CARE HOME ADULTS 18-65 Carrick 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU
Lead Inspector Lowenna Harty Announced 10 May 2005 09:30 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 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 Stationary 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. Carrick Version 1.10 Page 3 SERVICE INFORMATION
Name of service Carrick Address 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU 01209 864657 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Spectrum Mr Michael John Cross Care Home 5 Category(ies) of Learning Disability (5) registration, with number of places Carrick Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 5 adults with a learning disability (LD)Total number of service users not to exceed a maximum of 5. Date of last inspection 7 & 11 January 2005 Brief Description of the Service: Carrick is a care home providing personal care and accommodation for up to 5 adults with a learning disability. The registered provider is Spectrum, an organisation that provides specialist care for people with autistic spectrum disorders. Spectrum employs a manager, who is registered with the Commission and a team of staff to provide care to the service users living in the home. The aim is to provide them with specialist support in a homely environment. The home is located in the village of Playing Place, which is within easy reach of the city of Truro. It has vehicles for providing transport to service users and there are accessible local bus routes.The home is a single storey building, set in its own grounds, slightly off the main road. All the service users have their own bedrooms. The home has ample communal space, including a lounge/dining room, further lounge and conservatory. There is a spacious kitchen, a separate laundry room and an adequate number of bathrooms. Staff have a small office and separate sleeping in accommodation. The home has a large garden with space for parking.The home has level access and could be adapted to provide for service users with physical disabilities if necessary. Current service users do not require specialist equipment or adaptations and are able to readily access all parts of the premises. Carrick Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the home’s annual inspection programme on 10 May 2005 starting at 9.30 am and lasting about five hours. A pre-inspection questionnaire was completed prior to the inspection, which consisted of the following activities: 1. Inspection of records, including assessment information and care plans 2. Discussion with the registered manager of the home on how it operates on a day-to-day basis 3. Inspection of the building 4. Interview with a member of staff 5. Individual interviews with each of the five service users 6. Observation of the daily life of the home. The inspector would like to thank everyone who was involved in this inspection, including the registered manager, staff and service users, for their kind assistance on the day. One letter was received from a relative of a service user at the home expressing their satisfaction with the care and services provided at the home. What the service does well: What has improved since the last inspection?
There have been several notable improvements since the previous inspection. The one likely to have the greatest impact is the return of the registered manager, following an extended period of leave, which inevitably had a destabilising effect on a previously improving service. The home’s environment has vastly improved, with the provision of new furniture, flooring and there has been a lot of building work to eradicate problems associated with damp. This work is ongoing. Service users have recently been given updated service users’ guides, which have been sent to their representatives for agreement on their behalf, where necessary. The home’s statement of purpose has also been amended in line with previous requirements and recommendations. Service
Carrick Version 1.10 Page 6 users have improved access to activities with an increase in the numbers of staff who are drivers on the staff team. Care planning has improved and there is better consultation with service users and/or their representatives in this respect. There are more staff employed who are qualified to NVQ level 2 or above. Staff supervision and support by senior managers has improved and there are better arrangements in place to ensure that they and the service users are safe at night. Arrangements for ensuring the house is kept clean have improved since the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carrick Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Carrick Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 5 Service users’ placements in the home are on the basis of detailed assessments to ensure their needs can be met there. Service users have written contracts, which were being updated at the time of the inspection. EVIDENCE: There have not been any new admissions to the home since the previous inspection, or for several years and none are expected at present. There are no current vacancies. Spectrum has detailed policies and procedures in respect of the admission of new service users and the statement of purpose makes it clear that there are no emergency admissions. Current service users and their representatives are very familiar with the services provided to them at Carrick. Service users’ guides also function as contracts for service users and are being updated to be sent out to their representatives for signature. The registered manager is also preparing to draw up service users’ guides in forms that service users can access directly. Progress on this will be reviewed at the next inspection. Carrick Version 1.10 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 & 10 Service users have written care plans that are regularly reviewed and include detailed written risk assessments. They are encouraged to develop their skills and make decisions for themselves where it is safe for them to do so although there are occasions when they are not able to make decisions because of staffing numbers. They are provided with information on confidentiality. EVIDENCE: All of the service