Inspection on 27/09/05 for Cloughside

This inspection was carried out on 27th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cloughside 08/10/07

Cloughside 20/09/06

Cloughside 17/02/06

Cloughside 11/03/05

Cloughside 14/10/04

Cloughside 04/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood Hall

Muston Road (70)

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

CARE HOME ADULTS 18-65 Cloughside Cloughside House Winterbutlee Road Walsden Todmorden Lancashire OL14 7QJ Lead Inspector Lynda Jones Unannounced Inspection 27th September 2005 10:30 Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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 Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cloughside Address 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) Cloughside House Winterbutlee Road Walsden Todmorden Lancashire OL14 7QJ 01706 819493 St Anne`s Community Services Mr Ewan Haswell Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th March 2005 Brief Description of the Service: Cloughside Care Home offers 24 hour nursing and personal care to 7 adults with learning disabilities. The home is operated by St Anne’s Shelter and Housing Action. Accommodation consists of 7 single bedrooms, an upstairs bathroom/ shower/ WC, a ground floor bathroom/ WC, and separate WC, a lounge, dining room, kitchen, staff office and basement laundry. Externally there are fenced gardens to the front and rear of the property. Local shops are within approximately 15 minutes walking distance, and there is easy access to the local towns of Todmorden and Littleborough by bus and train. The bus stop and train stations are two minutes walk from the home. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted by two inspectors over a five-hour period. This was the first time both inspectors had visited Cloughside As part of this inspection, a tour of the premises was conducted and care records were examined. Discussion took place with the person in charge of the shift about the service provided. The shift leader was a deputy manager from another St Anne’s home who was temporarily seconded to Cloughside. During the course of the day the registered manager of Cloughside called at the home briefly. He was not on duty but his visit allowed some discussion to take place on the homes seclusion policy. The home provides nursing care to people with severe to profound learning disabilities who have associated challenging behaviours and seclusion is sometimes used. Due to the service users complex needs, discussion with the inspectors was limited. What the service does well: What has improved since the last inspection? Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 6 This was the inspectors’ first visit to the home. 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. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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 Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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 of these standards were assessed on this inspection. EVIDENCE: Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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): 6,10. The management of challenging behaviour is not always consistent. Records regarding the use of seclusion and physical intervention do not contain sufficient detail. There is insufficient evidence in the records to show that deescalation techniques are routinely used. EVIDENCE: Inspectors were informed that seclusion is used in respect of some service users, although it was unclear how many individuals this applied to. It was reported that there was a policy regarding the use of seclusion, which was said to be reviewed annually. In addition staff reported that a multidisciplinary team meets quarterly to review the use of seclusion. Whenever seclusion is used the details are reported to St Anne’s head office. Unfortunately the staff member assisting with the inspection was unable to locate the current seclusion or physical intervention guidelines for the service users whose records were examined as part of the inspection. Some records that were examined were not sufficiently detailed. Evidence indicated that the management of challenging behaviour is not always Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 10 consistent. For example, the point at which seclusion ended was often unclear and appeared to be determined by individual staff. Records suggest that the amount of time that service users were quiet and calm before seclusion ceased could range from 10 to 20 minutes. In some recording there was no reference to a quiet period preceding the end of seclusion, other records did not clearly indicate when seclusion started. There was some variation in the amount of detail that staff recorded. The records did not always give details of events leading up to the incidents, which resulted in the need for physical intervention. On some records it was not possible to tell where the incidents took place, who was present and how incidents were resolved. There was no information available to indicate whether staff had received any debriefing following the use of physical intervention. Inspectors found little evidence in records to show that de-escalation techniques had been used prior to seclusion. From the minutes of the last multidisciplinary meeting, when the use of seclusion was reviewed, it had been noted that there had been insufficient information in the records regarding the use of de-escalation techniques. In order to protect service users from harm it is essential that clear, agreed guidance is available to staff about the management of challenging behaviour. It is recommended that the guidance is reviewed in line with standard 6.5 of the National Minimum Standards; ‘The plan establishes individualised procedures for service users likely to be aggressive or cause harm or self harm, focusing on positive behaviours, ability and willingness’. Guidelines on the use of physical intervention and seclusion must be in line with Department of Health guidance. The organisation’s policies and practice in both of these areas must be urgently reviewed. It was disappointing to see service user specific information displayed in communal areas. Notices on the doors of kitchen units displayed information about some service users’ dietary requirements. This information could be communicated in a more sensitive manner. This practice should be reviewed. