Inspection on 11/07/07 for Cragside House

This inspection was carried out on 11th July 2007.

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 no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cragside House 01/03/07

Cragside House 24/11/05

Cragside House 01/06/05

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 West Yorkshire HD3 4PZ Lead Inspector Alison McCabe Key Unannounced Inspection 11 and 12th July 2007 10:30a th Cragside House DS0000026306.V343167.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 Cragside House DS0000026306.V343167.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. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cragside House Address 207 Scar Lane Milnsbridge Huddersfield West Yorkshire HD3 4PZ 01484 460051 01484 460400 rm@valeoltd.com 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) VALEO Limited Miss Helen Thomas Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specific service user over the age of 65 in the category of LD(E), named on variation dated 29th December 2006, may reside at the home. 1st March 2007 Date of last inspection Brief Description of the Service: Cragside House is owned and managed by Valeo Ltd, a private company. It is a care home for 9 people who have learning disabilities and associated challenging behaviours, although there are currently only seven people accommodated and there are no plans to take any new admissions. The home is located just outside Huddersfield, close to local amenities and a regular bus service. The current scale of charges at this home is £1528.87 - £2421.60 per week. The service provider ensures that information about the service is available to prospective and current people using the service by way of the home’s Statement of Purpose, the Service User Guide and through CSCI inspection reports. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the inspection process, a visit was made to Cragside House by one inspector between the hours of 10.30am and 6.00pm. Due to a number of concerns identified, a second visit took place the following day on 12/7/07 between the hours of 10.10am and 2.15pm. In addition to the visit, information used to inform this inspection includes: notifications received from the home regarding accidents or incidents since the last inspection visit; information provided by the home about the service offered, people living at the home and people working at the home, including a self assessment; four surveys completed by relatives/carers/advocates of people living at the home and a survey from a health professional. Comments received in these surveys have been included as part of this report. Whilst there has been some positive feedback about the service provided, there are also some areas for improvement that have been identified in the surveys. These are referred to in the report. During the visit the inspector had the opportunity to talk to project workers, senior project workers, the deputy manager and the acting manager. Since the last inspection, the registered manager has gone on maternity leave and an acting manager had been in place for four months at the time of the visit. The inspector was unable to establish individuals views about what it is like to live in the home due to their complex needs, however time was spent observing interactions between staff and people living at the home and general care practice. A number of concerns were raised at the last inspection about the home’s procedures and practices in respect of protecting vulnerable people from harm. Action has been taken by the organisation to address the specific requirements made following the last visit, however there continues to be a number of concerns about how well people are being protected from harm or potential harm. Following the visit, a letter was sent to Valeo detailing the concerns that required the most urgent attention, and a meeting has been held between the CSCI and Valeo senior managers. The CSCI has been assured that action has, and will continue to be taken in order to improve the standards of care at Cragside House. The inspector would like to thank the people living at the home and staff for their cooperation and hospitality during the visit. What the service does well: Individuals’ needs are assessed before they move into the home. Staff support individuals to make some choices and decisions. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 6 Good information about how individuals prefer to be supported with their personal care routines is available so that staff know how to meet peoples’ needs. Staff are good at supporting people to keep in touch with family and friends. Clear procedures about how to make a complaint are in place. No complaints have been received by the home in the last twelve months. People live in a clean, comfortable home. Staff at the home receive relevant training on a regular basis. Good systems are in place to monitor the quality of the service. What has improved since the last inspection? What they could do better: All identified risks to individuals need to be properly documented, assessed and reviewed where necessary so that staff are clear about how to keep people safe. Staff need to be clearer about how they manage difficult behaviours that are sometimes presented by people living at the home. Staff need to improve how they communicate with people living at the home using positive approaches. More support should be given to people to keep them engaged in meaningful activities both at Cragside House and out in the community. More effective action needs to be taken to keep people living at the home safe from harm. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 7 Improved information about when emergency medication should be given is necessary. Staffs understanding of why people are taking particular medicines would be beneficial. Staff should continue working towards obtaining NVQ qualifications in care so they have a better understanding about caring for vulnerable people. Recruitment procedures must be followed to ensure the vulnerable people living at the home are protected from potential harm. Stronger leadership of the team is necessary in order to raise the standards at the home. 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. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 8 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 Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 9 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are assessed prior to them moving into the home. EVIDENCE: Records relating to two individuals were examined as part of the key inspection. Both contained evidence that pre-admission assessments had been completed prior to them being admitted to the home. