Inspection on 13/07/06 for Cavendish House

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Cavendish House 11/03/09

Cavendish House 26/02/08

Cavendish House 18/03/06

Cavendish House 17/11/05

Cavendish House 18/03/05

Cavendish House 17/05/04

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Dystlegh Grange

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Springfield Cottage

Parkside

Park Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cavendish House Elizabeth Street Workington Cumbria CA14 4DA Lead Inspector Liz Kelley Unannounced Inspection 13th July 2006 9:30 Cavendish House DS0000036777.V291987.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 Cavendish House DS0000036777.V291987.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. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cavendish House Address Elizabeth Street Workington Cumbria CA14 4DA 01900 605280 01900 871107 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) www.cumbriacare.org.uk Cumbria Care Post Vacant Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 4 service users to include: up to 4 service users in the category of LD(Learning disability under 65 years of age) up to 4 service users in the category of LD(E) (Learning disability over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 18th March 2006 2. Date of last inspection Brief Description of the Service: Cavendish House is run by Cumbria Care and from the 1st April Cumbria Care came under the umbrella of Cumbria Social Services. A tender process has been completed for the respite service, and Thera North are the new providers organising the re-provision of the service. This is likely to be at a new location due to the unsuitability of the building. The home had previously been a large home for people with learning disabilities which has now been scaled down to provide 4 respite beds. Cavendish House is a two-storey building situated a short distance from the centre of Workington a town on the West Coast of Cumbria. The ground floor is used for the registered care home providing respite breaks for up to four people with a learning disability. There is stairs access between the two floors. The ground floor is comprised of a games room, lounge, dining room, large kitchen, reception area and office. Private bedrooms are situated away from the communal and kitchen areas. There are sufficient bathrooms and toilets and specialist bathing facilities are available. The first floor is used by Cumbria Care and Social Services as a base for domiciliary staff and office space for meetings. The current scale for charging is £501.81. A Service Users Guide is available for prospective residents, which includes a summary of the homes customer survey findings and details of how to get the latest Inspection report. All referrals and bookings are made through social services. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection where all the key standards were examined and included two visits to the home. On the first visit, 13/07/06, the manager was available to assist in the inspection and staff, resident’s records and administration files were examined. On the second visit 17/07/06 time was spent with service users to seek their experiences of using the service. Feedback cards had been received from residents, relatives and professionals. A tour of the building was carried out, and the home returned a questionnaire which included the latest details of the service. The Home has been operating as a four-bed respite facility since September 2004 and a completely new staff team has been formed. There is currently a vacancy for the mangers post, however in agreement with CSCI, the senior is covering until the reprovision process arranges a reconfigured staff team. What the service does well: What has improved since the last inspection? The home is able to be flexible to the needs of individuals and staffing levels change to make sure that each person’s needs are met during their stay. This was the case on this visit when two members of staff were on duty to support four service users. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 6 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. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 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 Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 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): 2, 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Service Users Guide is informative, and assists prospective service users in making an informed decision about staying at the Home. On occasions the needs of respite users is negatively affected by the use of Cavendish House as an emergency placement facility. EVIDENCE: Cavendish House has recently updated its Statement of Purpose and Service User Guide. These contain useful information for a person staying at the home. Details of the new provider, Thera North have been included. Service users are only admitted following a community care assessment and the majority of these are followed up with a home visit. One file examined detailed a series of visits for tea, for the day and building up to over night stays. The Home has recently had service users who have been using the respite facility for a number of months after being placed as an emergency due to lack of appropriate permanent housing. This has an impact on the homes main purpose to offer short-term respite breaks. The new facility will need to give consideration to how this is managed, without having a detrimental effect on other service users having to cancel and rearranged planned respite breaks. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 9 Consideration needs to be given to the compatibility of emergency placements and holiday respite users to determine if both groups of peoples needs can be met by one service. All admissions are managed by social services in consultation with the manager of the Home, to endeavour to ensure the appropriateness of each placement. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users felt confident that their needs could be met by having an individually tailored plan to help them enjoy their stay at the home. EVIDENCE: Each person has an individual plan based on social work assessments and on questionnaires of likes/dislikes, interests and daily routines which was sent out prior to a stay. These measures meant that staff had the most up-to-date information to ensure that each persons stay was both enjoyable and that basic needs are looked after in the way people would wish. The Home had developed a good set of documents and forms to be used with service users and their families. A recent addition made as a recommendation at a previous inspection had been the development of consent forms for administering medications and seeking emergency medical attention, this had included emergency contact telephone numbers. The individual plans included risk assessments and the home had sought advice from appropriate professionals. The staff have been up-dating these Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 11 plans to ensure they have, for example a recent photograph and detail of interests and hobbies. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While staff endeavour to offer service users opportunities to be more independent this is hampered by the institutional nature of the building. While services users expressed that trips out were a positive feature of their stay, the activities within the home are limited and could be more interesting. The meals in the home are of a good quality offering both choice and variety, and cater for special dietary needs. EVIDENCE: The building is institutional in appearance and feels too large for its present purpose. For example the kitchen is designed for large scale catering and the communal room is very large and unwelcoming. This has a knock-on effect to the style of care delivered and service users are often “looked after” rather than trying to encourage development of new skills. Again, for example staff mostly use the kitchen to cook meals for everybody. