Inspection on 09/06/04 for Craigmore House

Care Homes For Adults (18 ­ 65)Craigmore House49-51 Bede Road Barnard Castle Durham DL12 8HBUnannounced Inspection9th June 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Craigmore House Address 49-51 Bede Road, Barnard Castle, Durham, DL12 8HB Email address craigmore-house51@tiscali.co.uk www.britnettnett/craigmore.co.uk Name of registered provider Christine Taylour Name of registered manager (if applicable) Type of registration Care Home No. of places registered (if applicable) 10 Tel No: 01833 630684 Fax No: 01833 637700Category(ies) of registration, with (number of places) Learning disability (10) Registration number B040000068 Date first registered 15/9/1997 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply? Date of last inspection Date of latest registration certificate 19th July 2002 YESNO 17/9/03If Yes refer to Part CCraigmore HousePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspection9th June 2004 1:00 p.m. ­ 8:15 p.m. Paul Emmerson N/A Christine TaylourID Code073281Craigmore HousePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementCraigmore HousePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of Craigmore House. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Craigmore HousePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Craigmore House is a care home providing personal care and accommodation for up to ten adults (aged 18 ­ 65) with learning disabilities. Craigmore House operates within the private sector and is owned and managed on a day-today basis by 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 HousePage 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This unannounced inspection took place on the afternoon and evening of Wednesday 9th June 2004. The inspection considered: Standards 1-5 (Choice of Home); Standards 6-10 (Individual Needs & Choices); Standards 11-17 (Lifestyle); Standards 18-21 (Personal & Healthcare Support); Standards 22-23 (Complaints & Protection); Standard 24 (Premises); Standard 29 (Adaptations); Standard 30 (Hygiene & Control of Infection); Standard 32-34 (Staffing); and Standard 42 (Safe Working Practices) of The National Minimum Standards for Care Homes for Adults (18 ­ 65). In addition, a number of issues that had been raised in previous inspections of the home were examined. The inspection found that all of the National Minimum Standards inspected are now met or almost met. Positive comments were received from service users and staff. The commitment and progress being made to meet National Minimum Standards is acknowledged. However, as highlighted below, some matters require attention. Choice of Home (Standards 1-5). 2 of the 5 Standards assessed were met. Although there have been no recent admissions to the home, from discussions with management and staff, previous admissions to the home were appropriately managed. However, although Contract, Statement of Purpose and Service Users Guide documents have been prepared, some amendments are required. Individual Needs and Choices (Standards 6-10) All of the 5 Standards assessed were met. Service users needs are being met and service users are offered choice. Care planning arrangements within Craigmore House are now much improved. The homes commitment and progress in this area is acknowledged. Lifestyle (Standards 11-17) 6 of the 7 Standards assessed were met. Service users engage in appropriate leisure facilities and relationships are supported. The food provided is of a good quality and sufficient quantity. The home enjoys very good links with the local community. A comprehensive social and recreational programme is available, which encourages service users to participate in a range of activities that are organised throughout the week. To ensure future work placement opportunities the home, through the day service it operates, has recently opened a shop in the town, which sells ceramics and craft items. Service users and staff expressed great enthusiasm for this project. Activity in this area is commended. Continued:Craigmore HousePage 6 Personal and Healthcare Support (Standards 18-21) All of the 4 Standards assessed were met. Arrangements are in place to meet service users health and personal care needs. Care plans and care planning arrangements generally ensure such needs are documented and reviewed. Appropriate arrangements, policies and procedures are in place in relation to medication. Concerns, Complaints & Protection (Standards 22-23) 1 of the 2 Standards assessed was met. Systems are in place to safeguard service users from abuse and service users are encouraged to express any concerns they may have. However, the home must produce revised adult protection policies and procedures. Environment (Standards 24-30) All of the 3 Standards assessed were met. Craigmore House is conveniently situated, well maintained and meets the needs of the service users currently accommodated. Staffing (Standards 31-36) All of the 3 Standards assessed were met. The home is adequately staffed with employees who are experienced and competent. Staff training is being provided. All staff have almost completed NVQ level 2 training. Appropriate references and Criminal Record Bureau enhanced disclosures are requested for all staff. Conduct and Management of the Home (Standards 37-43) The 1 Standard assessed was met. The inspection confirmed that the homes management arrangements are open, effective and ensure the health and safety of service users and staff.Craigmore HousePage 7 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report, which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action As highlighted in the previous inspection 4, 5 & 1. report, the homes Statement of Purpose and 1 October Schedule YA1 Service Users Guide documents require 2003 1 revision to ensure compliance with Standard 1. 