users have written care plans that are subject to regular review. Service users and their representatives are invited to attend reviews and asked to sign care plans as evidence of their agreement with them. Care plans list individual goals for service users, with a view to ensuring that they are encouraged to develop their skills and independence in a way that is safe for them and realistic. Their care plans consider their skills in making decisions for themselves and how these can be developed. There are times, however, when service users are not able to make choices because of the numbers of staff on duty, particularly at weekends. Although the situation in relation to individualised activity planning has improved somewhat, since the previous inspection, with more drivers employed to work at the home, the inspector noted that they still spend a lot of their time engaged in group based activities. When the inspector questioned why all five of the service users were taken out
Carrick Version 1.10 Page 10 to choose a shower curtain for the home one Saturday afternoon, for example, the registered manager stated that they all had to go because there were only two staff members on duty on that day. Service users are provided with detailed written risk assessments as part of the care planning process, which are regularly reviewed and amended. The home’s statement of purpose contains information on confidentiality, which can be accessed by service users and their representatives upon request. The registered manager is currently considering ways in which key aspects of service users care plans can be translated into formats that they can access directly. Progress in respect of this will be reviewed at the next inspection. Carrick Version 1.10 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14 & 15 Service users are encouraged to develop their self care skills and take part in a variety of activities in and out of the home, although at times their choices may be limited by the numbers of staff available to them. They engage in activities in the local community and family contact is encouraged. EVIDENCE: Service users’ care plans and records demonstrate how they are encouraged to develop their skills and independence and they have individual targets in this respect. They are often out in the local community, but frequently as part of a supervised group. Service users engage in a range of activities, including attendance at a local college. Their interests are recorded and they are provided with opportunities to spend their leisure time in ways they enjoy. Family contact is encouraged and some of the service users spend time away from the home on family visits. Whilst there is evidence of some improvement with regard to service users’ access to individualised activities outside of the home, with the provision of more drivers to take them out, they continue to engage in a high proportion of group-based activities according to the records reviewed at the inspection, particularly at weekends, as stated previously in
Carrick Version 1.10 Page 12 this report. The inspector noted that there is a holiday away from the home booked for the whole house, later on this year. Carrick Version 1.10 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 20 Service users access a range of local NHS care providers according to their needs. The home’s written procedures in respect of medication are being updated currently so this standard will be reviewed in more detail at the next inspection. EVIDENCE: There are records of service users’ attendance at a variety of healthcare settings according to their individual needs including routine checks and attendance for appointments in specialist healthcare settings where necessary. The Commission’s pharmacist recently undertook a detailed inspection in respect of the home’s arrangements for the safe handling of medication. This is currently in the process of being addressed by the pharmacist and Spectrum’s senior management team and will be inspected in more detail at the next inspection. One staff member has been booked to attend safe handling of medicines training. This needs to be extended to all staff who handle medication on behalf of service users. Carrick Version 1.10 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 There are measures in place to protect vulnerable service users from abuse but these should be strengthened and improved. EVIDENCE: The home has a written policy for the protection of vulnerable adults from abuse, which is in the process of being updated, as the current version is now several years old. The registered provider should also obtain copies of local multi-agency procedures and those of the various placing authorities in respect of service users who have been placed there from out of county. Staff are provided with guidance by Spectrum as part of their induction training prior to entering the home, but should also be given access to external, multi-agency training. Carrick Version 1.10 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 There have been several improvements to the home’s environment and more are planned. An immediate requirement was issued in respect of fire safety arrangements in the home. The home was clean and tidy throughout at the time of the inspection and hygiene standards have improved although further action in this respect is required. EVIDENCE: There is evidence of ongoing improvements to the home’s physical environment and builders are continuing to do work to eradicate the smell of damp in the home. This was not apparent at this inspection. Fire safety training records need to be completed, signed and dated for all staff and the home’s fire safety risk assessment needs to be completed urgently. Weekly checks on fire safety equipment need to be undertaken weekly and signed for. Equipment checks by external contractors have been completed. The home was clean and tidy throughout and staff are provided with protective equipment with regard to maintaining hygiene in the home but they also need training in infection control and suitable arrangements still need to be made for dealing with heavily soiled laundry as the home operates with ordinary domestic washing machines.
