CARE HOME ADULTS 18-65
Charles Court Northfields Strensall York YO32 5XP Lead Inspector
Jean Dobbin Unannounced Inspection 14th March 2006 09:45 Charles Court DS0000015792.V281834.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 Charles Court DS0000015792.V281834.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. Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Charles Court Address Northfields Strensall York YO32 5XP 01904 491589 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) Joseph Rowntree Housing Trust Anthony Egan Care Home 15 Category(ies) of Learning disability (15), Learning disability over registration, with number 65 years of age (3) of places Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The number of service users over the age of 65 should not exceed 3 at any one time. The category LD (E) is only for use by current service users who have reached 65 and above whose needs can still be met by the home. 15th November 2005 Date of last inspection Brief Description of the Service: Charles Court is a purpose built single storey care home jointly managed by the Joseph Rowntree Housing Trust and the York Mencap Hostels Association, which provides long-term residential care for fifteen people with learning disabilities three of which may be over 65.The home has one respite place. The home is situated in the large village of Strensall, five miles north of York, and is within easy walking distance of a range of facilities, which include shops, pubs and community centres. A regular bus service operates between the village and York city centre. Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This summary relates to an unannounced visit on Tuesday 14th March 2006. The inspection lasted more than four hours, including preparation time. The manager was not present, however feedback was provided to the senior carer on duty, and a telephoned discussion was held with the manager several days later. The Registered Individual was present for part of the visit. Some residents’ files were looked at to see how individual needs are assessed and the recruitment files of the latest two employees were examined. The medication systems within the home and the Accident book were also looked at. A tour of the home was carried out, and there was the opportunity to observe staff interacting with residents. (Most residents were at home because of the severe weather that day, which meant that the planned events had been cancelled.) A number of residents and a visiting community nurse were spoken with during the visit. What the service does well:
Staff and residents work together to ensure the smooth running of the home. Residents are supported in maintaining their independence and making decisions about their lifestyle in a very informal and natural way. They are integrated into the local community attending a variety of work placements, day centres and community groups. Social events are an important part of the calendar and on the day of the visit three residents were travelling to London to stay over, see the sights and attend a show. One resident said that she liked living there and was always very busy. She was looking forward to going away soon. The bedrooms are all very different, having been personalised according to the residents’ preferences. A small number of the residents require more assistance with their care, and this care is provided appropriately with support and guidance from external professionals. Indeed the community nurse was present for part of the visit, and she was extremely complementary about the standard of care and the appropriateness of the referrals. There is adequate specialist equipment to ensure care is given safely. Staff are supported in attending a wide range of study sessions to provide the knowledge and skills to care for the residents. The individual daybooks are completed by all members of staff, and provide good information about the care provided. Charles Court DS0000015792.V281834.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.
Charles Court DS0000015792.V281834.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 Charles Court DS0000015792.V281834.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): None EVIDENCE: Charles Court DS0000015792.V281834.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): None EVIDENCE: Charles Court DS0000015792.V281834.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): None EVIDENCE: Charles Court DS0000015792.V281834.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): 18,19,20 Service files record how residents prefer to be supported, though some risk assessments need reviewing, and there are robust systems in place to store, record and administer medications within the home. EVIDENCE: Two service files were examined during the inspection. The documentation is generally of a very good standard with information gained from a number of sources. Each resident has an individual record book, where day-to-day routines are recorded. One file was specifically chosen to confirm that a previous requirement has been met. Both service files require a review of their risk assessments relating to moving and handling. The second resident has complex needs and should have risk assessments in place for the use of the hoist, bed rails, use of a restraining belt in the chair, and assessment for their inability to use the call bell when in bed. This will enable staff to provide consistent care, and ensure residents are not put at risk by poor practice. Both residents have visits from outside professionals recorded briefly in their file, as well as more detailed information in their daybook. The management should keep a chronological record in the service files of all contacts with external professionals, with the outcome of each consultation clearly documented. This is a more systematic method of recording these visits, will be easier to access and ensure residents’ health needs are recorded in a consistent manner. This was a requirement from the last inspection.
Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 12 No residents look after their own medication. Charles Court uses the ‘Medication Dosage System’ and the record sheets examined were all signed, with reasons for omissions appropriately completed. Some medication has to be dispensed from individual boxes and these are counted and recorded when delivered to the home. There is however no regular audit of these drugs to ensure the number of tablets stored, correlates with the number on the MAR sheet. Current practice means that it would be extremely difficult to explain any anomalies. Items requiring cold storage are stored in a locked box on a high shelf within the main fridge in the kitchen. The fridge temperature is monitored daily, however the temperature has been recorded as high as 11°C, as the fridge door is frequently opened. Two items in the box were no longer in use and were removed. A separate small fridge would mean that resident’s medication could be stored safely at a more constant temperature. Charles Court DS0000015792.V281834.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 Residents’ complaints will be listened to, and investigated appropriately. EVIDENCE: There have been no complaints at Charles Court since the last inspection. There is a complaints policy within the home and residents spoken with said that they would tell a member of staff if they were unhappy about anything. There are regular residents’ meetings, with a staff meeting taking place the following day, so that concerns, if appropriate, can be discussed in that forum. Residents can feel confident that staff will listen to what they have to say. Charles Court DS0000015792.V281834.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): None EVIDENCE: Charles Court DS0000015792.V281834.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): 34,35 There are recruitment policies in place to protect the resident, but these have not been followed. There are excellent varied training opportunities available for the staff. EVIDENCE: The recruitment files of the two latest employees were examined. One file demonstrated that all checks had been completed prior to them starting work. The second file contained only one reference. The CRB was issued in February, yet the employee started work in early January. There is no evidence that a POVAfirst check was requested. New staff must not start work until statutory checks are completed to ensure residents are not being put at risk. There is a clear training plan with members of staff allocated to attend specific events. These include sessions related to the care provided, such as Continence training and Abuse Awareness, as well as social support such as Craft Inspirations and Basic Signing. There is well-established induction training for new staff. Residents can be confident that staff are supported in gaining the skills and knowledge required to care for them. Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 16 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): 42 Recognised and familiar health and safety policies need to be adhered to at all times. EVIDENCE: Standard 42 was not fully inspected however during the visit it was noted that a member of staff who was cleaning, had left a cupboard unlocked, and not even closed properly, where substances hazardous to health (COSHH) were stored. The staff member was not nearby. Staff must ensure that these rooms are kept locked to be certain that residents are not put at risk. The games room, which also contains a snooker table, smelled of cigarette smoke. On enquiring, the room, which has no extractor fan, is also used as a smoking area for staff. The management should look at this policy and whether this practice needs changing so that the room provides a better environment for the residents. Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 17 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 X 4 X 5 X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X X X X X X 1 X Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 18 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 YA18 Regulation 13.4c, 13.8 Requirement Risk assessments must be incorporated into the care plan, which explain a) the need for equipment, which restricts the movement of the resident. b) the need for bed rails c) support of residents unable to use the call bell when in bed. Timescale for action 10/04/06 2. YA34 19.1b 3. YA42 13.4c Records must be kept as evidence that bed rails have been checked on a regular basis to ensure that they are safely fitted. From the time of the next 14/03/06 employment, and thereafter, all staff must have two references. A POVAfirst check must be carried out prior to starting work, if the manager is unable to wait for the CRB clearance. Areas where hazardous 14/03/06 substances are stored must be kept locked at all times Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 19 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 YA19 YA20 YA42 Good Practice Recommendations The management should maintain a chronological record of all contacts with external professionals in the service file, which will ensure clarity and continuity. The management should consider counting and recording, regularly, the quantity of tablets in boxes to check that the expected totals agree with the actual totals. The smoking policy for staff should be reviewed to determine if the present practice adversely affects residents’ lives. Charles Court DS0000015792.V281834.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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