5, 17(1)(c) & Schedule 3(q) As highlighted in the previous inspection report, service users responsibilities for housekeeping tasks must be specified in the Service 1 October Users Guide and individual care plans. Rules 2003 on smoking, alcohol and drugs must be clearly stated in the homes contract with service users. As highlighted in the previous inspection report, policies and procedures, which ensure that service users are protected from harm, abuse, neglect and self-harm, must be developed. The home should obtain a copy of `Durham & Darlington Adult Protection Committees Inter-Agency Adult Protection Policy & Procedures and make any necessary amendments to its own documentation covering this issue.2.YA5 & YA163.13(6)YA231 October 2003Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements.Craigmore HousePage 8 RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard 1. YA2 As highlighted in the previous inspection report, an assessment tool for service users who are self-funding and therefore without a Care Management Assessment / Plan should be developed. As highlighted in the previous inspection report, a policy and procedure document should be developed and implemented which explains that emergency admission does not imply the right or requirement to stay in the home following assessment and that when an emergency admission is made the service user will be informed within 48 hours about key aspects of the service and that all other admission criteria will be met within 5 working days. As highlighted in the previous inspection report, the home should prepare a statement on confidentiality to give to partner agencies, setting out the principles governing the sharing of information. As highlighted in the previous inspection report, policies and procedures should be developed regarding service users right to have intimate personal relationships and access to specialist guidance to support service users in making appropriate decisions. Staff training in this area should also be considered. As highlighted in the previous inspection report, the registered manager should complete a management-training course at NVQ level 4 or equivalent by 2005.2.YA43.YA104.YA155.YA37CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS). None.MET (YES/NO)Craigmore HousePage 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action As highlighted in previous inspection reports, the homes Statement of Purpose and 1 October 4, 5 & 1. YA1 Service Users Guide documents require 2004 Schedule 1 revision to ensure compliance with Standard 1. Contract documents should be updated to reflect: any changes in fees payable; service users contributions; and the manner in which such contributions are collected. YA5 & YA16 As highlighted in previous inspection reports, 1 October service users responsibilities for house- 2004 keeping tasks must be specified in the Service Users Guide and individual care plans. Rules on smoking, alcohol and drugs must be clearly stated in the homes contract with service users. As highlighted in previous inspection reports, policies and procedures for the home, which ensure that service users are protected from harm, abuse, neglect and self-harm, must be developed. Having obtained a copy of `Durham & Darlington Adult Protection Committees Inter-Agency Adult Protection Policy & Procedures the home should make any necessary amendments to its own documentation covering this issue.2.5, 17(1)(c) & Schedule 3(q)3.13(6)YA231 October 2004Craigmore HousePage 10 RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * Any reference to the NCSC in the homes Statement of Purpose, Service Users Guide or other documentation should be amended to refer to the Commission for Social Care Inspection (CSCI). As highlighted in previous inspection reports, an assessment tool for service users who are self-funding and therefore without a Care Management Assessment / Plan should be developed. As highlighted in previous inspection reports, a policy and procedure document should be developed and implemented which explains that emergency admission does not imply the right or requirement to stay in the home following assessment and that when an emergency admission is made the service user will be informed within 48 hours about key aspects of the service and that all other admission criteria will be met within 5 working days. As highlighted in previous inspection reports, the home should prepare a statement on confidentiality to give to partner agencies, setting out the principles governing the sharing of information. As highlighted in previous inspection reports, policies and procedures should be developed regarding service users right to have intimate personal relationships and access to specialist guidance to support service users in making appropriate decisions. Staff training in this area should also be considered. Creams and ointments should be stored separate from other medicines. As highlighted in previous inspection reports, the registered manager should complete a management-training course at NVQ level 4 or equivalent by 2005.1.YA12.YA23.YA44.YA105.YA156. 7.YA20 YA37· Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Craigmore House Page 11 Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs)YES NO NO YES YES NO NO NO YES YES YES NO YES YES NO NO NO YES NO YES 10 0 0 YES YES YES YES 10 0 9/6/04 13:00 7.25The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: Craigmore House Page 12 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met(Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Craigmore HousePage 13 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. £337 £337 Range of fees charged From To £ £ (per week) NO Any charges for extras If yes, please state what the extras are 2 Key findings/Evidence Standard met? Although it is acknowledged that Statement of Purpose and Service Users Guide documents have been prepared, as highlighted in previous inspection reports, these documents require revision to ensure compliance with this Standard. Further, in April 2004 the previous registration authority ­ the NCSC ­ ceased to exist. Any reference to the NCSC in the homes Statement of Purpose, Service Users Guide or other documentation should be amended to refer to the Commission for Social Care Inspection (CSCI).Craigmore HousePage 14 Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 2 Key findings/Evidence Standard met? For service users referred to the home via care management arrangements a summary of the assessment and care plan prepared for care management purposes is obtained prior to admission. This serves to ensure that the home can determine if it can meet the persons needs. However, whilst it is accepted that most new service users will come to the home via this care management route, for service users who may be self-funding no pre-admission assessment documents are available in the home. As highlighted in previous inspection reports, an assessment tool for service users who are self-funding and therefore without a Care Management Assessment / Plan should be developed. Such a tool would also assist in the homes own assessment of persons being admitted to the home.Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 4 Key findings/Evidence Standard met? This Standard is met. From observations made, documents examined and discussions with service users (within the limits of their communication and understanding) management and staff, Craigmore House provides a very good standard of care to the ten service users accommodated. The care provided is underpinned by the knowledge, values and experience of the homes management and staff. Specialist needs are met through interventions within the home or through access to specialist services as required. Activity in this area is commended.Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 3 Key findings/Evidence Standard met? This Standard is met. Although there have been no recent admissions to the home, from discussions with management and staff, previous admissions to the home were appropriately managed. However, as highlighted in previous inspection reports, a policy and procedure document should be developed and implemented which explains that emergency admission does not imply the right or requirement to stay in the home following assessment and that when an emergency admission is made the service user will be informed within 48 hours about key aspects of the service and that all other admission criteria will be met within 5 working days.Craigmore HousePage 15 Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 2 Key findings/Evidence Standard met? Contracts have been drawn up and provided to all service users. Where people are admitted to the home via care management arrangements, a copy of the contract between the home and the Local Authority is obtained. However, contract documents should be updated to reflect: any changes in fees payable; service users contributions; and the manner in which such contributions are collected. Further, as highlighted in previous inspection reports, rules on smoking, alcohol and drugs must be clearly stated in the homes contract with service users.Craigmore HousePage 16 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 3 Key findings/Evidence Standard met? This Standard is met. 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 reflect a shift towards a more person centred aproach and operate within a risk management framework. Care planning arrangements are regularly monitored and reviewed where necessary. The homes commitment and progress to meet this Standard is acknowledged.Standard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 3 Key findings/Evidence Standard met? This Standard is met. Such rights are respected. Care planning arrangements have been developed and reflect a shift towards a more person centred aproach within a risk management framework. Likes, dislikes and lifestyle preferences are evidenced in care planning arrangements and wherever possible ­ within the limits of their communication and understanding - service users are encouraged and supported to make choices. Any limitations on facilities are recorded in service users care plans.Craigmore HousePage 17 Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? This Standard is met. From observations made during the course of the inspection and from discussions with service users, management and staff it is evident that service users participate in activities associated with the day-to-day running of Craigmore House. Service users are also actively encouraged to raise concerns and complaints about the services they receive.Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 3 Key findings/Evidence Standard met? This Standard is met. From observations made, documents examined and discussions with management and staff, within the limits of their communication and understanding, service users are enabled to take responsible and informed risks associated with daily living. Risk assessment documents have been prepared as part of service users care plan documents. For example, care planning and risk assessments document the actions taken to enable a service user to use public transport to attend college.Standard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 3 Key findings/Evidence Standard met? From observations made during the course of the inspection and from discussions with service users, management and staff it is evident that confidentiality is respected. Care plans and other records are appropriately stored. However, as highlighted in previous inspection reports, the home should prepare a statement on confidentiality to give to partner agencies, setting out the principles governing the sharing of information.Craigmore HousePage 18 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 4 Key findings/Evidence Standard met? Service users needs in this area are met by the home. Service users are provided with opportunities for personal development and to maintain or enhance their personal living skills. Activities within the home provide service users with opportunities to develop practical life skills. House meetings are regularly held. Service users also attend a local speaking up group. Craigmore House operates as a family home. The homes management and staff are clearly committed to enhancing the quality of life of the service users accommodated. Activity in this area is commended.Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 4 Key findings/Evidence Standard met? Service users attend a local technical college. Service users have undertaken / are undertaking cooking and basic skills courses. One service user attended a horse management course. A range of `day-care options is accessed to ensure that the service users are able to participate in a wide range of activities and settings. Appropriate social and recreational activities are arranged in consultation with service users. A number of service users have work placements arranged through the home. To ensure future work placement opportunities the home, through the day service it operates, has recently opened a shop in the town, which sells ceramics and craft items. Service users and staff expressed great enthusiasm for this project. Activity in this area is commended.Craigmore HousePage 19 Standard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 4 Key findings/Evidence Standard met? Staff provide support to service users to be part of the local community and participate in community-life. For example, one service user is involved with a local theatrical group. Service users access local facilities including, shops, pubs, the local library and local events. A range of day-care provision is arranged to ensure that the service users participate in a wide range of activities and settings. Appropriate social and recreational activities are arranged in consultation with service users. A number of service users attend work placements arranged through Craigmore House. The home, through the day service it operates, has recently opened a shop in the town, which sells ceramics and craft items. The home takes a proactive approach to tackle discrimination where it arises. Activity in this area is commended.Standard 14 (14.1 ­ 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. 4 Key findings/Evidence Standard met? Service users are encouraged to participate in a variety of activities available to them. Holidays are arranged and regular `short breaks take place. Short breaks now include regular trips to Spain. There are frequent nights out including pop concerts, pub visits and shopping trips. Good use is made of the local sports centre and swimming pool. Activity in this area is commended.Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? This Standard is met. Family links and friendships are supported. There is documented evidence of contact between service users and families held within care plans. The home has open visiting arrangements and visitors are warmly welcomed into Craigmore House. However, as highlighted in previous inspection reports, policies and procedures should be developed regarding service users right to have intimate personal relationships and access to specialist guidance to support service users in making appropriate decisions. Staff training in this area should also be considered.Craigmore HousePage 20 Standard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 2 Key findings/Evidence Standard met? Routines within Craigmore House are flexible to suit individual needs and lifestyle preferences. Service users rights are protected and privacy is respected. Locks are fitted to bedroom doors and service users are able to hold their own keys. Staff were observed to actively include service users in conversation, thus ensuring ongoing interaction within the activity of the home. However, as highlighted in previous inspection reports, service users responsibilities for house-keeping tasks must be specified in the Service Users Guide and individual care plans. Rules on smoking, alcohol and drugs must be clearly stated in the homes contract with service users.Standard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? This Standard is met. From observations made, documents examined and discussions with management and staff, any specific dietary requirements are accommodated. Records / menus of food supplied and also stocks of foodstuff seen to be available within the home on the day of the inspection show that a varied, flexible and sufficient diet is provided. Where service users require assistance, support or encouragement with dining it is provided. Service users likes and dislikes are accommodated and are catered for within menus provided.Craigmore HousePage 21 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes 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.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 3 Key findings/Evidence Standard met? This Standard is met. From observations made, documents examined and discussions with management and staff, where personal support is required it is provided appropriately. Where guidance and encouragement is required it is provided to ensure that service users needs are met in accordance with their preferences.Standard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) 203 Key findings/Evidence Standard met? This Standard is met. From observations made throughout the inspection, an examination of service users care plans together with discussions with service users, staff and management, service users health is monitored. Where necessary, referral to specialist services is facilitated.Craigmore HousePage 22 Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 3 Key findings/Evidence Standard met? This Standard is met. From observations made, documents examined and discussions with management and staff, although no service users administer their own medication, staff are adhering to the homes medication policies and procedures. The homes medication records were found to be accurate and complete. Care staff who administer medication receive training in the safe handling of medicines. Satisfactory arrangements have been made for the safe storage of medicines. However, creams and ointments should be stored separate from other medicines.Standard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 3 Key findings/Evidence Standard met? This Standard is met. The homes care plans and care planning arrangements generally consider service users changing needs, monitor health needs and any changes over time. Formal care reviews are held where such issues are considered.Craigmore HousePage 23 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI (previously NCSC) Percentage of complaints responded to within 28 days 5 4 0 1 0 1 100 3 Key findings/Evidence Standard met? This Standard is met. The homes 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. Regular house meetings are held, user satisfaction questionnaires have been distributed and the home facilitates service users access to a local speaking up group.Craigmore HousePage 24 Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists NO02 Key findings/Evidence Standard met? Systems are in place within Craigmore House to ensure the protection of service users. A copy of `Durham & Darlington Adult Protection Committees Inter-Agency Adult Protection Policy & Procedures has now been