Carrick Version 1.10 Page 16 Carrick Version 1.10 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32. 33. 34 & 35, 36 Staff roles and responsibilities are clear but whilst they have access to a range of training courses it is difficult to determine what training they have actually done and what they need. Evidence to support fair, safe and effective recruitment and selection of staff in the home has improved but key information is still lacking. There have recently been substantial staff changes and at times numbers of staff on duty need to be increased. Staff are now better supported and supervised. EVIDENCE: Staff are provided with clear written job descriptions and half the current staff team is qualified to NVQ level 2 or above, but staff training records need to be updated and organised into a system that can be verified, checked, monitored and reviewed by the registered manager. There is currently a part-time staff vacancy according to the home’s statement of purpose and there have been three changes in staffing personnel since the previous inspection, which amounts to half the current staff team. At times there have been insufficient staff, particularly at weekends, to enable service users to make full choices about the activities they wish to participate in and to ensure that they are provided with sufficient access to activities on an individual basis. The home’s registered manager has just returned from a period of extended leave from the home. In the meantime, the previous acting manager had met formally with
Carrick Version 1.10 Page 18 staff and provided them with individual supervision. There has also been a recent staff meeting, with records kept. An annual appraisal scheme still needs to be introduced. Carrick Version 1.10 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39 & 42 There have been improvements in the running of the home since the previous inspection. There are systems for seeking the views of service users but these should be developed further. There are arrangements in place to protect and promote the health, safety and welfare of service users but improvements are needed. EVIDENCE: The registered manager has returned to work at the home following a recent period of extended leave away from it and it is likely that the necessary improvements required are likely to be implemented as a result. There has been increased input to the home be Spectrum’s senior management team directly to the home since the previous inspection and some standards have improved as a result but copies of their monthly reports need to be sent to the Commission in a timely fashion. Service users are provided with questionnaires to seek their views on the care and services provided to them on an annual basis but this should be extended to their relatives and other external
Carrick Version 1.10 Page 20 stakeholders and the results need to be analysed and published as part of an annual development plan for the home. The inspector noted several shortfalls in respect of fire safety arrangements in the home, as previously stated and issued and immediate requirement for improvement in this respect. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 2 Standard No 22 23
ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 x 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 1 x x x x x 2 Standard No Score Carrick Version 1.10 Page 21 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score 3 2 2 2 3 x x 31 32 33 34 35 36 2 3 2 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x 2 2 x x 1 x Carrick Version 1.10 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6, 7, 12, 13, 14 Regulation 21 (1)(a), 12(3), 16(2)(n) Requirement Timescale for action 01/06/05 2. 7, 12, 13 & 14, 33 12(3), 18 (1)(a) 3. 20 13(2) The registered provider must ensure that there is evidence that service users care plans are adhered to, with particualr regard to individual activity plans. This requirement was previously set to be achieved by 30.04.05. It has been re-set to enable full compliance following the registered managers return to work. The registered provider must 01/06/05 ensure that service users are fully enabled to make choices about the activites they engage in by ensuring sufficient staff and resources are in place at all times. The registered provider must 01/07/05 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This requirement was previously set to be achieved by 30.04.05. It has been re-set pending the completion of ongoing work by the registered provider with advice from the Commissions pharmacist.
Version 1.10 Page 23 Carrick 4. 23 12(1)(a), 13(6) 5. 24, 42 23(4) 6. 30, 42 13(3) 7. 31,35 18(1) 8. 34 17(2) More robust systems for the protection of service users from abuse must be introduced into the home including updated policies and procedures, ensuring copies of multi-agency protocols and procedures are available for each placing authority and the provision of access to multi-agency training by staff. The registered manager must ensure that there are adequate precautions against the risk of fire with regard to records of staff training, records of weekly alarm tests and completion of an up-to-date fire safety risk assessment. Suitable arrangements must be made to prevent the spread of infection in the home with particular reference to training in infection control for staff and the provision of suitable laundry equipment for heavily soiled laundry such as a washing machine with specified programming ability to meet disinfection standards. This requirement was previously set to be achieved by 30.04.05. It has been re-set to enable full compliance following the registered managers return to work. Records of staff induction and training must be maintained in the home.This requirement was previously set to be achieved by 30.04.05. It has been re-set to enable full compliance following the registered managers return to work. Records required by regulation in relation to staffing must be held in the home. This requirement was previously set to be
Version 1.10 01/07/05 13/05/05 01/07/05 01/07/05 01/0705 Carrick Page 24 9. 38 26 (5) 10. 39 24(1), 24 (2), 24(3) achieved by 30.04.05. It has been re-set to enable full compliance by the registered provider following introduction of a computerised record system into the home. Copies of Regulation 26 visit 01/06/05 reports must be sent to the Commission on a monthly basis. This requirement was previously set to be achieved by 30.04.05. It has been re-set to enable full compliance following the registered managers return to work. The registered provider must 01/07/05 implement effective quality assurance systems in accordance with the regulations. This requirement was previously set to be achieved by 30.04.05. It has been re-set to enable full compliance following the registered managers return to work. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 5 6 33 36 39 Good Practice Recommendations Plans to translate key documents, such as the service users guide into formats that service users can access directly should be implemented. Plans to translate key aspects of service users care plans into formats that they can access directly should be implemented. The registered manager should ensure that staffing changes are kept to a mimimum in light of the recent relatively high turnover of staff in the home. The registered provider should introduce a formal system of staff appraisal. The registered manager should draw up an annual development plan for the home in accordance with the
Version 1.10 Page 25 Carrick National Minimum Standards. This should include a business and financial plan specific to the home. Carrick Version 1.10 Page 26 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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