CARE HOME ADULTS 18-65
Cavendish House Elizabeth Street Workington Cumbria CA14 4DA Lead Inspector
Liz Kelley Unannounced Inspection 18th March 2006 10:00 Cavendish House DS0000036777.V284172.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 Cavendish House DS0000036777.V284172.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. Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 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 Ms Jacquelin Reed 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.V284172.R01.S.doc Version 5.1 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. 17th November 2005 2. Date of last inspection Brief Description of the Service: Cavendish House is run by Cumbria Care and from the 1st April Cumbria Care will come under the umbrella of Cumbria Social Services. A tender process has begun for the respite service, and the organisation, location and building is highly likely to change in the next 12 to 18 months. 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. Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. 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 the senior is covering until the tender process has been completed. This inspection took place over 3 hours, across a Sunday morning. Three service users were spoken to and were having a leisurely morning, getting up a bit later and having a bath before a full cooked Sunday dinner. A full tour of the premises took place and administration files and service users files were examined. Earlier in the year service users, relatives, and professionals returned a questionnaire on their experience of Cavendish House. What the service does well: What has improved since the last inspection? What they could do better:
The issues on the building remain the same. The use of Cavendish House is a temporary measure while all options are explored to provide for the future of respite provision in the area. This means that although some measures have been put in place to improve the building, this has been limited due to the uncertainty. The building, therefore, remains rather institutional in appearance
Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 6 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. The general decoration of the building is now looking worn and dated. The Home currently has two 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. 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. 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.V284172.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 Cavendish House DS0000036777.V284172.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): 3 The needs of respite users is sometimes negatively affected by the use of Cavendish House as an emergency placement facility. EVIDENCE: The Home currently has two 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. 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. Cavendish House DS0000036777.V284172.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): 9 While staff endeavour to offer service users opportunities to be more independent this is hampered by the institutional nature of the building. EVIDENCE: As mentioned previously the building is not conducive to a more independent style of living. Obviously the providers are fully aware, as this is one of the reasons for seeking a redeveloped respite service. Staff have received training in promoting independence skills. Through the Learning Disability Awards Framework Induction and a number of staff are also taking NVQ level 3 in Promoting Independence. The staff group, who will be transferring to the new setting, were judged to have the skills and competence to work with people with learning disabilities in supporting them to have lifestyles that are fulfilling and manage any associated risks. Cavendish House DS0000036777.V284172.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): 15 Service users are offered a varied range of activities and staff are good at supporting service users to make choices. EVIDENCE: The majority of placements offered were weekend breaks or breaks of up to a week. While staying at the home service user were encouraged to maintain their usual social activities, if this is possible. Other activities noted in care notes and discussed with service users were rentals of videos and DVDs, visits to cafes, pubs, take-aways, and playing pool. The atmosphere within the home was observed to be relaxed and friendly with both staff and service users having friendly conversations that were warm and open. The atmosphere within the home was observed to be relaxed and friendly with both staff and service users having friendly conversations that were warm, respectful, and supportive. Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 11 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): 20 and 21 Service users physical and emotional health needs are well met during their stay at the home. EVIDENCE: The home does not have overall responsibility for managing healthcare but it does monitor health across service users stay. Medications in the home are well managed and effective systems have been developed for the recording and safe handling 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. The Home is now registered to include service users over 65 years of age and consideration needs to be given to appropriate training for staff in issues relating to old age, in order to continue to offer a good service to this group. Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 12 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 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.V284172.R01.S.doc Version 5.1 Page 13 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 Staff do a good job keeping the home was clean, tidy and hygienic. EVIDENCE: 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. The relocation is anticipated to take 12-18 months and in the meantime emergency repairs are being attended to. The home should include the reprovision and proposals in its Statement of Purpose and Service users Guide to inform new users of the service o these plans. Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 14 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): 34 The Home followed a thorough recruitment procedure which safeguards and promotes the welfare of service users. EVIDENCE: 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. The Home does not use temporary or other employment agency staff. Appointments were subject to a six-month probationary period, and regular supervision sessions are given to staff at all levels. Staff surveys also indicated high levels of job satisfaction with regular and effective supervision. Staff had clear and thorough job descriptions and were, therefore when interviewed, clear on their roles and responsibilities. Staff handbooks were issued on employment, which included important policies and key contacts and the General Social Care Council code of conduct is also issued to all staff. A relief member of staff was spoken to and they confirmed the recruitment procedure and said they were part way through a Learning and Disability Awards framework Induction course, and had been given a thorough introduction to the Home. This had made this person feel confident and competent in delivery a good service. Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 15 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 and 42 Good systems are in place to ensure the well-being and safety of those who stay and work at Cavendish House. EVIDENCE: The senior had managed the Home recently through the absence of the manager and had provided the home with continuity and in particular had ensured all the administration of the home was maintained and up-to-date. The senior, who has run the home in the manager’s absence, said 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. 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.V284172.R01.S.doc Version 5.1 Page 16 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 X 3 2 4 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 2 2 X X X X 3 X Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 17 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA3 YA24 YA21 Good Practice Recommendations Consideration needs to be given to the compatibility of emergency placements and holiday respite users The homes Statement of Purpose and Service users Guide should inform of the proposed change to the provision and how this affects the building Staff should receive training and increase their understanding of old age as it affects people with a learning disability Cavendish House DS0000036777.V284172.R01.S.doc Version 5.1 Page 18 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
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