CARE HOME ADULTS 18-65
Craigmore House 49-51 Bede Road Barnard Castle Durham DL12 8HB Lead Inspector
Mr Paul Emmerson Unannounced Inspection 25th January 2006 11:00 Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 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 Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 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. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Craigmore House Address 49-51 Bede Road Barnard Castle Durham DL12 8HB 01833 630684 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) Mrs Christine Taylour Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Craigmore House provides personal care and accommodation for up to ten adults (aged 18 - 65) with learning disabilities. The service operates within the private sector and is owned and managed on a day-to-day basis by Mrs. Christine Taylour. The home was formerly two large terraced houses. A door between the dining room and the television room connects the two properties. All bedrooms are for single occupancy. The home is situated within walking distance of the town centre and other local amenities. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. By law we have to inspect all care homes at least twice a year. This unannounced inspection was carried out in accordance with this obligation. The inspection took place over 5½ hours on the afternoon and evening of Wednesday 25 January 2006. In line with current CSCI policy on ‘Proportionality’, the inspection focused upon a number of key standard outcomes for service users. The key standard outcomes not inspected on this occasion were assessed during the last inspection of the home. The inspector looked around the building and a number of records were examined. The home’s proprietor, deputy manager, 3 staff members and 10 service users were spoken to. What the service does well: What has improved since the last inspection?
Communal areas and some bedrooms have been redecorated. Staff training continues. Most staff have NVQ (National Vocational Qualification) level 2 and have nearly completed NVQ level 3. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 6 Holidays and additional leisure opportunities have been arranged. A number of service users now have work placements that the home has arranged for them. 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. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these outcomes / standards were assessed on this occasion. They were examined during the last inspection of the home. EVIDENCE: N/A Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these outcomes / standards were assessed on this occasion. They were examined during the last inspection of the home. EVIDENCE: N/A Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 10 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 the following standard(s): None of these outcomes / standards were assessed on this occasion. They were examined during the last inspection of the home. EVIDENCE: N/A Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 11 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 the following standard(s): Personal and healthcare needs are met. Any medicines required are dealt with correctly. EVIDENCE: The inspector spent time talking to, and in the company of, service users and saw that they are supported to live relatively independent lives, are well cared for and comfortable in their home. Management and staff ensure that service users’ health care needs are met. Where specialist intervention is required it is sought. Records confirm that contact with GPs and other health professionals is maintained. Where necessary, referral to specialist services is facilitated. Where service users’ needs change over time the home responds accordingly. There are good relationships between care staff and service users. Staff have a good understanding of service users’ needs, wishes and preferences and respond appropriately. Care plans identify: assessed health, personal and social care needs; goals & aspirations; and highlight the specific action / interverventions required and being taken to meet them. Care plans have been prepared in a person centred manner and operate within a risk management framework. Care planning arrangements are regularly monitored and reviewed where necessary.
Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 12 Appropriate policies and procedures are in place with regard to the receipt, recording, storage, handling, administration and disposal of medication. The home uses a monitored dosage (Nomad) system. Although no service users administer their own medication, staff are adhering to the home’s medication policies and procedures. The home’s medication records were found to be accurate and complete. Care staff who administer medication receive training in the safe handling of medicines. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 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 the following standard(s): Systems are in place to respond to any complaints. Service users are safeguarded from abuse. EVIDENCE: The home’s complaints policy and procedure is made available to service users. From observations made during the course of the inspection and from discussions with service users, management and staff it is evident that service users are positively encouraged to raise concerns about matters affecting their lives. Staff interviewed voiced a commitment to the service users they work with and to upholding service users’ rights. Regular house meetings are held. Service user satisfaction questionnaires have been distributed and completed by service users. The home facilitates service users’ access to a local speaking up group. One person who lives at Craigmore House represents the home on the committee of the speaking up group. More creative ways to obtain service users views have also been adopted. For example, through role-play. Friday night is ‘Big Brother’ night where one of the lounges is used as a ‘Diary Room’ for service users to discuss any concerns they have or raise matters if they wish to. However, it was noted that although complaints are adequately dealt with, the recording of complaints in the home requires further consideration. A record must be kept of all complaints made by service users or representatives or relatives of service users or by persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint.
Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 14 Although in a CSCI inspection comment card a service user wrote, “I sometimes feel unsafe when other residents lose their temper” systems are in place within Craigmore House to ensure the protection of service users. A copy of Durham & Darlington Adult Protection Committee’s Inter-Agency Adult Protection Policy & Procedures is available in the home. The home also has its own policy and procedure documents relating to abuse and whistle-blowing. Policy and procedure documents relating to adult protection provide information and guidance to staff. Staff training in this area is also provided. However, these documents should be reviewed, and where necessary amended, to reflect recent developments, local protocols, contact arrangements and the initial action to be taken (things to do and things not to do) if an allegation of abuse arises. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these outcomes / standards were assessed on this occasion. They were examined during the last inspection of the home. However, it is acknowledged that since the last inspection a number of rooms and communal areas have been redecorated. EVIDENCE: N/A Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Appropriate staffing and recruitment arrangements are in place. The home’s commitment to training is commendable. EVIDENCE: Staffing levels and rostering arrangements within the home are considered adequate to meet the needs of the service users currently accommodated. Where additional staff hours are required to provide additional support for individual service users it is provided. From observations made, documents examined and discussions with service users, management and staff, the people employed are experienced and competent. Service users are supported by an effective staff team of sufficient number. All staff left in charge of the home are at least 21 years of age. The home has appropriate recruitment policy / procedure documents based upon equal opportunities. Albeit informally, service users are involved in the recruitment process for new staff. Two written references are taken before employment can commence. New staff receive a statement of terms and conditions and their appointment is subject to a probationary period. CRB (Criminal Records Bureau) enhanced disclosures are obtained. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 17 However, as highlighted in the previous inspection report, to ensure the suitability of staff working in the home, Criminal Records Bureau (CRB) Disclosures and Protection of Vulnerable Adults (POVA) checks are required for all staff (including those who are employed as domestic assistants) appointed after 26 July 2004. The home is working with an accredited training college to provide appropriate staff training through induction and NVQ (National Vocational Qualification) courses. Training is also now being provided through LDAF (Learning Disability Award Framework) courses. 9 of the home’s 10 support staff have an NVQ qualification and most have nearly completed NVQ level 3. The home’s activity in this area is commended Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Craigmore House is a well run home. Appropriate quality assurance systems are in place to identify and rectify any concerns. EVIDENCE: Craigmore House is owned and managed on a day-to-day basis by Mrs. Christine Taylour who is qualified, experienced and competent in her role. Previous inspection reports have referred to a need for her to complete a management training course at NVQ level 4 or equivalent by 2005. However, it is understood that a separate manager is to be employed who will be applying to CSCI to become ‘registered manager’. Nevertheless, management and supervision arrangements are clear. A deputy currently supports the proprietor / manager. Shift handovers and regular staff meetings take place, which ensure the sharing of information and continuity of care. Staff also have regular and recorded formal supervision meetings where issues regarding working practices, training and personnel needs are discussed. Staff supervision has been developed to incorporate appraisals. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 19 Staff have received a copy of the home’s grievance and disciplinary procedures. From documents examined and discussions with service users and staff, the management approach within Craigmore House is open and inclusive. Staff and house meetings are held and there is a proactive approach to obtaining service users’ views. Systems are being developed to produce effective quality assurance and quality measuring systems. Feedback is obtained through staff meetings, residents meetings and day-to-day dialogue within the home. Service user satisfaction questionnaires have been distributed, completed and returned by service users. The home facilitates service users’ access to a local speaking up group, which is empowering and enabling service users to speak up about issues within the home and matters affecting their lives. Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 20 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 X 2 4 X 3 X 2 4 X X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X X 3 X 3 X 3 X X 3 X Craigmore House DS0000007461.V259299.R01.S.doc Version 5.1 Page 21 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 YA22 Regulation 17(2) & Sch. 4(11) 19 & Sch. 2&4 Requirement A record must be kept of all complaints made, which should include details of any investigation and action taken. As highlighted in the previous inspection report, to ensure the suitability of staff working in the home, Criminal Records Bureau (CRB) Disclosures and Protection of Vulnerable Adults (POVA) checks are required for all staff (including domestic assistants) appointed after 26/7/04. Timescale for action 01/04/06 2. YA34 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA23 Good Practice Recommendations Policy and procedure documents relating to adult protection should be reviewed, and where necessary amended, to reflect recent developments, local protocols, contact arrangements and the initial action to be taken (things to do and things not to do) if an allegation of abuse arises.
DS0000007461.V259299.R01.S.doc Version 5.1 Page 22 Craigmore House Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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