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 13 Menus were examined and found to be well balanced and healthy; and service users questionnaires all stated that they enjoyed the meals. Menus are planned with residents on a weekly basis and a communal evening meal is encouraged. Food cupboards and freezers contained good quality food such as lean meat, and numerous fresh vegetables and fruit. Four out of five feedback cards returned from service users felt that activities in the home could be improved. One said “only colouring books available”. The home should look at its resources and seek views from service users on meaningful activities that could take place during their stay. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 14 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems have been developed to monitor individual’s health and medication. Established links with local health care professionals ensure residents receive effective and timely health care. EVIDENCE: The home does not have overall responsibility for managing healthcare but does monitor health across a person’s stay. The home had relevant contact details of GPs and details on medical conditions, and medications. Staff have a good understanding of residents healthcare needs. The staff team work positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain good health during their stay. Records on healthcare needs are well maintained and kept up-to-date, these are linked to care plans to alert staff on any changes, and include monitoring sheets for specific issues. The home works to an efficient Medication Policy supported by procedures and practice guidelines. Staff follow robust systems to make sure that medication Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 15 records are fully completed, contain required entries and are signed by staff. Staff have received basic awareness training in the care of medicines. For each stay a new information sheet is completed requesting details on changes in medication or any change in health. These systems have been strengthened recently after a medication error and now medications are checked by two staff against the original package. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have good knowledge and understanding of Adult Protection issues which protects residents from abuse. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. EVIDENCE: Staff had received training in the use of physical intervention procedures, which focused on diversion tactics. Physical restraints were not used. The home had polices and practices that safe guarded the handling of residents monies. Personal monies and records were examined and found to be correct, with the signatures of both staff and the resident. The atmosphere developed in the home encourages open discussion and expression of views. These areas, and training in Adult Protection safeguard residents from abuse. The Home had a complaints procedure, with a response time of 28 days. A system was in place to record all complaints. All service users had a copy of the complaints procedure, and details of how to complain were posted in the home and was available in different formats. Up-to-date information about the Commission for Social Care Inspection was included. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. The Home is not designed for respite stays, and is therefore not ideal for its current use. If it were to be used long-term it would require considerable adaptation and investment to change both the layout and to up-grade the property. Staff do a good job keeping the home was clean, tidy and hygienic. EVIDENCE: As a temporary solution the building is a satisfactory stopgap. The relocation is anticipated to take 12-18 months and in the meantime the building is safely maintained with all the necessary repairs and annual safety checks being carried out. The care staff are responsible for the cleaning of the home and this was done to high standards. Cleaning rotas were examined which included the kitchen areas which were in good detail and records were up-to-date. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well-trained and have the skills to support people with a learning disability. The recruitment practices of the organisation and the home ensure that residents are safeguarded and that staff have the qualities and aptitudes to work in social care. EVIDENCE: The numbers of staff on duty have recently been improved and this has allowed more opportunities for residents to go out or to spend more time with staff doing individual activities. A sample of staff files were examined and these contained all the relevant documentation and were clearly sectioned and well-organised. The selection procedure includes obtaining two written references, and a formal interview. All staff have CRB enhanced disclosure checks, and the supervisor was aware of extra precautions to be put in place when recruiting using POVA 1st. These records are held in accordance with the organisations policy. The Home does not use temporary or other employment agency staff. Appointments were subject to a six-month probationary period. Staff had thorough job descriptions and were, therefore when interviewed, clear on their roles and responsibilities. Staff handbooks were issued on Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 19 employment, which included important policies and key contacts and the General Social Care Council code of conduct is also issued to all staff. All staff undergo Learning Disability Awards Framework induction programme, and specialist training is sourced to assist staff in meeting the individual needs of service users. This ensures that training is targeted and focussed on improving outcomes for service users. The Home has more than 50 of staff qualified in NVQ level 2 in Care, 3 staff have progressed onto the Level3 and the supervisor is undertaking level 4. Staff have recently completed a number of short courses on the Safe Handling of Medication and health related issues. The supervisor is aware that staff supervisions need to be on a more regular basis. Due to providing additional support to one service user recently this has had a knock on effect to the time available for supervision. However team appraisals were held to discuss important issues. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 20 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is currently operating without a manager. However, suitable temporary measures are in place to ensure that service users staying here benefit from a well-run service. EVIDENCE: The senior has managed the Home recently in the absence of a manager and has provided the home with continuity and in particular ensured all administration of the home is up-to-date. She reported that she had been well supported by the management of the organisation. Fire Records, annual gas and electrical checks, and servicing of hoists were all checked and these were all up-to-date. The home had effective systems in place to ensure the safety and up keep of the physical environment, such as cleaning rotas and maintenance records. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 21 The administrative systems within the home were found to be up-to-date and in good order, ensuring the home was run in an efficient and effective manner. Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 22 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 x 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 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 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x 3 x Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 23 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 YA14 Regulation 16 Requirement The home must consult with service users with a view to improving the range of activities available Staff supervision sessions must be held on a regular basis. Timescale for action 31/08/06 2 YA36 18 31/08/06 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 YA3 YA21 Good Practice Recommendations Consideration needs to be given to the compatibility of emergency placements and holiday respite users Staff should receive training and increase their understanding of old age as it affects people with a learning disability Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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 Cavendish House DS0000036777.V291987.R01.S.doc Version 5.2 Page 25 - 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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