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are supported to make some choices, however individuals’ needs are not always reflected in the individual care plans and some people are put at risk of harm due to lack of planning and appropriate assessment of risks. EVIDENCE: Two individual’s care plans were examined. Both contained some excellent detail about how their needs should be met including detailed information about how they prefer to be supported. However there were some gaps in information in relation to how behaviour should be managed positively and how to meet healthcare needs. This is discussed in detail later in this report. Daily records were examined and showed that individuals’ identified needs are frequently not met as intended or agreed. For example, it is identified that an individual should be supported to go for regular walks and outings, however the daily records did not demonstrate that this has taken place. Through discussion with staff it was noted that staff are not always aware of what is in individual care plans. The acting manager reported that keyworkers are being Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 11 encouraged and supported to participate in the care planning process to increase their awareness and knowledge. Evidence of this was seen during the visit where a staff member was working on updating an individual’s care plan. There is evidence that reviews have taken place, involving family/advocates/carers. Most records had been signed and dated as recommended at the last inspection, and this is positive. People living at Cragside House have complex needs and therefore require significant support to make choices and decisions. Some examples of staff supporting people to make choices were observed during the inspection for instance whether or not they would like a biscuit or a drink. However, staff were often observed to make choices for people without consultation or attempt to involve individuals. For example, an individual was listening to music through earphones, and staff were observed to change the music, adjust the earphones, adjust the volume etc without any interaction at all with the individual. A senior member of staff explained that those individuals who were not going out in the afternoon would have a ‘snooze’. No choices or alternatives were offered to people about how to spend their time. People living at Cragside House are not in a position to make decisions regarding finances, long term plans etc due to the level of their disability, therefore choices regarding day to day matters, for example, how to spend their time, should be encouraged and facilitated. Records examined showed that people are supported to take some reasonable risks, and that appropriate assessments of some risks had been completed identifying agreed ways to reduce the risks. It was found however that some identified risks had not been documented adequately, or steps to reduce identified risks not agreed. It was also noted that whilst a risk assessment was in place regarding individuals being physically hurt by other people living at the home, these had not been effective as incidents continue to occur. Steps must be taken to ensure that risk assessments are reviewed and appropriate action taken to protect vulnerable people living at the home from being hurt. Through discussion with staff and observation of care practice, it was apparent that staff do not have a clear understanding of the supervision required in order to keep all people living at the home safe from harm. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples lifestyles are good in that support is offered to maintain relationships, enjoy a reasonable diet and generally have their rights respected, however the lack of stimulation and opportunities to engage in meaningful activities both in and outside of the home does not support people to enjoy a good quality of life. EVIDENCE: Five of the seven people living at Cragside House have some day service provision provided by Valeo day services. Four are allocated one half day session per week, and one is allocated two half day sessions per week. Staff at Cragside House are responsible for providing occupation and activities for the remaining time. Through observation during the visit, examination of daily records and discussion with staff, it was noted that opportunities for participation in meaningful activities both inside and outside of the home are very limited. (This was also raised at the last inspection conducted in March Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 13 2007.) People spent long periods of time wandering around the house with nothing to do, and few attempts were made to encourage individuals to engage in any meaningful activity. Some of the people living at the home went out with staff in the home’s vehicle to deliver post to head office. Staff explained that people living at the home would not actually get out of the vehicle as this had not been planned on the activity schedule, even though it was a dry and warm day. It is agreed for an individual that they should be supported to go out for a walk on a regular basis and be supported to access community venues such as cafes and restaurants. Daily records suggested that although the individual had been out of the house four times in the previous four weeks, only one occasion had involved getting out of the vehicle; the remaining outings had been for a drive. A more person centred, flexible and imaginative approach should be adopted so that individuals identified needs are met. A completed survey from a relative/care/advocate of an individual living at the home included the comment, “ I occasionally have the feeling that some staff lapse into ‘minding’ mode as an easy alternative to ‘doing’, and that this may be a side effect of low morale”. Observations on the day of the visit would support this comment. The self-assessment information provided by the home prior to the inspection acknowledges that more structured in house activities need to be arranged for those people who don’t want to go out. In order to improve people’s quality of life, significant improvements need to be made in this area. Records examined indicate that people are supported to maintain contact with their families. Completed surveys from relatives of individuals confirm this, with one commenting, “They keep me informed about any problems relating to my