Inspection on 31/05/05 for Culby House

This inspection was carried out on 31st May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Culby House 29/07/08

Culby House 18/07/07

Culby House 19/09/06

Culby House 05/09/05

Culby House 21/01/05

Culby House 24/06/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 Culby House 32 Warwick Road Cliftonville, Margate Kent CT9 2JY Lead Inspector Christine Grafton Unannounced 31 May 2005 10:00 st The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Culby House Address 32 Warwick Road, Cliftonville, Margate, Kent, CT9 2JY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01843 298887 Mrs Jean Kelly Care Home 3 Category(ies) of Mental Disorder (3) registration, with number of places Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21/1/2005 Brief Description of the Service: Culby House is a small family style home occupying a terraced property with three bedrooms for residents use on the first and second floors. Residents have their own lounge/diner overlooking a small enclosed patio area to the back. The registered provider/manager, Mrs Kelly, lives at the home with her 4 children and has a separate lounge, dining room and bedroom accommodation for family use only. The residents have their own toilet and separate bathroom and there are separate facilities for the family members. The home is situated in a residential area of Cliftonville, close to shops and other communal facilities. Mrs Kelly is the main carer but there is a volunteer, who regularly helps out. The 3 current residents live independent lifestyles within a supportive environment. The environment is homely and well maintained. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was re-scheduled, as there was no one in at the original planned visit on Friday 20th May 2005. This visit took place on a Tuesday afternoon and lasted three and a half hours. Additional time was spent in preparation and report writing. At the time of this visit there were three male residents. Time spent in the home comprised of speaking with the three residents and the registered provider, looking round the residents’ accommodation and reading some of the records. What the service does well: What has improved since the last inspection? What they could do better: The registered provider clearly has a good understanding of the residents’ health care needs and knows their wishes. However, there has been no formal care planning system within the home to ensure that care is planned and residents’ goals and aspirations are recorded. It is important that when residents’ needs and wishes are discussed, a record is made, to provide a Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 6 bench mark - a starting point, from which care can be structured towards meeting their desired outcomes. Without such a record there is no way of knowing if care goals are being achieved or not. The registered provider has struggled with the concept of care planning and would benefit from some training in this area. Pre-admission assessments also need to be recorded before any new residents are admitted, to make sure that their needs can be met at the home. Risk assessments need to be recorded, setting out how risks are to be managed to ensure that residents’ safety is protected. The vetting procedure for volunteers needs to be thorough enough, including criminal records bureau (CRB) checks, to make sure that the residents’ well being is safeguarded. 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. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Residents are involved in discussions about their needs and feel that these are being met at the home. There is no formal written assessment process for new residents to show how their needs can be met. EVIDENCE: The newest resident was admitted in July 2004. At the last inspection, there had been no records of the pre-admission assessment, neither had a copy of the care management assessment been obtained. This resident’s needs were case tracked and it was found that a copy had since been obtained, but the registered provider has not recorded her own assessment and care plan. It was clear from discussion with the registered provider that she has worked closely with the resident, his social worker and the community mental health team. Records of care provided indicate that she is working on the outcomes of these discussions to meet the resident’s needs. The resident spoke about his needs and said that these are being met at the home. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 There is no way of validating what residents’ personal care goals and aspirations are at any given point in time. Care is not planned and structured to make sure that desired outcomes are achieved. Residents’ rights are respected and they are able to make choices about their daily lifestyles. Residents are encouraged to be independent, but the lack of risk assessments and planned strategies for dealing with risks could compromise the residents’ and other people’s safety. EVIDENCE: The records that the registered provider has entitled ‘care plans’ consist of monthly summaries of the care provided. These records describe how care needs have been met, including any issues relating to choice and personal freedom. It was clear from the records, discussions with the residents and with the registered provider that current and changing needs are being met on a day to day basis. If risks are identified, the registered provider talks to the resident, their social worker, community psychiatric nurse and psychiatrist and records show how these are being dealt with. However, the home’s records do not show any forward planning and the needs identification comes solely from the care management assessments that are only reviewed annually. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 10 The three residents were each spoken with individually and they all confirmed that they are able to make their own decisions about their lives. They said that the registered provider is very supportive and treats them with respect. They each described how they manage their own finances. One resident does this completely independently by collecting his own benefits weekly, whilst the other two sign for their weekly personal allowance payments. Residents are encouraged to be independent and they each go out during the day as they please. Where this has involved elements of risk, the registered provider has discussed this with the resident and agreement has been reached as to how the risk is to be minimised. Risk assessments have not been recorded and there are no recorded planned strategies for dealing with risks. The registered provider described how aggressive behaviour is managed but again this had not been recorded. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14, 15,16 & 17 Residents are encouraged to pursue their own interests and maintain community contacts. Residents are encouraged and enabled to maintain relationships that are important to them. Daily routines respect residents’ rights, responsibilities and individuality. The meals in this home are good, providing a varied nutritious diet. EVIDENCE: All three residents go out into the community every day. One resident goes out every morning for a walk along the seafront and visits local shops and cafes. Another resident regularly uses public transport to visit friends and goes to the shops. One resident attends adult education classes. A resident enjoys reading and drawing and has joined the local library. The resident had done some sketches of the local area that he keeps in his room. Other interests discussed include collecting vintage cars, doing puzzles and listening to music. All three residents said they enjoy watching the television ‘soaps’ in Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 12 the evenings together in their lounge. They also enjoy a weekly visit to a neighbouring town market each Friday morning. Relationships are supported and one resident’s brother