Inspection on 17/01/06 for Chapel Lane, 4

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Chapel Lane, 4 23/08/06

Chapel Lane, 4 10/05/05

Chapel Lane, 4 17/11/04

Chapel Lane, 4 10/06/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Chapel Lane, 4 4 Chapel Lane Monkseaton Whitley Bay Tyne And Wear NE25 8AD Lead Inspector Anne Brown Unannounced Inspection 17th January 2006 12.10 Chapel Lane, 4 DS0000000351.V275976.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 Chapel Lane, 4 DS0000000351.V275976.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. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chapel Lane, 4 Address 4 Chapel Lane Monkseaton Whitley Bay Tyne And Wear NE25 8AD 0191 2518734 0191 2518734 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.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Miss Sylvia France McKenzie Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Chapel Lane was built within the last few years to provide a home for up to six adults who have a learning disability and who need residential care. Nursing care is not provided. The home is within walking distance of local shops, pubs and transport networks. The house is detached and has three storeys. The home provides single bedrooms on the ground and first floor. One room has en suite facilities. The staff facilities are located on the second floor. There are a suitable number of bathrooms and toilets. A yard is available to the rear of the building and a small paved garden area to the front. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over three and a half hours. A tour of the premises took place and a sample of care records was inspected. The fire logbook, accident book, complaints book and minutes of meetings were also examined. Two members of staff were on duty and all four residents were spoken to. There are two vacant beds in the home at the present time. What the service does well: What has improved since the last inspection? The service user guide has been expanded to provide a clear description of the service and relevant qualifications and experience of the management and staff team. The staff team have all undergone training on the protection of vulnerable adults. The staffing levels have been reviewed and a post for a 20-hour per week home support worker is currently being advertised. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 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. Chapel Lane, 4 DS0000000351.V275976.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 Chapel Lane, 4 DS0000000351.V275976.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, 3 and 4 Prospective residents are provided with information to make an informed choice about whether they would like to live in the home. Prospective residents are able to visit the home and assess whether their individual needs can be met. EVIDENCE: The service user guide has recently been reviewed and expanded to include a clear description of the people for whom the service is intended. Details of relevant qualifications and experience of the management and staff team are also included. Since the last inspection two residents have moved out of the home to live in independent accommodation. Two prospective residents have been visiting the home to assess whether they would like to move in. They have been able to spend time with the current residents. They have enjoyed a meal in the home and have stayed overnight. They have also been given a copy of the service user guide to help them make a decision. Chapel Lane, 4 DS0000000351.V275976.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. The content of the care plans continues to improve. Residents’ individual needs are recorded along with their personal goals. Residents can make decisions about their lives and are able to participate in the day-to-day running of the home. They are supported to take risks to help them lead an independent lifestyle. EVIDENCE: The care records were examined and contained information on personal goals and guidelines to ensure residents are encouraged to become independent. Two residents had signed their care plan and there was evidence to show that residents are invited to review meetings. Some documents were not dated and there was no evidence of monthly evaluations being carried out. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 10 The residents confirmed that they are involved in the running of the home. They stated they helped with household chores and two are able to travel alone to various venues. Two residents are able to stay in the home alone from time to time following an assessment of their skills and risks involved. All residents are encouraged to clean their own bedrooms, do their own washing and a rota is produced to cover housework tasks in the communal areas. Menus are discussed and planned with the residents on a monthly basis. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 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 the following standard(s): 12, 13 and 14. Residents are supported by the staff team to lead fulfilling lives and access activities in the local community. Advice is given to help residents obtain work and college courses. EVIDENCE: A member of staff confirmed that residents are given information and good support to find suitable employment or college courses. Two residents confirmed this. Each resident has an individual programme for personal development and leisure activities. The residents confirmed that they enjoyed a wide range of activities such as keep fit, bowling, shopping, visiting pubs and attending college courses. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 12 All residents have enjoyed holidays in this country during the last few months and two residents have visited Spain. Family and friends are made welcome in the home and the staff support residents to visit their families in the community. During the inspection two residents were discussing the venues they would like to visit during the weekend. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 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 the following standard(s): 19 and 20. Residents are given advice and support with regard to health and emotional needs, which ensures they maintain good health and wellbeing. A suitable system is in place for dealing with medications. EVIDENCE: There was evidence in the case files to confirm that residents have access to GPs, dentist, opticians and other health care professionals. The storage system for medications is suitable. A sample of medications and records was examined and was in accordance with the pharmacy guidelines. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 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 the following standard(s): 22 and 23 The home has a satisfactory complaints system in place. Staff receive training in adult protection to help protect residents from abuse. EVIDENCE: The complaints book was examined and no complaints have been received since the last inspection. Two residents confirmed that they would discuss any concerns they may have with a member of the staff team. Since the last inspection all staff members have attended training on the protection of vulnerable adults at Care Ponteland. Comprehensive policies and procedures are in place to ensure the residents are protected from all forms of abuse. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 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 the following standard(s): 24 and 25. The standards of the facilities and décor within the home is good, providing residents with an attractive and homely place to live. Bedrooms are personalised and provide the residents with the necessary facilities. EVIDENCE: The house is comfortably furnished, well equipped and well maintained. All areas were observed to be clean and hygienic. Service users confirmed that they are consulted about the décor and furnishings. Each resident has her own room that shows evidence of her individual taste and interests. Redecoration is currently taking place and one resident is moving to a vacant bedroom, as it is more suitable to their personal needs. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 16 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, 35 and 36. Minimum staffing levels are met. The staff team receive appropriate training and are well supported and supervised. EVIDENCE: On the day of the inspection two members of staff were on duty. The assistant manager confirmed that since the last inspection, staffing levels had been reviewed. A vacancy for a home support worker (20 hours per week) is currently being advertised. The assistant manager confirmed that mandatory health and safety training for all staff is up to date. Three members of staff have completed NVQ Level 3. One staff member has completed LDAF training and another member is currently undergoing this. The staff members on duty confirmed that they receive regular supervision sessions. The written copies were not available for inspection as the manager was not present during the inspection. The residents confirmed that they enjoyed good relationships with the staff team. Chapel Lane, 4 DS0000000351.V275976.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): 39 and 42. The residents benefit from a well run home and staff encourage them to express opinions. Health and safety of the residents is promoted by well-trained staff and appropriate risk assessments are in place. EVIDENCE: Meetings are held to consult service users about all aspects of the day-to-day running of the home and this information is recorded in minutes of meetings. The last meeting was held on 14/11/05. The previous meeting was held six months ago. An agenda is placed on the notice board so all residents can add items to be discussed. Minutes of the last meeting are not part of the agenda to ensure all issues are followed up. The staff receive regular training in health and safety issues and all accidents are recorded and monitored on a monthly basis. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 18 The fire logbook was examined and all necessary tests were up to date. Fire instruction provided to staff is out of date. Regular checks are carried out and recorded for water, fridge and freezer temperatures. Chapel Lane, 4 DS0000000351.V275976.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 3 2 X 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 3 25 3 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X X X 2 X X 2 X Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 20 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 2 Standard YA6 YA42 Regulation 15(1) 23(4(e) Requirement Care plans should be updated and evaluated on a monthly basis. Fire instruction for staff to be updated. Timescale for action 28/01/06 31/01/06 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 Refer to Standard YA39 Good Practice Recommendations House meetings to be held on a monthly basis and minutes of the last meeting added to the agenda. Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Chapel Lane, 4 DS0000000351.V275976.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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