Inspection on 01/11/05 for Creykes Lodge

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Creykes Lodge 17/10/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Creykes Lodge Rawcliffe Road Rawcliffe East Yorkshire DN14 8SE Lead Inspector Ann Day Unannounced Inspection 1st November 2005 13.45p Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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 Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Creykes Lodge Address Rawcliffe Road Rawcliffe East Yorkshire DN14 8SE 01405 839198 01405 839012 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) St Annes Community Services Mrs Andrea Catherine Sanderson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection: 6th June 2005 Brief Description of the Service: Creykes Lodge is owned and managed by St Anne’s Community Services, which has a headquarters in Leeds. Creykes Lodge provides personal care and accommodation for up to six adults with a learning disability. The premises consists of a detached bungalow on the main road in the village of Rawcliffe, on a bus route, close to local amenities, and the towns of Goole and Selby. The home offers single room accommodation, and well maintained communal areas. There are well maintained gardens to the front, side and rear of the property; level access to all doors and car parking to the front of the property. The grounds are fully enclosed and accessed by a secure gate, providing a safe environment for the residents. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one afternoon and evening on 1st November 2005. The inspection took four hours with two hours’ preparation. Case tracking was employed as an inspection tool, which involves following the experience of a sample of service users and assessing the service they receive. An accompanied tour of the building was undertaken. The home manager and members of staff were interviewed. Two relatives were interviewed over the telephone and documentation was examined. Some conversation was held with four of the people currently living in the home, however, due to these individuals’ high levels of dependency and the nature of their disabilities, verbal communication was very limited. There were, however, opportunities to observe the residents involved in activities of their choosing, be shown their bedrooms and observe their interaction with the staff team. What the service does well: What has improved since the last inspection? Work has been undertaken to meet the requirements and recommendations from the last inspection. A fire risk assessment has been completed for the home and was available for inspection. The home’s manager has sought advise from the fire officer regarding the need to have doors open to aid observation of residents who may be unsettled, whilst minimising the risk to all the residents and staff in case of a fire. No doors were wedged open on the day of the inspection. Work has been undertaken and is on going to improve information available for prospective service users. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 6 Members of staff have attended safe handling and administration of medication training. Andrea Sanderson, the registered manager is a registered nurse and is currently undertaking the Registered Managers Award. Arrangements are being made to encourage further positive involvement of relatives, by inviting them to meet with the company’s area manager annually, as part of the home’s quality assurance programme. Two vehicles have been leased to further improve the residents’ access to activities and the local community. 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. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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 Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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): 1,2,5 Prospective service users are provided with information in various forms to help assist them to make a choice about where they live. Service users individual needs and goals are assessed before admission. Prospective service users and or their relatives have the opportunity and are encouraged, where appropriate to visit the home and are provided with a written contract. EVIDENCE: The home’s Statement of Purpose and Service Users’ Guide are detailed. The home is looking at sourcing different methods of communicating information for prospective residents. The current residents are unable to benefit from the use of “Makaton” or “Widget” symbols pamphlets or programmes, alternatives for the home are limited. Currently the home relies on trial visits, 1:1 time with a member of staff and the involvement of relatives and the multidisciplinary team. Care records included comprehensive assessments of the individual’s needs. All residents are provided with a contract following admission. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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): 6,7,8,9,10 People living in the home are encouraged and supported to make as many decisions and choices as possible. They also live as independently as possible, taking into account any risks that have been identified and are assured that their individual care package is treated in confidence. EVIDENCE: Care records examined contained a well-detailed individual life plan which clearly describes the individuals strengths, needs; likes and dislikes; and informs members of staff, how they can best meet these needs. Care plans are regularly reviewed. The complex needs of the residents, means that they need considerable support to make decisions about many aspects of their lives and to be involved in any way with the running of the home. Members of staff were seen to encourage their involvement. They are also assisted to make independent decisions wherever possible and to take responsible risks subject to risk assessment. Well-detailed risk assessments were in place for each resident. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 10 Members of staff were very clear about their responsibilities to ensure the confidentiality of the residents. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 Residents have a varied and interesting lifestyle and are fully involved in their local community. Individuals enjoy a wide range of social and educational opportunities and develop and maintain relationships with family and friends wherever possible. EVIDENCE: Each resident has a weekly programme of varied activities, some organized by the home others accessed through a local day centre. The staff team is keen to identify new activities that the residents might enjoy and all the residents have active lives within their local community supported by a committed staff team. They can choose from a number of activities and outings organized and are as involved in the running of the home as much or as little as they like and as much as is possible. The home has just recently leased two vehicles to further aid the residents’ activities programme. The home has “snoelen” (sensory) equipment available for individual residents to use. On the day of the inspection one resident was accompanied by staff, to visit their parents and another resident was supported and assisted to make a telephone call to their parent. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 12 Members of staff communicated very well with residents, they sought permission to enter residents’ rooms, where permission could be given. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users’ physical and emotional health needs are met. EVIDENCE: Every service user is registered with a General Practitioner; specialist health professionals are accessed. Service users are supported and assisted by staff, when attending dental and optician appointments. A psychologist visits the home regularly to give support to the residents and staff. All the residents in the home require assistance with the taking of medication. Medication was safely stored and medication administration records were well maintained; the registered manager and members of staff have attended a training course recently on the safe handling and administration of medication. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 14 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): 22,23 Service users’ concerns are appropriately dealt with and their interests are safeguarded. EVIDENCE: There is a comprehensive complaints procedure in operation that is available in various formats and is made available to anyone who wishes to see it. Whilst the residents might not use the formal procedure, they can all make any dissatisfaction known to staff. Members of staff have developed very good relationships with the residents and were seen to communicate extremely well with them. No complaints have been made either to the home or to the C.S.C.I. within the last twelve months. The home has an adult protection policy and procedure; members of staff have attended training as part of the NVQ programme and they were clear of their role and responsibilities in this regard, they know when and to whom they should report any concern. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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): 24,25,26,27,28,29,30 Service users are provided with a homely, comfortable, appropriately equipped and clean place to live. EVIDENCE: The home is generally well maintained. All six bedrooms are for single accommodation and are of a suitable size and are individually decorated. There are sufficent shared bathroom and toilet facilities appropriately situated throughout the home. There are also comfortably furnished and bright, shared areas including a quiet/soft room. Particular attention has been paid to the provision and securing of pictures and furnishings, to minimise risk to the residents and members of staff. Appropriate aids and adaptations are fitted throughout the home and there is level access to the home. Several rooms are kept locked at certain times to prevent risks to one or more of the residents. A good standard of cleanliness is maintained throughout. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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): 32,33,34,35,36 Service users are well cared for by a skilled, trained and highly motivated team of staff. EVIDENCE: Four care staff, are currently undertaking NVQ Level 3, in addition to four registered nurses; and 3 carers who have already obtained NVQ Level 2, contributing to a well trained and skilled staff team. Current duty rosters show that staff are employed in sufficient numbers and are deployed in such a way as to ensure that the needs of the residents are met at all times. Staff files examined and interviews with the manager and members of staff evidenced that, appropriate recruitment procedures were being followed thereby safeguarding the wellbeing of residents. New members of staff receive an induction and attend a foundation course (LDAF) specifically focusing on the care needs of individuals with learning disabilities. The manager, members of staff and staff files confirmed that staff are regularly supervised, are in receipt of an annual appraisal and that staff meetings are regularly held and are found to be helpful by the staff. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 17 Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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): 37,3842 The residents benefit from a well run home in which their safety, needs and wishes are put first. EVIDENCE: Andrea Sanderson, the registered manager is a registered nurse, RNMH qualified, and is currently undertaking the Registered Managers Award. She has considerable experience as a nurse and a manager. Relatives and members of staff described the manager as supportive and approachable. “Morale here is brilliant, good manager, supporting the service users”. “ Clients have come on in leaps and bounds”. A relative said, “Highly delighted with care at Creykes Lodge, in a year they have worked wonders with ------ Andrea, (the manager) always addresses issues immediately”. Fire Risk assessment had been completed and was available for inspection Where a need for a fire door to be held open has been identified, this may be done with the aid of authorised means, in line with advice from the Fire Safety Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 19 Officer, which has been sought. No doors were inappropriately propped open during the visit and all other documentation examined was in order. St Anne’s Community Services has a quality assurance and monitoring system in place that includes regular unannounced visits by the service manager to check on quality issues. Arrangements are being made to encourage further positive involvement of relatives, by inviting them to meet with the company’s area manager annually, as part of the home’s quality assurance programme. Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Creykes Lodge Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 X DS0000062522.V262190.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Creykes Lodge DS0000062522.V262190.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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