Adequate laundry facilities must be provided to make sure dirty laundry is not left for long periods of time. This will help control the spread of infection. DS0000001432.V358581.R01.S.doc 31/03/08 30/04/08 31/03/08 31/03/08 31/03/08 9 YA28 23 30/06/08 10 YA30 13 16 30/04/08 Carlton House Dispersed Scheme Version 5.2 Page 34 11 YA32 18 12 YA33 18 Staff must have the skills and knowledge of the disabilities and specific conditions of the people living at the home. This will help make sure people’s needs are met. There must be sufficient staff working at the homes at all times to meet the needs of the people living at the homes. A manager must be appointed to manage Woodhouse Cottage to make sure the home has a person who is responsible for the day to day running and is accountable to the Commission. 30/06/08 30/03/08 13 YA37 8 30/04/08 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 YA13 Good Practice Recommendations The level of community participation should continue to be developed to make sure people benefit from integration in community life. The registered manager should be suitably qualified to make sure they have the knowledge and skills to manage the service. People who live at Woodhouse Cottage and their relatives should be given opportunities to complete relevant survey material to make sure they can put forward their views. Any comments then should be looked at and acted upon if appropriate. People who live at Carlton House and Carlton Cottage should have opportunities to meet separately to talk about their own homes. 2 3 YA37 YA39 4 YA39 Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Regional Office St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB National Enquiry Line: 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 © 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 Carlton House Dispersed Scheme DS0000001432.V358581.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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