had visited the previous weekend and he visits his father every Sunday. Another resident had a friendship that was important to him, but sadly the friend had recently died. The registered provider and two other residents were being very supportive, by listening to him and giving him time to talk about his friend, which was clearly important to him. Residents are free to come and go as they please, so long as they let the provider know they are going out. They have their own bedroom door keys, but they do not have a front door key. The registered provider stated that there is always someone at the home to let them in (unless they all go out together). Rules about smoking are clearly set out in the residents’ terms and conditions of residence statement. Two residents smoke and this is only allowed in the residents’ lounge. The third resident does not smoke. He said he does not mind the smoke, but the lounge does not have an extractor fan. Residents said they like the food provided. The registered provider knows the residents’ food tastes and makes sure that favourite dishes are regularly incorporated into the menus. A record of food provided is kept and this indicates a varied nutritious diet. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Personal care is provided in a way that protects residents’ dignity. Residents’ health care needs are met. The medication procedures are appropriate for this small home and current residents. EVIDENCE: The registered provider described how she gives guidance and support regarding personal hygiene. This includes discreet monitoring of appearance to ensure dignity, such as reminding to shave. Residents go to local barbers for their hair cuts. Such things are reflected in the monthly care plan summaries. Records detail how personal care needs are being met. Daily records include visits to doctors’ surgeries and other health care professionals. The registered provider supports residents to attend their hospital appointments, meetings with psychiatrists and their annual reviews with their social workers/care mangers. The records show that the registered provider monitors residents’ health and acts upon any potential complications to their mental health. The registered provider has recently completed a safe handling of medicines course and is awaiting the certificate. Since the last inspection, the practice of pre-dispensing medications has stopped and medications are now being received from the pharmacist within a monitored dosage system. The medication cupboard is clearly labelled and sectioned and colour coded for each of the three residents. Records of administration are kept. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 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 standard(s) 22 Residents know that their complaints will be listened to and acted upon. EVIDENCE: Residents said they had no complaints and would speak to the registered provider if they were unhappy about anything. They also know that they can contact people from outside the home, such as their social worker, community psychiatric nurse or the commission, which they see as a ‘last resort’. A complaints notice is displayed in the residents’ lounge/diner, with details of how to contact the commission. The registered provider said there had been no complaints, and is aware that records of any complaints must be kept. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 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 standard(s) 24 & 30 The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: Residents’ bedrooms and their lounge/diner were seen to be comfortably furnished, bright, cheerful, airy and clean. Furnishings are of good quality and there is an on going maintenance and renewal programme for the fabric and decoration of the building. Residents said that their bedrooms and communal space suit their individual needs. There is a separate laundry area off the provider’s private dining room and she launders and irons the residents’ clothing. The provider has completed an infection control course, but has not been issued with a certificate yet. Systems were discussed for dealing with soiled articles and odour and found to be appropriate for this small home. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 35 The process for vetting people who help at the home has not been thorough enough to ensure that the residents are fully safeguarded. The registered provider is committed to her own personal development and works positively with residents to improve their quality of life. EVIDENCE: The registered provider is the manager and sole carer in this small home. A volunteer regularly helps out. The registered provider is committed to training and has tried to access funding over the last year to undertake either an NVQ (National Vocational Qualification) level 3 in care, or level 4 in management and care. Unfortunately this was not successful and she is now looking into other options. In the meantime, she has completed her short courses already referred to, plus a basic first aid course. The volunteer’s CRB (Criminal Records Bureau) check has been applied for via an umbrella organisation, but has not been returned and this is outstanding from the last inspection. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 The registered provider has a clear vision for the home and has the skills and experience to meet its stated purpose. Residents benefit from a well run home. EVIDENCE: The registered provider has been running this small home since 1994 and previous to that ran board and lodging accommodation for people with a range of problems. She has an NVQ level 2 in care and has attended various short courses. She hopes to be able to pursue the training specified, but as this is a small home with limited income, the cost of funding the course would have implications on the financial viability of the home. From discussions at this inspection with the registered provider and the three residents, it is clear that she understands the needs associated with mental health problems and has the experience necessary to successfully run this home. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 18 Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 19 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 x 2 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Culby House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x x x H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 20 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 YA2 Regulation 14 Requirement Timescale for action 31/8/2005 2. YA6 15 3. YA9 13(4) 4. YA34 18 An assessment must be undertaken prior to admission and the registered person must confirm in writing to the person that their needs can be met at the home. A full assessment must be completed following admission and a care plan drawn up. (Previous requirement 21/1/2005 not met). Each resident must have an 31/8/2005 individual care plan showing how their needs in respect of health and welfare are to be met. Plans to be kept under review and updated as needs change. (Previous requirement 21/1/2005 not met). Individual risk assessments must 31/8/2005 be recorded for each resident, showing management strategies and any other actions to be taken to minimise risks and hazards. (Previous requirement 21/1/2005 not met). An enhanced CRB disclosure and 31/8/2005 POVA check must be obtained for the volunteer. (Previous requirement 21/1/2005 not met). Version 1.30 Page 21 Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc 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 YA16 Good Practice Recommendations That an extractor fan is fitted in the residents lounge/diner to take account of the residents needs who does not smoke. Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Culby House H56-H05 S23181 Culby House V224985 310505 Stage 4 doc.doc Version 1.30 Page 23 - 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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