CARE HOME ADULTS 18-65
Coalway Lane Nursing Home 4 Coalway Lane Swalwell Gateshead Tyne & Wear NE16 3EY Lead Inspector
Mrs Katie Tucker Unannounced Inspection 1 March 2007 9:00
ST Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Coalway Lane Nursing Home Address 4 Coalway Lane Swalwell Gateshead Tyne & Wear NE16 3EY 0191 488 6877 0191 496 1926 coalway@medicalhealthcare.org 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) Mental Health Concern Mr Gordon Christopher Charlton Care Home 12 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (12), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (5) Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The LD service user category relates to one current service user only. Date of last inspection 19th December 2005 Brief Description of the Service: Coalway Lane is a group of three houses that have been purposely built to provide nursing care for twelve adults with mental health needs. The fees at the home are £924 but several grants and funding bodies pay these monies. The houses blend into the community well and comprise of three domestic style houses. The houses are detached but share a garden at the rear of the building. Each house contains four bedrooms, 2 lounges, dining room, kitchen, laundry, toilets and bathrooms. There is a converted building attached to one house, which contains staff facilities and two offices. Most back doors have steps leading to them but all of the front doors have level access. Coalway lane forms part of a housing estate in Swalwell. The home is near to the Metrocentre and local shops. A bus service runs locally to the town centre, Gateshead and Newcastle. Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced visit. They spent the day speaking to people using the service and staff. The inspector also looked around the houses and checked the standard of the record keeping. Prior to the visit the inspector looked at comment forms from people living at the home. Several residents’ care was tracked through what people said and looking at the service user plans and other records. Staff practice, attitude and approach were also watched and judgements made on how well staff worked with people. During this inspection all of the key standards were checked. What the service does well:
The manager, deputy manager and staff are very skilled and have successfully worked with people who have mental health needs for a lot of years. They have made sure they understand residents’ needs and try to get to know how people’s mental health needs affect their day-to-day life. This hard work has helped people work through difficult times in their lives and a number of people have been helped to remain well. Nine mental health nurses work at Coalway Lane and at least three staff work during the day. Often two nurses will be working during the day. The high number of nurses have helped the home to care for people even they have become very unwell. Because staff have very good skills and knowledge has meant that residents have not had to return to hospital. Coalway Lane is made up of three houses and the people living in each house decide how they run the house. Residents have regular meetings to decide on domestic rotas, meals for the week and activities. The staff help residents complete day-today tasks, when needed. Residents said ‘I like living here, the staff are good and we get on well’, ‘I do the things I want to do’, ‘sometimes me and the staff disagree but I know that they are really trying to help’ and ‘I can talk to the staff about problems’. The staff work with residents to write down a lot of information about people’s lives and needs. The records are very well written and really helps people tell staff who they what they want. Staff are also skilled at writing down how they are working with people to help them get to their goals. The manager and deputy manager always check that the records continue to give people the right information. So each year they add bits and check that this is working. Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 6 Staff clearly show when they have to make decisions on residents behalf or ask people not to do a particular thing such as drinking large amounts of alcohol. The residents work with staff at these times to make sure they understand why they have been asked to so this and agree that it is right for them. Mental Health Concern’s staff training department is extremely active and all of the staff go on a wide range of training. The type of training offered includes access to degree and masters level courses as well as secondments onto nurse training. Mental Health Concern is not only the owner of Coalway Lane but also a charity. Headquarters staff want people with mental health needs to be treated like anyone else and look at ways to do this. They run service user boards and help people with mental health need to gain employment. 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. The summary of this inspection report can be made available in other formats on request.
Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent This judgment has been made from evidence gathered both during and before the visit to this service. Staff make sure assessments are very detailed. All of the information staff need to know they can work well with residents is collected. Therefore residents’ can be confident that staff know how to work with them. EVIDENCE: The manager with staff from Mental Health Concern’s Headquarters has developed a very detailed assessment for people with mental health needs. Case tracking showed that the records help staff and residents write down all the information they need to understand residents’ lives, experiences and how they see life. Also staff make sure that the assessment outlines how people’s mental health and sometimes learning difficulties affect them and things that cause difficulties to increase. This has worked well for residents who have lived at Coalway Lane for some time, as year on year this information is added too. Most of the residents have come from NHS ran service and consultant psychiatrists continue to work with residents. These consultants are confident that staff look after the records properly and need all of the information about people. Therefore residents’ medical records are also kept at the home. Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent This judgment has been made from evidence gathered both during and before the visit to this service. Records clearly show how staff work with residents and meet any needs. The residents’ are fully involved in working out how best to meet their needs and goals. Therefore residents’ can be confident that their needs will be met. EVIDENCE: The manager and staff have developed an excellent care planning system. Case tracking showed that the staff record all of the actions needed to take to meet someone’s needs, including managing challenging behaviours. Staff record where they restrict people’s choices and help them make positive decisions. Plus staff have written risk assessment plans for all of the residents. The risk assessment formats give detailed information about the presenting risk and actions staff have to take to reduce or work with the risk. Residents talked about their plans and how they had been asked to help write them. They were happy with all the care plans and risk assessment saying the staff made sure they agreed to the actions before putting them in.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgment has been made from evidence gathered both during and before the visit to this service. Residents actively choose how they live but staff have helped them to become more independent and find or maintaining fulfilling activities. EVIDENCE: Residents said ‘I come and go as I please’, ‘I like going to the Metrocentre and can do that everyday’, ‘the staff are helping me get a football team together coz I need to do more exercise’ and ‘I’m too old for college but used to go before – I wouldn’t want to now but staff help others go if they want’. Some of the residents talked about friends they had made and how they meet up with these people when they are out. The residents with staff help have decided how each house runs. This means that each house has different ground rules and domestic rotas. Residents said ‘staff help out when we need them but we look after the house and are food’. Other residents talked about their family. Recently some residents lost close friends and family. They said ‘staff were great and helped me go to funerals and talk about the people that died’.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is excellent This judgment has been made from evidence gathered both during and before the visit to this service. Systems for making sure resident’s physical and emotional health needs are looked after work well. Thus residents can be confident that their health and emotional needs will be met by the service. EVIDENCE: Case tracking showed that staff have made very good links with the local hospitals and community healthcare services. Most residents continue to see consultant psychiatrists and can easily get help when they need it. Also staff have repeatedly shown that they can get medical support when people’s mental or physical health deteriorates. Staff have successfully worked with residents to deal with the difficulties caused by their particular mental health needs. When residents have felt down or upset staff use various skills to find out what causing the upset. Then work with the resident to find out how best to resolve issue. Some residents have Autism spectrum disorders and staff have had training around working with people who have a learning disability.
Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 12 These training has helped them work out behaviours that are to do with the person’s learning disability and those that are caused by everyday events or mental health needs. Case tracking showed staff have worked with the other residents to find ways to cope with various issues they face when living with someone with a learning disability. Plus have given people information to help them understand why people would behave in certain ways and that a person doesn’t mean to keep talking about the same thing and not let them get a word in. Also the residents’ records detail people’s particular spiritual, cultural and sexual preferences. Residents also talked about how they continued to lead lifestyles that followed these needs. Case tracking showed that staff work with residents to help them take care of their own medication. Some of the residents do this, others look after some of their tablets and a small group of people need staff to take control of the medication. Staff make sure all of the systems for getting and looking after medication are in place and work well. It was easy to check that all of the medication was being looked after properly. Staff worked well with people. They were very respectful and valued people. Residents said ‘staff were very good and were always kind’. They said that staff listened to them and thought their views were important. Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgment has been made from evidence gathered both during and before the visit to this service. The owners have shown that they will check that the service is working for residents, help people to raise concern, work in partnership and take all actions necessary to resolve issues. Thus, residents can expect that poor practice will not be tolerated. EVIDENCE: The complaints procedure is made available to residents and relatives through the service user guide. Resident said ‘the manager listens to what you have to say and he sorts stuff out’ and ‘sometimes I disagree with staff and shout at them but it’s about me not really the staff – they are trying to do the best but I don’t listen then but find out they were right to talk to me about it’. Case tracking showed that when people had raised concerns, even minor irritations staff treated these seriously and took action to resolve the issue. Coalway Lane has an appropriate protection of vulnerable adults policy and follow Gateshead Social Services Department guidance. This guidance does, however, require Mental Health Concern to put in a section about what they would do if an allegation of abuse were made. Staff do not have experience of using the procedures, as allegations of abuse have never been made but staff receive regular training and up dates. Senior managers are aware that if residents or staff behave abusively that this must be looked under the POVA guidance, and CSCI need to be alerted.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is excellent This judgment has been made from evidence gathered both during and before the visit to this service. The service is broken down into good size domestic style houses, which the owners are always improving. Thus residents’ needs are well met. EVIDENCE: Coalway Lane consists of 3 separate houses. Each house has enough room for 4 people to comfortably live there. One of the houses has a bedroom on the ground floor and this is big enough for someone with mobility needs. The houses are well maintained and many areas exceed the standards. Residents told me about recent decorative works that had been done in their houses and how this had been done to a good standard. One the houses had a conservatory fitted and residents were extremely pleased with how it looked and the extra room it gave them. Case tracking showed that the residents are responsible for completing household tasks and staff help them do this when it is needed.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is excellent This judgment has been made from evidence gathered both during and before the visit to this service. The high staffing levels, large proportion of mental health nurses and good range of training means residents can be confident that their needs are met. EVIDENCE: Coalway Lane of a minimum of 1 first level nurse (RMN) and 2 care staff during the day. During the night 1 first level nurse (RMN) and 1 care staff is provided. When a resident’s mental health has deteriorated because the service employees enough RMN’s to provide 2 nurses on each day shift people have been cared for at home rather than returning to hospital. Mental Health Concern has a dedicated training department. This department gives staff the chance to go on a wide range of job specific training. 100 of staff have completed training up to and in excess of NVQ level 2. Staff have been going training about how to make sure people’s equality and diversity needs are met plus insight into the Mental Capacity Act. The nurses and care staff are able to go on various courses including degrees.
Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 16 Plus secondment opportunities are provided for care staff that wish to complete nursing qualifications. The local university has approved Coalway Lane to offer training placements to student nurses. Staff records are kept centrally but these can be seen via an intranet link. These are well maintained. The manager told about new legislation related to age, diversity and protection of staff from harassment that will need to be incorporated into the recruitment practices and management policies. Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good This judgment has been made from evidence gathered both during and before the visit to this service. Overall management systems are effective and make sure the home meets the residents’ needs. EVIDENCE: The manager is competent and holds management qualifications well in excess of those required by the standards, as well as being a registered nurse. A skilled deputy manager is in post and he holds the registered managers award. Mental Health Concern has got a very good quality assurance system, which shows up gaps in the service. A service user board is used and made up of residents and relatives of the services. Senior managers visit the home to complete audits of the service being offered. Residents are regularly asked what they think and staff peer review the records they write.
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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 4 3 X 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 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 3 X Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? NO 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. Refer to Standard YA35 Good Practice Recommendations Staff should receive regular training around working with people who have a learning disability. Coalway Lane Nursing Home DS0000018170.V322049.R02.S.doc Version 5.2 Page 20 Commission for Social Care Inspection South of Tyne Area Office St Nicholas Building St Nicholas Street Newcastle NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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