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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): 13,14,15,16 The staff support service users to go out regularly to take part in leisure activities. The use of view holes in some of the doors impinges on service users rights to privacy and dignity. EVIDENCE: Staff reported that they have a number of hours designated each week specifically to support people in taking part in leisure activities. The records indicated that people go out regularly. Activities took place on the day of the inspection and service users went out individually with members of the staff team. The home has access to its own transport in the form of two people carriers; staff reported that two individuals are supported to use public transport. Staff said that service users accessed community based activities and use a range of facilities that are available in the locality. This was supported by evidence in the records. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 12 Staff reported that they had good links with the families of service users and that they support and encourage service users to maintain their relationships with their family and friends. A number of restrictions are placed upon service users at Cloughside due to the nature of some behaviour displayed. Inspectors were concerned to find that during seclusion, some service users are at times locked in their bedrooms, as a way of staff managing challenging behaviours. View holes have been installed in some bedrooms. The manager reported that this was to enable staff to monitor service users when they were secluded in these areas. In order to protect the privacy and dignity of service users at times when they are using their bedrooms and not being secluded, the provider needs to explore how views holes could be covered over when not in use. The use of view holes needs to be agreed within the individual service user plans and a risk assessment completed in order to ensure the protection of individuals. The provider should also have a plan about how such restrictive practice might be reduced in the future. The house is large enough for people to have their own personal space. During the course of the day it was noted that service users were able to choose when to spend time alone or in the company of others. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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): 19,20 Health care issues are dealt with thoughtfully and sensitively by staff. Guidelines for administering PRN (as required) medication need to be more detailed. EVIDENCE: One service user was due to attend a hospital appointment on the day of the inspection. In preparation for the appointment he was required to refrain from eating and drinking. All of the staff on duty dealt with this in a caring, sensitive manner. Plans had been made for other service users to go out to lunch to avoid him getting upset if he saw others eating. No cooking took place in the morning to avoid the smell of food and staff constantly checked with him to make sure he was feeling OK. For the past eight months one service user has required dialysis four times each day. Staff reported that they worked closely with staff from Leeds Renal Unit in order to prepare for this taking place within the home. Staff had been provided with information, training sessions and support from the renal nurse linked with the home. Staff indicated that they were in the process of changing the layout of the room where the treatment took place following a recent risk assessment. This whole issue appears to have been has been dealt with both thoughtfully and sensitively. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 14 It was noted that the bathrooms and toilets were not equipped with toilet paper, towels or soap. Inspectors were informed that this was because one service user would destroy or remove these items. The manager said that this situation was under constant review. Staff need to ensure that this does not impact upon the privacy, dignity and independence of other service users. Guidelines for the use of PRN (as required) medication should be included in individual behavioural management plans. There was no evidence in the records to show that this was taking place. The guidelines must give clear instructions about when PRN medication should be used. Behaviours should be described in adequate detail. Describing behaviour as ‘heightened anxiety’ is not adequate as this is could be interpreted differently by members of the team. Another record indicated that PRN medication could be administered when “intimidating and threatening behaviour is displayed”, this is also open to interpretation. Inspectors were told that there were concerns regarding a particular service user, who it was felt could be displaying some behaviour in order to be given a sedative. No record had been made of these concerns and no risk assessment had been completed regarding this. A member of staff said that this information had been passed on verbally amongst the staff team. PRN medication that was checked was found to balance with what was recorded on the administration records. Inspectors noted that instructions about when to give PRN medication to one service user had been changed from 3 tablets allowed in a 7 day period to 1 tablet allowed every day . It was unclear who had authorised the change, as this was not in line with the prescribing instruction. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 15 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): 23 Service users are not always adequately protected from potential harm or abuse. EVIDENCE: There is an adult protection procedure in place, which includes a whistle blowing procedure. This is in addition to the Calderdale vulnerable adult procedures. St Anne’s have a comprehensive physical intervention policy and procedure that is in line with Department of Health guidance. From the records examined, it was noted that practice in respect of physical intervention does not reflect the policy and procedure Physical intervention and seclusion is used at this home. Records in respect of this practice were unsatisfactory. Insufficient detail was recorded on physical intervention records. Seclusion is being used in circumstances other than in emergencies as described in the Department of Health Guidance. Guidance for staff about when to use physical intervention or seclusion were either not available or unclear. Inspectors were concerned that this does not adequately protect the service users from possible harm. Inspectors were also concerned about the high numbers of accidents/incidents that had occurred in the home during recent months. Monthly reports sent to CSCI by the service manager for St Anne’s for June 2005 indicated that there had been a high number of incidents/accidents to both staff and service users in June 2005 but that number had fallen significantly in July 2005. This area will be monitored by inspectors. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 16 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): 24,27,28,30 Service users live in a clean, pleasantly furnished home. Each person has their own bedroom. A range of comfortable shared space is also available. EVIDENCE: A tour of the building took place. The shared areas were noted to be clean and comfortably furnished. The house is large enough for people to have their own personal space and to be able to spend time alone if they wish. Some of the wallpaper had been ripped off at the top of the stairs. The landing light was not working and there was a strong smell of urine in this area. The manager indicated that the carpet would be replaced. There was evidence of personal possessions in some of the bedrooms. Some bedrooms were furnished with very little. Staff said that this was to create a low arousal environment. Inspectors questioned the need for the small notices in some of the bedrooms; these appeared to be there to serve as reminders for staff. Creams that were found in the bathroom cabinet were not labelled to show who they were to be used by. A bar of soap left on the bath appeared to be for communal use. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 17 The manager said that plans were in hand to replace the shower room on the first floor with a wet room. This will be a positive improvement for service users. According to staff, a communication board that had been used for one service user to help him to make sense of what was happening next, was not now being used properly. This was said to be because another individual kept going into his bedroom and removing the photographs off the board. The manager must explore how this can be resolved in order that this individual’s communication needs can be met. Staff reported that all parts of the house had to withstand some heavy wear and tear and there was often a long list of repairs that were required. These were dealt with through St Anne’s maintenance division in Leeds. The staff felt that the one planned maintenance visit each month was sometimes insufficient to keep pace with the need for repairs. Inspectors were informed that in recent months there had been an escalation in the number of repairs that had been required. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 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 There is a stable staff team at the home, who know the service users very well. It is unlikely that the NVQ target will be met by the end of 2005. EVIDENCE: The majority of staff working at Cloughside have been employed there for a number of years. Staff report that as a rule they do not need to use many agency staff. Gaps on the rota are usually covered by staff working additional hours or by staff from another St Annes home. This helps to ensure that service users are familiar with staff and vice versa, it should also ensure that care and support are delivered with some consistency. Inspectors were concerned to note that the target of 50 of staff achieving NVQ 2 by end of 2005 will not be met. This was reported to be due to staff not having had sufficient time to make progress on NVQ work because they had been dealing with an unsettled period at Cloughside, due to the behavioural difficulties of some service users living at the home. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 19 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): 41 Record keeping in respect of service users needs to improve. EVIDENCE: Service user records required by regulation were not all up to date. This has been discussed earlier in the report. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X x Standard No 22 23 Score x 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 X X x 1 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 1 3 x 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 3 16 1 17 Standard No 31 32 33 34 35 36 Score X 2 X X X x CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cloughside Score X 3 1 x Standard No 37 38 39 40 41 42 43 Score X X X X 1 X x DS0000001048.V265511.R02.S.doc Version 5.0 Page 21 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 YA16YA6 YA41 Regulation Requirement Timescale for action 31/01/06 2 YA23YA6 12(1)a,15(1), An up to date Sch 3 comprehensive, person centred plan must be in place for all service users. This must include a behaviour management plan including physical intervention plan, a record of any limitations agreed with the service user as to the service user’s freedom of choice, liberty of movement and power to make decisions. 12(1)a,13 The registered person must 6,7,8,37 ensure that seclusion is only used in an emergency situation as described in the Department of Health guidance. There must be recorded evidence that all agreed behaviour management strategies have been tried in the first instance. This must be kept under regular review. Any incident of seclusion must be recorded in full and the CSCI notified. 31/01/06 Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 22 3 YA24YA16 12(3)(4)a, 13(6) 4 YA20 5 YA18 The registered person must 31/01/06 review the current arrangements in respect of view holes in doors and the use of “star locks” on doors. The use of these measures must be agreed and recorded and risk assessments must be in place regarding these practices. There must be a clear rationale for any restrictions and these must be kept under review so that restrictions can be reduced wherever possible. 13(2) Guidelines regarding the 05/12/06 use of PRN medication must be included in behaviour management plans. The guidelines must give clear instructions about when PRN medication should be used. Medication must be administered as prescribed. 12(1)a,b,(4)a Service users must be 27/09/05 supported to have their personal care needs met. Service users must have access, with support if necessary, to items required for their personal care, including toilet paper, hand soap and towels. Cloughside DS0000001048.V265511.R02.S.doc Version 5.0 Page 23 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 YA23YA6 YA10 Good Practice Recommendations Behaviour management plans currently in place should be reviewed to ensure they are current, clear and in line with current good practice guidelines. The practice of displaying information about service users dietary requirements on kitchen units and the reminders for staff in service users bedrooms should be reviewed. 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