obtained and is available in the home. However, as highlighted in previous inspection reports, policies and procedures for the home, which ensure that service users are protected from harm, abuse, neglect and self-harm, must be developed. Having obtained a copy of `Durham & Darlington Adult Protection Committees Inter-Agency Adult Protection Policy & Procedures the home should make any necessary amendments to its own documentation covering this issue.Craigmore HousePage 25 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? This Standard is met. Craigmore House provides homely and comfortable accommodation with adequate living space for the service users currently accommodated. The furnishings and fitments of the home are domestic in style and appearance. The building, furnishings and fittings are kept in good decorative order and repair. The home offers easy access to local amenities and public transport and the premises are in keeping with the local community.Craigmore HousePage 26 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq. m. usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq. m. usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq. m. Total no. of wheelchair users accommodated for in rooms less than 12 sq. m. Total no. of shared rooms at least 16 sq. m. Total no. of shared rooms below 16 sq. m. Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite YES NO NO 10 1 0 0 10 00 0 0 00 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Craigmore HousePage 27 Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Craigmore HousePage 28 Standard 29 ( 29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 3 Key findings/Evidence Standard met? This Standard is met. Suitable aids and adaptations are provided to meet service users assessed needs. Grab rails have been provided in the bedroom of one service user to assist his mobility and he has a wheelchair for use on longer journeys outside the home. For other service users any adaptations and equipment would be provided if necessary.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 3 Key findings/Evidence Standard met? This Standard is met. On the day of the inspection Craigmore House was found to be clean, tidy and free from offensive odours. Appropriate systems are in place to prevent the spread of infection.Craigmore HousePage 29 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 3 Key findings/Evidence Standard met? This Standard is met. From observations made, documents examined and discussions with 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. Specialist needs are met through access to community health & social care resources. House meetings are held. Staff training is being developed through induction and NVQ courses.Craigmore HousePage 30 Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme X X X X 1 No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X XXX3 Key findings/Evidence Standard met? This Standard is met. Staff receive appropriate training and all staff without NVQs have almost completed NVQ level 2. In relation to staffing levels, the CSCI has been advised by the Department of Health that homes registered prior to 1 April 2002 must continue to implement staffing levels as required by the previous registering authority. The statistical information referred to above is only required to be included within inspection reports in relation to homes registered after the 1 April 2002. However, staffing levels and rostering arrangements within the home are considered adequate to meet the needs of the service users currently accommodated.Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? This Standard is met. The home has developed appropriate recruitment policy / procedure documents based upon equal opportunities. 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 have been obtained for all staff.Craigmore HousePage 31 Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Craigmore HousePage 32 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. NO0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home). However, as highlighted in previous inspection reports, the registered manager should complete a management-training course at NVQ level 4 or equivalent by 2005.Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Craigmore HousePage 33 Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Standards 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Craigmore HousePage 34 Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? This Standard is met. From observations made during the course of the inspection, documents examined and discussions with management and staff, the health and safety of service users and staff is ensured. Risk assessmnets have been completed in key areas of health & safety. A member of staff undertakes regular health & safety audits.Standard 43 (43.1 ­ 43.7) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 0 Key findings/Evidence Standard met? This Standard was not assessed on this occasion (it will be considered during the next inspection of the home).Craigmore HousePage 35 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition None. CommentsComplianceLead InspectorPaul EmmersonSignatureRegulation Manager Date Public reportsGeoff Newton 9 June 2004SignatureIt should be noted that all CSCI inspection reports are public documents.Craigmore HousePage 36 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 9 June 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possible Action Plan and Providers comments can be viewed on file at Area Office.Action taken by the CSCI in response to provider comments: Craigmore House Page 37 Amendments to the report were necessaryNOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESNOYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan by 12 July 2004, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther: enter details here NOCraigmore HousePage 38 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I Christine Taylour of Craigmore House, Barnard Castle confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I Christine Taylour of Craigmore House, Barnard Castle am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Craigmore HousePage 39 - 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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