relative”. Some restrictions are placed upon people living at this home in order to protect them from harm; for example, the cooking area of the kitchen is kept locked unless staff are available to support people. The manager reported at the last inspection that any such restrictions have been agreed and risk assessed. Evidence of this was seen in some of the records examined. Some staff were observed to knock on bedroom/bathroom doors prior to entering in order to ensure the privacy of individuals, however some staff were observed to be less aware of good practice in this area. There were occasions observed where staff attempted to interact with people living at the home, however some staff did not interact or communicate with individuals in a positive manner and spent more time interacting with other staff. This is not good practice and needs to be addressed by the managers of the home. Since the last visit, a cook has been employed to work at the home four days per week. At the time of the inspection, the cook had only been in post for a few days and was still settling in. The cook explained that she was in the process of revamping the menus to ensure that a balanced and varied diet was offered, and would be including the recommended five portions of fruit or vegetables each day. On the day of the visit, the lunch provided was tinned Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 14 spaghetti and quiche and the planned evening meal was cold meat and salad, however there was no salad available. The cook and staff explained that none of the people living at the home like salad anyway. The likes and dislikes of people living at the home must be taken into account when planning the menu. There was no fresh fruit, vegetables or salad available however the staff explained that it was shopping day the next day. It is essential that people living at the home are provided with nutritious and varied meals, and planning in this area must improve. The cook reported that she was in the process of establishing individuals’ likes and dislikes and dietary requirements. Staff reported that people living at the home are encouraged to make choices about what breakfast they would like. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individuals’ personal care needs are met (although how staff support people in this area could improve), however although most peoples’ healthcare needs are met, unclear guidance regarding these needs and use of medication puts some people at risk of harm. EVIDENCE: Individual records examined contained excellent information about how people prefer to be supported with personal care. The level of detail would allow any member of staff to be able to provide personal care using a consistent approach, which is crucial in this service as none of the people living at Cragside House verbally communicate. However, during discussion with staff it was apparent that not all staff are aware of individual care plans, and some care practice observed did not demonstrate that individual’s privacy is protected. For example, some staff were observed to openly discuss peoples’ personal care needs in front of other people living at the home, staff and visitors, and not all support in this area was conducted in private. Information in the records suggests that times for getting up, going to bed etc are flexible and based on what individuals choose to do. A number of people living at the Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 16 home have poor sleep patterns, which could be made worse by the lack of stimulation during the day leading to people not being ready to sleep at the usual times. People living at the home looked well cared for, and there was evidence in the records that people are supported to have regular haircuts. Surveys completed by relatives/advocates/carers included a comment, “Service users seem to be reasonably dressed and fed”. There was evidence in the records that people are supported to attend healthcare appointments when necessary, and all are registered with a GP. A completed survey from a GP gave positive feedback and indicated that they had no concerns about the service and that the home works in partnership with them. Instructions within a care plan about how staff should support an individual with elements of healthcare were unclear and unsafe. This was discussed with the acting manager at the time of the visit who agreed to review the procedure. Since the inspection visit, a meeting has been held between the Commission for Social Care Inspection and senior staff from Valeo, and it has been agreed that alternative arrangements will be made in order to meet the individual’s healthcare needs. Medication and records were examined. With the exception of a few gaps in the medication administration records, most medication could be reconciled with the records. Since the last inspection, staff are now recording medicines received into the home so that it is possible to check medicines against stock balances. A number of the people living at Cragside House are prescribed medication to be administered in an emergency or when required (prn). Guidelines instructing staff when such medicines should be administered are poor or not available. It is very concerning that some of the guidelines give the wrong instructions, potentially putting individuals at risk of harm, and for some there was no guidance at all for staff about when it should be administered. It was also noted that prescribed creams are not consistently applied. One individual had not had their prescribed cream for twenty-one days prior to the inspection. Staff thought that they might have run out. Whilst there is a record in individuals’ care plans of medication they are prescribed, there is no information about why they are taking it. Some staff spoken to were unsure of why individuals were taking certain medicines, and it would be good practice to include this information in the records to assist with monitoring effectiveness. At the meeting between CSCI and Valeo following the inspection, the Director of Care informed the CSCI that a review of all medication guidelines had taken place. Following the inspection, a letter expressing serious concerns about some aspects of the care provided at Cragside House was sent to the provider. This included a requirement about the safe administration of medicines which has been included as part of this report with the timescales given in the letter. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 17 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): 22,23 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Clear complaints and protection procedures are in place, however people living at Cragside House are not adequately protected from harm by the home’s practice in relation to the management of challenging behaviour. EVIDENCE: A satisfactory complaints procedure is in place that is available in the home. Information received from the home prior to the inspection indicates that no complaints have been received in the last twelve months and that all staff are made aware of the procedure as part of their induction training. Of four completed surveys, three relatives/advocates/carers indicated that they were aware of the complaints procedure and one was not. Three indicated that the service usually responded appropriately to concerns they have raised and one indicated that this is always the case. Procedures are in place for safeguarding vulnerable adults and staff spoken to were able to give a satisfactory account of how they would respond if they suspected abuse. The organisation has an identified named co-ordinator for safeguarding issues. Since the last inspection where a number of protection matters were identified, all staff have received training in safeguarding, and this has been discussed at team meetings. Since the last inspection the deputy manager has piloted the new role of ‘Protection of Vulnerable Adults (POVA) Watchdog’ at the home. POVA watchdog guidelines have been sent to the CSCI and these clearly set out the objectives and responsibilities of this Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 18 position. The deputy manager described how new systems for checking incident and accident reports have been implemented in order to monitor any injuries etc to people living at the home. The new systems are reported to have been effective in that unexplained bruising or injuries to individuals are followed up appropriately, and it was reported that staff are much more likely to question where an injury/bruise has come from. Some of the people living at Cragside House display challenging behaviour, and this sometimes results in other people living at the home, and staff being physically hurt. It has been identified that a particular individual has been the target of many of these incidents, however staff spoken to did not demonstrate that there was a clear understanding of what action should be taken in order to protect this individual from further assaults. Although a risk assessment is in place, steps agreed to minimize risks are clearly not effective or are not being adhered to as there continues to be incidents whereby an individual is being targeted physically. These concerns were raised at the inspection, in a letter sent to the provider following the visit and in a meeting held with the providers soon after the inspection visit. The provider has taken these concerns very seriously and had made arrangements to review how the individual is being protected from harm. A number of the people living at Cragside House have physical intervention plans in place. Following discussion with staff it was clear that what is agreed in the plan is not what happens in practice. Staff did not agree with some of the plans stating that if these actions were taken, the incident requiring physical intervention would make the situation worse and potentially escalate further. Some staff did not demonstrate a good understanding of physical aggression and the possible reasons for this, and presented as negative in their approach. It must be acknowledged however that a number of staff have been hurt or injured during behavioural incidents, and it is crucial that they are supported and appropriately trained to manage these incidents safely and positively. The acting manager is addressing this. Further information about how to de-escalate situations as part of a general behaviour management plan is necessary. These should be individualised, as a number of specific elements are the same in each plan, despite the people at the home having very different needs and responses. It is most concerning that some staff, including senior staff, have not read all the physical intervention plans. This is unsafe practice and puts both staff and people living at the home at risk of harm. There is evidence that staff have received training in physical intervention, although this is not accredited by the British Institute of Learning Disabilities (Bild) as recommended by the Department of Health. The organisation has since reported that they are reviewing their approach to the management of challenging behaviour, including what training is required. The acting manager and deputy manager were advised at the time of the visit to familiarise themselves with the Department of Health Guidance regarding safe physical intervention. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 19 Information provided prior to the inspection indicates that in the last twelve months there have been three referrals made under safeguarding procedures, in order to protect people living at the home. Two of these have involved investigations into poor/abusive care practice by staff members, and one was unrelated to the homes staff. Appropriate action has been taken by the organisation and the acting manager has reported that close monitoring is taking place. The home has notified the relevant authorities of these incidents. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a clean, comfortably furnished home that is domestic in style and homely. EVIDENCE: A tour of the premises was conducted as part of the visit and all bedrooms and communal areas were seen. The house is generally clean and free from unpleasant odour and is comfortably furnished in a domestic style. Accommodation and facilities are provided over four floors. Laundry, multisensory room and medication storage is in the basement, communal areas on the ground floor, and bedrooms on the first and second floors. This home is not accessible to people with mobility difficulties, as there is no lift. People living at the home have access to a large lounge, conservatory, dining room and hallway in addition to their own bedrooms. The home also has the benefit of a multi-sensory room in the basement and large attractive gardens. There is a large office on the ground floor and two vacant bedrooms on the top floor Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 21 of the house. One of the vacant bedrooms is used by staff for meetings and completing records. Since the last inspection, new sofas have been purchased for the lounge which are much more comfortable and suitable for the people who live at the home. The acting manager reported that there is a planned programme of redecoration. Some bedrooms are highly personalised and comfortable. The acting manager explained that some of the people living at the home prefer not to have lots of personal items in their bedrooms. Since the last inspection a cleaner has been employed, and had been in post for two weeks at the time of the visit. The acting manager explained that the cleaner is responsible for all communal areas of the home, however staff would continue to support individuals with cleaning their bedrooms. Staff are responsible for doing the laundry, and good laundry facilities are available including an industrial washing machine and tumble dryer, hand washing facilities and a paper towel dispenser, which has been installed since the last visit. The washing machine has a sluice cycle and systems are in place to deal with soiled items appropriately. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A trained staff team supports people living at Cragside House, however general care practice needs to improve and recruitment procedures must be more thorough to ensure that all people living at the home are protected. EVIDENCE: Staff training is provided covering a range of relevant areas including, moving and handling, protection of vulnerable people, fire safety, first aid. The acting manager reported that staff training needs are discussed in one to one consultation meetings between the manager and staff member. Records examined confirmed this. Of twenty-six care staff, five have achieved NVQ (National Vocational Qualification) level two or above and nine are working towards NVQ level two or above. The self assessment form submitted prior to the inspection states that the home’s plans for improvement over the next twelve months includes staff achieving their NVQ qualifications within a short timescale. All four relatives/carers/advocates who completed surveys as part Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 23 of this inspection commented that in their view staff needed extra training, though unfortunately none indicated what areas they felt this was needed in. It was not possible to ascertain the views of the people living at the home due to their level of learning disability, therefore time was spent observing interactions between staff and individuals. Some staff were observed to engage in a positive manner with people living at the home and make attempts at engaging with individuals, for example, a staff member was observed to include a number of people in throwing and catching a ball, and a member of staff was observed to dance and sing with another individual. However, several examples of less positive interactions were observed with some staff seeming to have little understanding of the needs of the people living at the home. For example, there was a lack of effective communication with individuals, and some staff were negative and sometimes confrontational with individuals. Staff morale appeared to be low and at times there seemed to be a lack of motivation to enable individuals to engage in positive behaviours and activities. Feedback from relatives/carers/advocates of people living at the home in response to the question ‘do care staff have the right skills and experience to look after people properly?’ two responded ‘sometimes’, and two responded ‘usually’. Comments added include, “some staff have the necessary skills and understanding, others don’t”, “ I think staff could do with more training in some areas”, “in relation to staffing levels, I always have the impression that some staff are less ‘driven’ than others”. Other comments received about what the home could do to improve and whether or not individuals needs are being met include, “Improve all round standards. Better training for staff. Appreciating all service users needs”, “ Not always (meets needs of relative). Staff morale appears to be down on occasions”. Staff care practice and morale has been discussed with the acting manager and senior managers at the meeting held between CSCI and Valeo following the inspection. Staff recruitment records for six staff members were examined. All had an application form and two written references as required, however gaps in employment history were noted on three application forms, and there was no evidence to indicate that this had been discussed during the recruitment process. The acting manager reported that staff would be asked about this at interview stage, but acknowledged that this should have been recorded. It was also noted that a member of staff had been working at the home without Criminal Records Bureau (CRB) clearance. The acting manager explained that a check against the Protection of Vulnerable Adults (POVA) register had been completed, and that the staff member would be in addition to the number of usual staff, would be supervised at all times and not deliver personal care. However, the rotas examined showed that this staff member had not been extra to the usual numbers of staff on shift. Whilst it is accepted that the staff member did not provide personal care and was supervised, this will impact upon the staff available to support individuals safely. The acting manager Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 24 reported that on the day of inspection it had been discovered that the cleaner had been working without a CRB or POVA check and had therefore been asked not to come into work until these checks had come back. It is unacceptable that staff are working with vulnerable people without having had the necessary checks, although it is acknowledged that the organisation did identify this and take the appropriate action. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 25 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): 37,39,42 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Good quality assurance systems are in place, however a clearer sense of direction and leadership is necessary in order to improve peoples quality of life, and the health and safety of people needs to be better protected in some areas. EVIDENCE: Since the last inspection, the registered manager has gone on maternity leave, and an acting manager is in post. The acting manager has worked at another Valeo home for eight years in the positions of project worker, senior project worker, deputy manager and acting manager. The acting manager has recently started NVQ level four in care and intends to complete the Registered Managers Award following this. She reported that she has attended all the relevant training events including two management training days recently. At Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 26 the time of the inspection, the acting manager had been in post for four months, so was still in the process of settling in. During the visit, the acting manager was observed to act as a positive role model for staff and demonstrated good care practice and positive approaches with people living at the home. Unfortunately, she reported that she has little time available to spend working alongside staff, and is largely dependant on the deputy manager and senior project workers to monitor and lead the day-to-day running of shifts. There was however a number of concerns identified during the inspection about the leadership of the staff team, and it was observed that stronger leadership and positive role modelling would be beneficial to the people living at the home. Cragside House is going through an unsettled period due to changes in management and the move of three people with complex needs from The Lodge (a Valeo home next door to Cragside House) to Cragside House. In order to improve peoples’ quality of life, the leadership and management approach of the home needs to get better. Since the inspection, discussions have taken place with the Director of Care regarding management of the home. She has assured the CSCI that additional support will be provided to the acting manager to enable her to address the areas that require attention. Quality assurance systems are in place. Annual surveys are sent to relatives of people living at the home, and the Director of Care addresses any matters arising with families directly and with staff where necessary. The Director of Care conducts monthly unannounced visits and a detailed report is sent to the Commission with the findings of the visit. These are of a high standard, are detailed, focused on people living at the home and include an action plan with timescales for any work to be completed. A recent visit was conducted during the night to enable the Director of Care to meet with night staff and observe the usual nighttime routine. This is good practice. The monthly reports evidence that time is spent observing care practice, routines and consulting with staff about how peoples needs are being met. The most recent report indicates that people are offered good support at night and that night staff have positive relationships with individuals. Information received prior to the visit indicates that equipment is maintained and serviced at the required intervals. Evidence of this was seen in fire safety records. Comprehensive health and safety policies and procedures are in place and staff attend health and safety training during the induction period and then annually. Whilst there are risk assessments in place concerning people living and working at the home, as previously discussed, these are not always effective or followed and care needs to be taken to ensure risk assessments are reviewed when necessary. Since the last inspection, the home has made improvements in notifying the appropriate authorities of any accidents, incidents or safeguarding matters and this is positive. However improvements in the management of challenging behaviour are necessary in order to ensure the safety of people living and working at the home. Some areas of medicine management are unsafe and do not protect individuals health and safety. The Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 27 CSCI have been in discussion with the organisation since the inspection in order to ensure this matter is addressed as a matter of urgency. Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 28 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 Standard No Score 1 X 2 3 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 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 X 3 X X 1 X Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA23 YA42 Regulation 13(7)(8), 15 Timescale for action In order to protect people living 27/07/07 at the home, where it is necessary to use physical intervention, this must be agreed as part of the care plan (and should be in line with Department of Health guidance) and only used in exceptional circumstances. All staff working with people that may require physical intervention must be aware of the agreed plan, and this must be kept under review and changed when necessary to reflect individuals’ current needs. In order to protect individuals 23/07/07 from harm, unnecessary risks to the health or safety of people living at the home must be clearly identified and so far as possible eliminated. In order to protect the health 20/07/07 and well being of people living at the home, clear guidance must be available to staff about when ‘as required’ (prn) medication should be administered, and medication must be administered DS0000026306.V343167.R02.S.doc Version 5.2 Page 30 Requirement 2. YA9 YA23 YA42 13(4) 3. YA20 13(2) Cragside House as prescribed. 4. YA34 YA42 19, Schedule 2 In order to protect people living 15/08/07 at the home, recruitment procedures must be robust. Staff must not work with vulnerable people until all the required checks have been completed. Information and documents required are detailed under Schedule 2 of the Care Homes Regulations 2001. 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 YA12 YA13 Good Practice Recommendations People should be supported to participate in a range of fulfilling, valued activities appropriate to their needs and wishes both in and outside of the home so that a good quality of life can be maintained. De-escalation techniques described as part of behaviour management strategies should be individualised so that the use of restrictive physical interventions is minimised as far as possible. In order to improve physical intervention plans, in accordance with department of health guidance, multi-disciplinary agreement should be sought in consultation with the service user where possible, their carers or advocates and a record of this should be kept. In line with department of health guidance on ‘restrictive interventions for people with learning disability and autistic spectrum disorder’ the provider should explore training that is accredited under the BILD Code of Practice. 2. YA23 3. YA23 Cragside House DS0000026306.V343167.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 © 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 DS0000026306.V343167.R02.S.doc Version 5.2 Page 32 - 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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