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 19th December 2005 1:00 Coalway Lane Nursing Home DS0000018170.V256339.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 Coalway Lane Nursing Home DS0000018170.V256339.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. Coalway Lane Nursing Home DS0000018170.V256339.R02.S.doc Version 5.0 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 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.V256339.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The LD service user category relates to one current service user only. Date of last inspection 9th August 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 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.V256339.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Coalway Lane inspection was carried out as part of the routine yearly programme. No one working for Mental Health Concern was told that the visit was to take place. An inspector visted and spent half a day at home. The inspector looked at the residents’ records, staff training records and staff information. The staff were asked about the residents’ records, the guidelines for protecting residents, their training, staffing levels and changes to working practices. The residents and relatives were asked similar questions. Coalway Lane cares for people with mental health needs. The majority of people could share their opinions on the quality of the service. But staff practice, attitude and approach were also watched and judgements made on how well staff worked with people. During this inspection key standards were focused on but not all were checked. What the service does well:
The manager, deputy manager and staff are very competent when working with people who have mental health needs. They understand the needs of the service and care a great deal about the resident’s. Nine mental health nurses work at Coalway Lane, which means good staffing ration is maintained. Also a minimum three staff are on shift during the day. The high nursing staff levels have allowed the home to care for people even when their mental health has markedly deteriorated. Staff have found that they have continued to be able to look after people even when other services may have been unable to meet the person’s needs. Coalway Lane is made up of three houses and the people living in each house decide how their needs can be best met. Each household has regular meetings to decide on domestic rotas, meals for the week and activities. Residents discussed their life and how they had the freedom to make choices about what they did. One person recently got a part-time job and Mental Health Concern had helped them to find the job. All were complementary about the service being offered at Coalway Lane. Mental Health Concern’s staff training department is extremely active and all of the staff have access to 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. Coalway Lane Nursing Home DS0000018170.V256339.R02.S.doc Version 5.0 Page 6 Mental Health Concern is not only the owner of Coalway Lane but also a charity. Headquarters staff champion the recognition of people with mental health needs as full citizens. They run service user boards and provide opportunities for 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. Coalway Lane Nursing Home DS0000018170.V256339.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 Coalway Lane Nursing Home DS0000018170.V256339.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): 2 The assessment records now reflect the needs of people using the service. EVIDENCE: The manager with staff from Mental Health Concern’s Headquarters has developed a comprehensive assessment for people with mental health needs. This has lead to staff and residents being able to include a wide range of information about their live, experiences and how they see life. This has worked well for residents who have lived at Coalway Lane for some time, as year on year this information is added too. However at the last inspection, one person had moved to the home who had a learning disability and the assessment did not sufficient information about their disability or how best to work with the person. Staff were made aware about the specific cognitive limitations people with this type of learning disability experience. Since then staff have reviewed the records to make sure they are accurate. Also staff have received training around how to work with people who have a learning disability. This has led to an improvement in these specific records. In the future the manager and staff have undertaken to explore all aspects of people’s needs prior to admission. This should allow staff to be able to put in place appropriate plans of care and seek changes to the certificate of registration if it is needed. Coalway Lane Nursing Home DS0000018170.V256339.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): 7, 8 and 9 The available records and plans show how staff are meeting peoples needs. EVIDENCE: The manager and staff have developed a comprehensive care planning systems, which allows them to record all of the actions they need to take to meet someone’s needs. Staff continue to gather information about where staff restrict people’s choices because of the nature of their illness. Staff have now drawn up risk assessment plans for all of the residents. The risk assessment formats have been amended to include detailed information about the presenting risk and actions staff have to take to reduce or work with the risk. Risk-taking plans, which identify the strengths people have and the common day risk that would be acceptable for someone to take need to be developed further. The residents have the potential to challenge staff in many ways including passive challenge. Behavioural guidelines have not been drawn up for these people, which identify primary, secondary actions and whether staff will use of physical interventions. When physical interventions are applied staff were aware that each incidents of physical intervention being used needs to be recorded in a bound, numbered hardback book.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 16 and 17 Residents have chosen their lifestyles but staff have assisted them to become more independent and find or maintaining fulfilling activities. EVIDENCE: People said they chose where and when they go out and what they do during the day. The majority of residents use these facilities on their own and said they just needed to let staff know where they were going and when they would be back in case their was an emergency. Some of the residents talked about the network of friends they have formed and how they meet up with these people when they are out. Other residents shared information about their family and said ‘staff really helped me to talk to my relatives and were there for when I needed someone to turn too.’ The residents with staff support have organised how each house runs. This means that each house has different ground rules and domestic rotas. The residents they make sure everyone pulls their weight. The residents also work with staff to decide the menu that will be followed and who will cook what. Each house then organises when they will shop and who will go. Residents said that the food was ‘always very good’.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 Residents are able to use a wide range of healthcare services. And, staff work with people to make sure supported in all aspects of their care needs. EVIDENCE: Staff have formed very good links with the local hospitals and community healthcare services. Many of the residents continue to see consultants. Also staff have repeatedly shown that they can seek out medical support when people’s mental or physical health deteriorates. Staff have successfully worked with people to reduce the anxiety they experience. The staff use a wide range of skills to find out what is upsetting residents and how best to resolve people’s concerns. Staff have recently had training around working with people who have a learning disability and have started to identify behaviours that related to the person’s learning disability. It was suggested that the other residents were given an opportunity to discuss the issues they face when living with someone with a learning disability. Also staff were made aware of the range of literature that has been published for service users about learning difficulties. 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 what they wanted and respected their opinion. Coalway Lane Nursing Home DS0000018170.V256339.R02.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Staff, service users and relatives are made aware of the complaints procedure and staff have demonstrated that they adhere to the procedure. EVIDENCE: The complaints procedure is made available to service users and relatives through the service user guide. Residents said that the found the staff and manager easy to approach and friendly. They said they felt comfortable discussing any issue that concerned them with the staff. People gave examples of this and said that they were helped by staff to raise concerns. Other residents said that they had ‘never had anything to complain about’. The manager and staff have consistently shown themselves to be open and willing to listen to concerns people may have. The manager has followed the appropriate complaints procedure and where it cannot be resolved by the home this has been referred to the most appropriate person. Coalway Lane Nursing Home DS0000018170.V256339.R02.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The buildings are well maintained, exceed the national minimum standards and meet the needs of the residents. EVIDENCE: Coalway Lane consists of 3 separate houses. Each house provides accommodation for 4 people. One of the houses has a bedroom on the ground floor and this is sufficient in size to meet the needs of someone with mobility needs. The houses are well maintained and many areas exceed the standards. Residents discussed recent decorative works that had been completed in their respective houses and how this had been done to a good standard. The people in each house actively decide how their home will be run. Service users are responsible for completing household tasks and staff provide support to complete these when it is needed. People discussed how they took pride in keeping the house tidy but at times this was not always the case for others. However they felt the staff did a good job of encouraging others to do their fair share of work. Coalway Lane Nursing Home DS0000018170.V256339.R02.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The high staffing levels and large proportion of mental health nurses working at Coalway Lane ensures people’s mental health needs are met. EVIDENCE: The staffing levels at the home are well in excess of those required by the previous registering authority. The organisation provides a staffing levels at 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 provides staff with opportunities to go on a wide range of training. 100 of care staff have completed NVQ training. Recently staff completed training on working with people who have a learning disability. It is hoped that this will not be seen as one-off training because this is a specialised field. And, as staff working with people who have these needs they must be aware of the good practice and techniques that can be used. Staff records are kept centrally but these can be seen via an intranet link. Personnel staff make sure that CRB checks are completed, references obtained and full employment histories taken.
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The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 39 The management systems on the whole meet the needs of residents living at Coalway Lane. 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. He constantly makes sure his practices are line with recognised good practice. A skilled deputy manager is in post and he has been completing the registered managers award. Mental Health Concern has developed a robust quality assurance system, which includes a service user board. This board is made up of residents and relatives and they actively review the care being offered across all of the services operated by the organisation. Also a number of the operational managers visit each home to conduct different audits of the service being offered and this information is provided to the local CSCI office. Coalway Lane Nursing Home DS0000018170.V256339.R02.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 4 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 4 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Coalway Lane Nursing Home Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 4 X 3 X X X X DS0000018170.V256339.R02.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? Yes 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 YA7 Regulation 12(2) Sch 3(3) (q) Requirement Information must continue to be recorded around restrictions that are imposed. (Requirement made at previous inspections – timescale for action 9.03.05) Risk-taking assessments must continue to be developed. Timescale for action 19/06/06 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 YA2 Good Practice Recommendations When staff are asked to care for someone with a condition they have not seen before they should seek out information that will assist them to meet the persons needs. Staff should receive regular training around working with people who have a learning disability. 2 YA35 Coalway Lane Nursing Home DS0000018170.V256339.R02.S.doc Version 5.0 Page 18 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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