Inspection on 01/06/05 for Cragside House

This inspection was carried out on 1st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cragside House 11/07/07

Cragside House 01/03/07

Cragside House 24/11/05

Cragside House 24/11/04

Cragside House 21/04/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Cragside House 207 Scar Lane Milnsbridge Huddersfield HD3 4PZ Lead Inspector Jim Leyland Unannounced 1 June 2005 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. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cragside House Address 207 Scar Lane Milnsbridge Huddersfield HD3 4PZ 01484 460051 01484 480400 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) Valeo Limited Miss Helen Thomas Care Home 16 Category(ies) of 16 x Learning Disability registration, with number of places Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 24 November 2004 Brief Description of the Service: Cragside House is owned and managed by Valeo Ltd, a private company. It is a care home for 16 people who have learning disabilities and associated challenging behaviours. At present there are three, detached properties that make up the accommodation. The main house has 9 places, The Coach House 3 places and The Lodge 4 places. Cragside House is located on Scar Lane in Milnsbridge. There a local shops and facilities within walking distance and the home is located on a main bus route into Huddersfield Town Centre. Cragside House is set in its own well-maintained gardens. It has nine single bedrooms, a lounge, dining room, kitchen and laundry room. A new conservatory has recently been completed. The Coach House has three single bedrooms, a large lounge, dining room/sensory area and laundry room. The Lodge has four single bedrooms, lounge, dining room and kitchen. A new office and conservatory is being constructed. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is about an unannounced inspection to Cragside House, which started at 9.15 a.m. and was completed at 5pm. Eleven service users, eight staff and the manager were spoken to during the visit. Care plans, staff training files and a sample of other records were looked at. There are plans to set up a new home with the Coach House and The Lodge being managed separately. A new office base is under construction. Thank you services users, staff and the manager for your help and involvement during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Some improvements must be made in the home to ensure that service users and staff are safe. There must be a clear fire procedure in place and staff must be trained about what action to take in the event of a fire. Staff need to be suitably trained to protect service users, informing the appropriate people. Information for prospective service users needs to be accurate and accessible. Staff should receive regular supervision sessions. Evidence of asking service users whether or not they wish to be involved in activities would be helpful. In order to promote independence for service users, risks must be identified and a risk assessment devised. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 6 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. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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 Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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) 1 Service users and their relatives do not have access to the information they require in order to make an informed decision about where to live. EVIDENCE: The manager explained that the statement of purpose for the home is still in the process of being updated. Therefore the requirement remains that the statement of purpose includes the relevant details including the aims and objectives of the home and a statement of the facilities and services provided. As there is currently a vacancy in the home it is also recommended that the service user guide be developed in suitable formats, based on the work undertaken by another person in the organisation. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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 standard(s) 6, 7 and 9 Individual plans are being developed or have been completed setting out how the assessed needs and preferences of service users will be met. Service users are able to make decisions about their own lives, however there are restrictions on choice based on assessment. Detailed risk assessments are completed to promote independence and set out management strategies, however there are some omissions. EVIDENCE: Three service user plans were examined. Two had been completed and one was being developed. There has been significant progress in that all but one of the plans have now been finalised. Evidence was seen at the inspection that work on the last service user plan had commenced, with input from the service user and work on devising risk assessments was planned. The plans are very person-centred and set out details of preferred routines and lifestyle choices and a useful section on what skills staff need to work with service users, for example confidence and clear communication. The support requirements of service users are set out clearly and there was evidence that these plans have been reviewed. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 10 Daily records are written in a holistic way and any issues noted are followed through, with referrals to health and social care professionals and crossreferencing to accident books and incident reports. Information in one plan noted that a service user expressed concerns about their placement and these issues were taken seriously and followed up. Where the needs of service users change, the manager confirmed that appropriate agencies are consulted. Service users have separate files based on medication, information, support plans and daily records. On a tour of the main building, some service users have restrictions put in place, for example access to their clothes and water. Appropriate risk assessments are completed about these restrictions and the manager confirmed that these are reviewed and new ideas tried out to reduce these limitations. One service user has a dedicated waking night staff to support them, as an alternative to having a deadlock on their bedroom. Comprehensive risk assessments have been devised in each individual plan. These include identification of the risk, who is at risk and ways of managing the risk. Examples seen relate to drinking substances hazardous to health, attempts of a service user harming other service users and staff, swallowing small objects and hazards to staff identified when assisting a service user with personal care. A requirement is made as one of the service user’s assessments had not been completed. Daily records and incident reports highlighted a situation where two residents had compromised the safety of other service users and staff. A risk assessment must be completed relating to the impact of the service user’s behaviours on others living in the home and how these will be managed. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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) 11, 12 and 14 Several examples were provided where services users have had the opportunity to develop their personal development and independent living skills. Many service users participate in varied educational and social activities, however some service users require motivation and meaningful stimulation. Service users participate in various leisure activities and are offered the opportunity to have a holiday. EVIDENCE: Staff at the home were observed to support and counsel some service users and assist them to discuss concerns that they had raised. Appropriate agencies are referred to if more formal assessment and support is needed, for example the community nurse. Two service users do their laundry and ironing independently. One service user said that they had enjoyed attending a first aid course and course on portable appliance testing. The manager said that three service users attended a cookery course at either the college or day centre and had developed their culinary skills. It is recommended that staff evidence in daily records and reviews that attempts have been made to engage service users in suitable and fulfilling Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 12 activities. It is acknowledged that the service users may not wish to participate, however information on how staff have tried to motivate people should be recorded, highlighting that social needs in the care plan are being addressed. Otherwise there was evidence that service users can access appropriate activities including horse riding for the disabled, attending the day centre to do arts and cookery, hydrotherapy, aromatherapy and going to college. Service users participate in various leisure activities. One service user said that they enjoyed going to a local club to play snooker and bowls. Other service users sometimes go to the pub or local shops. Daily records show that some service users have been out on day trips, for example Cannon Hall Farm and the lights in Blackpool. One service user showed his photographs from their holiday in Skegness. Service users have been or plan to go on their own holidays with staff, including the Lake District and Pickering. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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 standard(s) 18, 19, 20 and 21 Service users’ preferences and personal support needs are detailed in individual support plans. The health needs of service users are met, with staff referring to and accessing appropriate services. Service users are protected by the home’s policies and procedures for dealing with medicines, although improved auditing is needed to track any errors. Attempts have been made by the manager to seek the views of service users about their final wishes. EVIDENCE: Two individual plans examined provide information about the personal support required for these service users. One plan was very detailed, noting specific preferences and risks when staff support them. Appropriate guidance is provided to safeguard both the service user and the staff working with them. Where service users require specialist support to manage their behaviours and emotions, input is provided from psychiatric services and/or a community psychiatric nurse. The manager gave examples where service users have been referred to appropriate healthcare services to meet their changing needs. Examples include a service user being referred to psychological services due to an erratic sleeping pattern, an individual being referred to a dietician and another service user have psychiatric input because of their mental health needs. Service users Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 14 have access to dentists, opticians, chiropodists and GPs as necessary. There is very useful documentation in service user plans recording information about visits to health professionals, the reason for the visit and outcomes of the consultation, with appropriate guidance for staff. The home uses the Boots Monitored Dosage system. Staff who administer medication have had the Boots training and some are undertaking more detailed medication training through Dewsbury College. The medication of two service users was checked in the main house. Appropriate codes are used and brought forward totals are used on the Medication Administration Record sheet. It is recommended that closer auditing of MAR sheets is undertaken, as there were some minor discrepancies with balances and a missing staff signature. The home has policies on the care of the dying, palliative care and the death of a service user. The manager explained that letters have been sent out to the families of service users regarding their final wishes. Evidence was seen in a written response from a relative about their response. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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 standard(s) 22 and 23 There is evidence that the views and concerns of service users and other parties are listened to, taken seriously and followed up. There are appropriate policies and procedures for protecting service users, however attention is required in notifying appropriate agencies when incidences of abuse take place. EVIDENCE: Two complaints have been made since the last inspection. The complaints are logged and have been investigated through the home’s complaints procedure. Evidence was seen that the complainants had been provided with a response within the 28 day timescale. One of the complaints resulted in appropriate outcomes for the service user, with input from a community psychiatric nurse and a revised risk assessment. The home has an adult protection and whistle blowing policy. A copy of the Kirklees Social Services adult protection procedures is available for staff to refer to. Staff confirmed that they receive adult protection training through the Learning Disabilities Award Framework. However three separate incidents in one service user file, highlight abusive situations, which have not been reported to the Vulnerable Adults Co-ordinator or the CSCI. A risk assessment has been devised, however the service user must be protected through consistency and competent staff in recognising abusive situations and knowing the correct procedure to protect the individual(s). The home has a challenging behaviour policy and training to staff is provided on control and restraint, to be used only as a last resort. Improvements have been made to recording the financial transactions for service users and the deputy manager explained various audit tools that were being used to trace any errors. A policy on staff receiving gifts has now been implemented. