CARE HOME ADULTS 18-65
Coalway Lane Nursing Home 4 Coalway Lane Swalwell Gateshead NE16 3Y Lead Inspector
Katie Tucker Unannounced Tuesday, 9 August 2005 : 10:00
th 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 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 Stationary 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 B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Coalway Lane Nursing Home Address Swalwell, Gateshead NE16 3EY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 488 6877 0191 488 7118 Mental Health Concern Mr Chris Charlton N care home with nursing 12 Category(ies) of 12 x MD; 5 x MD(E) registration, with number of places Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10 March 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 B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Coalway Lane, which was conducted as part of the routine yearly programme. An inspector spent 6 hours at the home and spoke to 9 residents. A sample of assessments, care plans and risk assessments and the complaints procedures were examined. The staff were asked about the service user plans, the complaints procedure, access to training and any changes to working practices, as were the residents. The general maintenance of the building was checked. Coalway Lane provides a service for people with mental health needs. People are able to express opinions about the service. The majority of residents chose to speak with the inspector. During the inspection process staff practice, attitude and approach were observed and judgements were made on the effectiveness of the interactions. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records. During this inspection key standards were focused on but not all were checked. What the service does well:
Coalway Lane employs 9 mental health nurses and 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. The level of control people have over their own lives is nearly that one would expect when living independently. The service is run from 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 the courses that they were considering going on and how they spent their time. One person said that they were getting 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 B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 6 Mental Health Concern is not only the owner of Briarwood but also a charity. Headquarters staff and Briarwood actively promote the recognition of people with mental health needs as full citizens. They run service user boards and provide opportunities for people with mental health needs to access 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 B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 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 standard(s) 2 and 5 The lack of detail in one person’s assessment could lead to others being inadvertently placed at risk. Each resident has a terms and conditions which clearly explains the conditions of their residency. 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 one person had recently moved to the home that 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. One file did mention an aspect of someone’s behaviour that had the potential to place others at risk but this was not outline in sufficient detail to cover the issue. Also staff had not explored whether this behaviour was current and what triggers may cause this behaviour to occur whether the person it was a current issue for the person. Mental Health Concern developed and introduced terms and conditions for residency at there services last year. These documents met the requirements of the service and were deemed to meet the standards although some
Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 9 elements were different to those seen elsewhere. On the whole consultants form the local mental health hospitals are the sole refers to Coalway Lane. Therefore the terms and conditions reflect the expectations of this agreement. The manager and deputy manger have designed a standard contract and this provides space for service users to agree to conditions of stay, house rules and make their own requirements. This readily meets the requirements of Care Home Regulations 2001 5 (1) (c) and has been fully introduced. Coalway Lane is not registered to accept people with a learning disability and the person who recently moved in primary needs was related to their learning disability. Mental Health Concern was asked to ensure staff understood the disability the person had and how to meet their needs before it was agreed that an application to vary the conditions of registration was submitted to the local CSCI office. Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 10 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 standard(s) 6,7 and 9 The available records and plans do not at times demonstrate 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 limitations people may experience or have imposed because of the nature of their illness. Staff had not drawn up risk assessment plans for some people even though the risk that presented could have serious consequences for themselves or others. Plus the risk assessment formats do not include detailed information about the presenting risk and actions staff have to take to reduce or work with the risk. Also there are no risk-taking plans. These would identify the strengths people have and the common day risk that would be acceptable for someone to take. 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.
Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 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 standard(s) 12 and 13 Residents have chosen their lifestyles but staff have assisted them to become more independent and find or maintaining fulfilling activities. EVIDENCE: People were eager to talk about recent developments in their lives. One person said that they had been assisted by Mental Health Concern to apply for a job. They were hoping to work as a part-time domestic at another service ran by Mental Health Concern for older people. They were optimistic that they would get this job and looking forward to the challenge. Another person said that they were looking at the possibility of taking up a course in September at a local college. Other people discussed the hobbies they enjoyed such as playing instruments, photography and music. Another person talked about how they enjoyed looking after the garden and got great pleasure from this activity. People said they regularly went to local shops, to the Metrocentre and used local community resources. People chose where and when they visited these places. 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.
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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 standard(s) 20 The medication system is satisfactory and meets the needs of the residents and staff. EVIDENCE: More residents have been assisted to start looking after their medication. Staff following an assessment determine what level of support people would need. When the assessment shows that people cannot look after their own medication they record that they agree to staff giving them their tablets. Other people are gradually assisted to look after more and more of their medication. Thus people can start with part of a days worth of tablets and then build up to the point whereby they would organise getting the prescription from the GP and looking after all of the medication. Mental Health Concern has made sure that people have a lockable facility in their room for storing their valuables. Staff make sure that when they are issuing medication both them and the person sign the prescription sheet to record it’s receipt. Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 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 standard(s) 22 The complaints procedure is available and has proved to work effectively. EVIDENCE: Mental Health Concern developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. This is reproduced in the service user guide and made available to residents or their representative. The manager recognises the importance of dealing with minor concerns in a proactive manner. Since taking over the operation of the Briarwood she has actively encouraged residents and relatives make their views known. Where people have raised concerns she has dealt with these to the satisfaction of all concerned and ensured the actions have been sustained. Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 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 standard(s) 24 and 30 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 B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 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. Staff have said that the level of individual care that they can offer in the houses is often higher than if the person needed to return to hospital. They said wherever possible people would be nursed in the home if their mental health needs changed. Coalway Lane provides placements for student nurses, residents and staff found this to be a positive experience. Recently some staff shortages have been experienced because of people being on holiday or on sick leave. Staff said this had not created a problem because of the cover arrangements and bank staff that were available. Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42 On the whole the service meets ensures the health, safety and welfare needs of residents but management processes must ensure this remains the case. EVIDENCE: The management decision to admit someone with a learning disability to the home needs some review. Although the person presented with both mental health needs and a learning disability the particular learning disability needs they have require very specific approaches to be adopted. None of the staff spoken to had any awareness of what these particular needs were or how to change their approaches to meet this person’s needs. Thus all of the care plan approaches were aimed at someone who could understand abstract concepts were not sufficiently concrete to allow this person to understand what was needed of them. Although the person had been at the home some months none of the staff, including the key worker had sought out information or training that would assist them to work with this person. In order to look after individuals staff do need to have a very good understanding of what is expected otherwise people may be inadvertently placed at risk or their well being may be detrimentally affected.
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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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x 3 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 4 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x x x Standard No 31 32 33 34 35 36 Score x x 4 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Coalway Lane Nursing Home Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 18 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 2 6 and 9 Regulation 12 (1) (b) 15 (2) (b) Requirement An application for variation must be completed to and submitted to the local CSCI office. Care plans and risk assessments must be updated so they accurately reflect the needs of one of the residents. The manager and staff must continue to compile information on agreed limitations service users experience whilst at the home or because of their mental health needs. (Requirement made at previous inspections – timescale for action 9.03.05) Staff must receive training around caring for someone with Aspergers syndrome. Timescale for action 10.08.05 10.08.05 3. 7 12 (2) Schedule 3 (3) (q) 14.12.05 4. 37 18 (1) (c) 10.10.05 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 2 Good Practice Recommendations When staff are asked to care for someone with a condition they have seen before they should seek out information that will assist them to meet the persons needs.
B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 19 Coalway Lane Nursing Home Coalway Lane Nursing Home B52-B02 S18170 Coalway Lane V219531 9 Aug 05 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Baltic House Port of Tyne 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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