CARE HOME ADULTS 18-65
Cartref Residential Care Home 1a Church Mount South Kirkby Pontefract West Yorks WF9 3QT Lead Inspector
Tony Railton Unannounced Inspection 14th February 2006 09:00 Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 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 Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 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. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cartref Residential Care Home Address 1a Church Mount South Kirkby Pontefract West Yorks WF9 3QT 01977 643592 01977 643592 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 Hall Mrs Hall Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Cartref is a residential care home providing personal care and accommodation for six younger adults who are subject to learning disabilities. The home has five permanent service users with one place for short stay care. The enterprise is privately owned and the owners live on the premises. The accommodation is an adapted detached house situated in a residential area of South Kirby, near Pontefract. All the residents accommodation is single and there is a large living room and a dining kitchen. The building is in the process of being extended and there is a car park to the front of the building and a sitting area and garden to the rear. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a very positive and enjoyable unannounced inspection when there was the opportunity to speak to three residents, Mr and Mrs Hall and one care staff. There was also the opportunity to look at residents’ case files including assessments, care plans, financial and medical records and daily records. The inspector also looked at staff training records, recruitment and selection records and staff rotas. The inspection visit commenced at 09.00 and there was the opportunity to observe the daily routines of the home. All residents appeared to be happy and comfortable and one resident who has recently been very poorly in hospital said that he “ is feeling much better” and is “pleased to be back home”. The inspector was pleased to note that the home has complied with the requirements noted at the last inspection and that they continue to meet the statutory requirements and almost all the minimum standards. The inspector would like to take the opportunity to thank the residents’, Mr and Mrs Hall and care worker for their hospitality and patience throughout the inspection visit which ended at 12.00. What the service does well:
From discussion with residents, observation and examination of residents’ records including assessments, care plans, reviews, daily records and photographs it is clear that residents are happy living in the home. The care provided by the home continues to be underpinned by ordinary living principles and residents are encouraged and supported to take advantage of ordinary community based healthcare and leisure services. The care provided is also underpinned by Christian values and records show that residents spiritual and emotional needs have a high profile within the home. It was noted that all care staff in the home have a National Vocational Qualification at Levels 2 or above and that Mr and Mrs Hall are A1 NVQ Assessors. This is to be commended as it is over and above the recommended standard of 50 . Resident bedrooms are homely and comfortable and residents appear to be happy surrounded by their own possessions including Compact Disk, DVD and video players, posters, photos and books. There is a relaxed atmosphere created and care staff were observed carrying out their duties in a quiet and unhurried manner. The home continues to involve residents in Quality Assurance by regularly asking their views and opinions regarding the quality of care and support provided by the home. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 5 All residents including short term care have their care and support needs assessed before they are admitted. Residents have a service users guide but would benefit from a more easier to understand format. Residents have a contract issued by the placing or funding local authority. EVIDENCE: Residents’ records show that they have a contract with the home, however, it also shows that the contracts don’t contain all the information required by minimum standards. Mr and Mrs Hall said that they are currently reviewing residents’ contracts and feel that they need to develop their own. Records show that there is a service user guide provided, however, this is typed and Mr and Mrs Hall said that consideration needs to be given to providing it in a more suitable and accessible format. Residents records show that there are assessments including risk assessments and that residents’ care and support needs are assessed before they are admitted. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Residents are involved in developing and reviewing their own care plans and they can and do make decisions about their lives. Residents are perceived as being part of an extended family and are involved in every aspect of the decision making processes in the home. Residents may, however, benefit from having clearer risk assessments. EVIDENCE: Through observation and discussion with residents and Mrs and Mrs Hall it was determined that residents are perceived as part of an extended family and are involved in every aspect of their care. This includes making choices and decisions about their lives, however, the daily records does not have descriptive words to reflect any decisions or choices they make about how they live their daily lives. Residents assessments, care plans and reviews show that they are involved in their care, however, residents could benefit by having risk assessments that show what action needs to be taken by staff to minimise any risks to residents in the pursuit of living an ordinary lifestyle. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Residents do have opportunities for personal development and also the opportunity to take advantage of ordinary community based leisure services. Residents participate in their own community and have a positive presence EVIDENCE: Residents care plans, assessments and reviews show that they participate in age, peer and culturally appropriate activities. The weekly activity sheets show that some residents also attend local authority run day services. Photographs show that one resident is involved in the local football club and others in local churches. The daily records although good and contain a lot of information do not contain descriptive words to show and reflect residents choices and preferences regarding activities undertaken. Mr and Mrs Hall and their staff team are to be commended for their efforts in ensuring residents have access to and enjoy participating in ordinary community based activities. Some residents last year took a helicopter ride which was very exiting. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 11 Residents are fully involved as much as possible in planning and preparing meals. However, there is a lack of descriptive words in the daily records indicating when residents chose an alternative menu. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 , 20 and 21 Residents receive personal care in a way they prefer and require and they are encouraged to take full advantage of ordinary community based healthcare services. The policies, procedures and practices regarding the ordering, storage, administration and recording of medicines protects and promotes residents well-being. EVIDENCE: Residents reviews and medical records show that they are encouraged to use ordinary community based healthcare services and that their health needs are appropriately met. It was also noted that if required the home can seek the advice of specialist social workers and community learning disability team. Through discussion with Mr and Mrs Hall it was noted that all staff have received training from the pharmacist on the administration of medicines. The home uses the guidelines issued by the Royal Pharmaceutical Society as its policy document. Discussion took place regarding planning for the hypothetical death of a residents and what was the appropriate action to take regarding pre-paid funerals and living wills. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Residents are protected and safeguarded from abuse and they know that any complaints they have will be taken seriously and acted upon. However, resident may benefit from having the complaints policy and procedure in an alternative and more accessible format. EVIDENCE: The home has not received any complaints over the past year. The homes complaints policy and procedure is typed and there are some residents who have difficulty accessing the information they require. Discussion indicated that the home is considering providing a complaints policy and procedure in a different format for example, the use of pictures and symbols or audio tape or video was discussed. It was noted that the home has a copy of the Wakefield Social Services and Health Multidisciplinary Adult Abuse and Protection Policy and Procedure. POVA forms part of the staff selection and recruitment process and the induction training for staff. POVA also forms part of the National Vocational Qualification obtained by all staff. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Residents own bedrooms promote their independence and they are comfortable and happy to be surrounded by their own possessions. Residents live in a comfortable, clean and well maintained home which they consider to be theirs. EVIDENCE: Through observation and discussion with residents it was established that they are happy and comfortable. Service users bedrooms are personalised and three bedrooms have recently been completely redecorated and provided with new furniture. One resident has decided to have his bedroom decorated in the Leeds United colours and two other residents have their bedrooms decorated to Manchester united colours, complete with posters of their favourite football team on the walls. Residents said that they were happy with their home and one resident sat watching his videos said that he was very pleased to be home and back in his own room following a short spell in hospital. This resident looked particularly comfortable and was happy. The inspector saw plans and discussed the proposed building extensions for the home. On the day of the inspection all parts of the home were clean and well maintained.
Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, and 36 Residents’ benefit from been supported and cared for by a competent and qualified staff team. Residents are also protected and safeguarded from harm by the staff selection and recruitment policies, procedures and practices. However, residents may benefit from staff having regular formal supervision sessions which are planned and recorded. EVIDENCE: Discussion with Mr and Mrs Hall, care staff and examination of staff training files it was established that all care staff have a National Vocational Qualification at level 2 or above. This practice is to be commended as it is over and above the 50 recommended by minimum standards. It was also established that Mr and Mrs Hall both have an NVQ Level 4 and are also A1, NVQ Assessors. Examination of staff records and discussion with Mrs Hall established that CRB and POVA (Protection of Vulnerable Adults List) checks are carried out before staff are employed. Mrs Hall went on to say that all staff receive informal supervision on a continual basis as the home is so small and they all work regularly together. The inspector acknowledged that staff may receive informal supervision, however, stressed the importance of planned, structured and recorded line management supervision for all staff. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 16 On the day of the inspection it was concluded that residents appeared to be happy , comfortable and that their personal needs were being met in a relaxed and unhurried manner. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 Residents’ benefit from living in a well run home and everyone including staff benefit from the leadership and management style adopted by the manager and owner. Residents do have the opportunity to comment on the way the home runs and on the quality of care it provides, however, the home is not good at showing others the good work that they do and how much residents influence what happens to them. EVIDENCE: Through observation and discussion with residents, care staff and Mr and Mrs Hall it was established that residents are perceived as part of an extended family and are involved in every aspect of the running of the home. Residents’ quality assurance questionnaires show that residents are asked on a regular basis their views on the quality of care provided by the home. Residents reviews also show that they have regular multidisciplinary meetings to discuss the support and care provided by the home. Mrs Hall said that she feels that there is a need to ask other people for example family, friends and healthcare professionals their views about the home. It was noted that the information
Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 18 gathered through the service users satisfaction questionnaires has yet to be collated and a report provided which reflects the outcomes for residents’ and any changes made to the way the home runs because of their comments. It was noted that the presentation of the care management and staff management systems in the home has improved by the use of IT (Information Technology) within the home for example the use of spreadsheets for staff rotas. It was also noted that residents case files appeared to be accurate, up to date and stored appropriately and securely. Staff training records show that staff have training in first aid, moving and handling and basic food hygiene. Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 19 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 2 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 2 X 3 3 x Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 20 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Timescale for action On this particular visit to the 14/02/06 home there was no failure to meet statutory requirements noted. Requirement 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 Refer to Standard YA1 YA5 Good Practice Recommendations The homes statement of purpose /service users guide should be updated and providing this in a more appropriate and accessible format should be considered Residents do have a contract issued by the local authority , however, the contracts should contain all the information recommended in the national Minimum Standards, standard 5.2 and the home may also consider providing this in an alternative more accessible format. The daily records would benefit from the use of descriptive words to reflect and show when residents make decisions about their day to day lives including any choices or preferences they may show. Although risk are identified in the integrated care management programmes they would benefit by been separated and made clearer as to the action to be taken to
DS0000006238.V283398.R01.S.doc Version 5.1 Page 21 3 YA7 4 YA9 Cartref Residential Care Home 5 6 YA16 YA22 minimise any risk to residents for example if someone needed to be supervised in the kitchen. The daily records would benefit from the use of descriptive words to reflect and indicate the preferences and choices expressed by residents on a daily basis. Residents may benefit by having the complaints procedure in a more appropriate and accessible format for example the use of pictures, symbols, audio tape. The service provider should ensure that a record is kept of staff that receive training in issues related to the homes speciality of learning disability At least six staff supervisions a year need to be formalised and a record maintained for inspection. The information gathered through residents questionnaires should be collated and a report provided reflecting residents views on the quality of care provided. The home should consider asking relatives , friends and other stakeholders for example social workers and day service staff their views on the quality of care provided by the home. 7 8 9 10 YA35 YA36 YA39 YA39 Cartref Residential Care Home DS0000006238.V283398.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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