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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 standard(s) These standards were not assessed at the inspection visit. EVIDENCE: Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 17 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, 34, 35 and 36 The needs of service users are met by sufficient numbers of staff, who have the appropriate skills and knowledge. Service users are protected by a robust recruitment procedure. Staff benefit from a comprehensive induction and receive training relevant to meeting the needs of service users. Staff receive supervision and support to carry out their work; some of the formal supervisions are overdue. EVIDENCE: Duty rotas show that there are sufficient numbers of staff required to support service users in each of the three houses. On some shifts this is exceeded. There are low levels of sickness and two staff vacancies. Agency staff are used as cover. The Lodge has its own dedicated staff team, so that there is more consistency for service users. The manager and prospective manager for the Lodge/Coach House explained that discussions and plans are taking place to determine new staff teams for the two distinct registrations. Three staff spoken to said that they had been consulted about this issue. Three staff files were examined and they all included the relevant information, including an up to date photograph, two written references, a Protection of Vulnerable Adults check and enhanced Criminal Records Bureau disclosure. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 18 All staff receive a five day induction at Valeo’s headquarters before they commence work in the home. The manager explained that staff are then put forward to do training through the Learning Disability Awards Framework. Staff training records that staff have completed training in autism awareness and suitable training courses are offered to meet the specific needs of service users. Staff are supervised by one of the managers. At least three members of staff have only received supervision on one occasion this year. All staff should receive supervision at least six times per year. The manager and one of the deputy manager have undertaken consultation and appraisal training in order to effectively supervise staff. Staff said that they receive an annual appraisal to identify training and development needs. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 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 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) 39 and 42 The views of service users are gauged about living at the home, however the views of other stakeholders should also be sought. Health and safety training is provided for staff, however service users are not protected by the current fire procedures. EVIDENCE: The manager confirmed that service users were sent a questionnaire seeking their views about living at the home. Views of service users are also listened to in regular service user meetings. A good example was given where a service user had expressed concerns about the availability of snacks. Appropriate action and support was provided to overcome these concerns. It is recommended that the views of relatives, visiting professionals and other stakeholders be sought on how the home is achieving goals for service users. Evidence was seen that monthly audit visits take place in the home. Staff receive training in health and safety, food hygiene, moving and handling and first aid. Staff explained that infection control is covered under the health Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 20 and safety element. Refrigerator and freezer temperatures are recorded on a daily basis and were found to be accurate. A recommendation is made that the manager purchase a new accident book, in order to promote data protection. On the day of the inspection there was some confusion about what the fire procedures are in the home. Staff had been advised to follow a ‘Stay put’ policy, whereas the procedure manual directed staff to evacuate the building in the event of a fire. The deputy manager said that because the home had followed a policy of staying put, due to risks with service users going out on to a busy road, that no fire drills had taken place in the home. The home must have a consistent and coherent fire procedure that all staff understand, through suitable training and have appropriate information provided in suitable formats for service users. Also drills must take place on a regular basis, so that staff are aware of the procedure to be followed in the event of a fire. It is acknowledged that the manager has consulted with the Valeo’s facilities manager to provide an interim policy. Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 21 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 1 x x x x Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 2 x 3 x x x Standard No 31 32 33 34 35 36 Score x x 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cragside House Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score x x 2 x x 1 x J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 22 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. Standard 1 Regulation 4 Schedule 1 Requirement The Registered person must compile in relation to the care home a written statement of purpose which shall consist of: a statement of the aims and objectives of the care home; statement as to the facilities and services provided and a statement as to the matters in Schedule 1 of the Care Homes Regulations 2001. This is an outstanding requirement from 21/04/04 The registered person must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The registered person must make arrangements through training and involving the appropriate agencies, to prevent service users being harmed or suffering abuse or being placed at risk of abuse or harm. The registered person, after consultation with the fire authority, must through training and drills ensure that staff are aware of the procedure to be followed in the event of a fire in Timescale for action 31st July 2005 2. 9 13(4) 30th June 2005 3. 23 13(6) 15th June 2005 4. 42 23(4) 30th June 2005 Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 23 the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 12 20 36 39 42 Good Practice Recommendations It is recommended that staff evidence in daily records and reviews that attempts have been made to engage service users in suitable and fulfilling activities. It is recommended that closer auditing of MAR sheets is undertaken, as there were some minor discrepancies with balances and a missing staff signature. All staff should receive supervision at least six times per year. It is recommended that the views of relatives, visiting professionals and other stakeholders be sought on how the home is achieving goals for service users. A recommendation is made that the manager purchase a new accident book, in order to promote data protection. N/a Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 24 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Cragside House J51J01_s26306_Cragside House_v220855_010605.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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