CARE HOME ADULTS 18-65
Daniel Yorath House 1 Shaw Close Garforth Leeds LS25 2HA Lead Inspector
Nadia Jejna Unannounced 20 October 2005 from 10:30am
th 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. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Daniel Yorath House Address 1 Shaw Close, Garforth, Leeds, West Yorkshire, LS25 2HA 0113 287 3871 0113 287 3278 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) The Brain Injury Rehabilitation Trust Mrs Ann Buckler Care Home 20 Category(ies) of Physical disability (20), Physical disability over registration, with number 65 years of age (20) of places Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17/02/05 Brief Description of the Service: Daniel Yorath House is situated in a quiet cul-de-sac in the village of Garforth. Its position allows easy access to local amenities and services. Accommodation is provided on two floors assisted by the provision of an internal lift. The home has an extensive rear garden and a small garden to the front. There are ample parking facilities to the front and side of the building as well as the availability of on road parking. The unit provides a specialist rehabilitation service to people with acquired brain injury. They aim is to help and support individuals to be able to live in the community as they did before. A complete psychlogical and rehabiliation support care package is provided. The multidisciplinary team within the home is made up of professional medical and healthcare workers who can best assist the needs of the tenant group. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was announced and took place on the 17th March 2005. This inspection was unannounced. It started at 10:30am and ended at 4:15pm. The people who live in the home prefer the term residents and for the establishment to be classed as a unit, these are the terms that will be used throughout this report. The purpose of this inspection was to monitor the unit’s progress and to assess whether the care given to tenants meets minimum standards. During the inspection records were examined and staff were seen carrying out their work. Discussions were held with staff, the manager and tenants. Comment cards/questionnaires were left for residents and visitors so that they can share their views of the home with the CSCI. None had been returned when this report was written. What the service does well:
Support is provided in a clean, tidy and well-maintained environment. The atmosphere in the unit was warm and welcoming and it was clear that good relationships are in place with tenants and staff. Prospective tenants are fully screened before admission to make sure that the unit can meet their needs and that they will benefit from the service provided. The unit works closely with the tenant, their families, the health authority head injury team and social service’s in order to make sure that that care packages continue seamlessly. Support is also provided to the tenant’s families via an education programme run by the psychologists. Tenants are fully involved with developing and reviewing their individual rehabilitation and support programmes. Clear risk management guidelines are in place and these are revised, as individual’s needs change. This is particularly important because of the rehabilitative nature of the home. Risks are reduced by this system whilst promoting the ability of service users to learn and develop with help, guidance and support from staff. The programmes also include social, educational and work related activities. Staff support and help the tenants to go out. This includes joining the local library and video shops, shopping trips, trips to the cinema, bowling and places of interest to them. Tenant meetings are held every two weeks and all aspects of living in the unit are discussed. One of the tenants is the nominated tenant representative and will take issues to the management team in between meetings. They said that
Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 6 they found this role fulfilling and that the management team were approachable and supportive to them as well as to the other tenants. The tenants are supported by well informed and knowledgeable support workers. There is a comprehensive training programme in place, which includes induction training, health and safety and abuse awareness, as well as specialist training about head injury, behavioural training and crisis prevention intervention. Team meetings are held regularly. Staff said that they find these useful and that is nice to know that they can air their views and opinions and be listened to. They said that they felt the unit was well managed; that the management team were approachable, supportive and would listen and take appropriate action if needed. What has improved since the last inspection? 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. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 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 Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 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) 1, 2, 3 and 4. Prospective tenants individual needs are assessed and they are given all the information required about the unit and the service it provides. EVIDENCE: Prospective tenants have their needs thoroughly assessed by a specialist team before any arrangements are made to admit them to the unit. This is to make sure that the unit will be suitable for them and that the multidisciplinary team will be able to provide them with an appropriate rehabilitation care package. If it is felt that the unit will be able to meet their needs, the prospective tenant will visit the unit. They will be able to look around and meet other tenants and staff. They will have been sent an information booklet about the unit and the service it provides. During the visit they will be given more information about assessments, rehabilitation, their care plan, contracts, ‘Saying No to Abuse’ booklet and the Service user Guide. Staff go through all the information with them to make sure it is understood. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 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, 8, 9 and 10. Tenants are fully involved with developing and reviewing their individual rehabilitation and support programmes. Clear risk management guidelines are in place for staff and tenants, which reduce risk while promoting the ability of service users to learn and develop with help, guidance and support from staff. EVIDENCE: Individual rehabilitation and support plans are in place. These are put together after detailed multidisciplinary assessments. The individual rehabilitation programmes are reviewed weekly during the first 8 weeks and then 2 weekly after that. A full review of all care needs takes place every three months and new goals are set with the tenants for the next 3 months. Tenants are fully involved with these processes. Tenants keep their own copies of their weekly rehabilitation programme. These show clearly when they are attending sessions with the speech therapist, physiotherapist, occupational therapist or the psychologist. It also sets out when they have planned activities such as dealing with daily living tasks such
Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 10 as cleaning their room, doing the laundry as well as other activities like going to the shops or the library. Tenant meetings are held every two weeks and all aspects of living in the unit are discussed. One of the tenants is the nominated tenant representative and will take issues to the management team in between meetings. They said that they found this role fulfilling and that the management team were approachable and supportive to them as well as to the other tenants. The day to day care records include risk management guidelines which are put in place and revised as needed. This is particularly important because of the rehabilitative nature of the home. Risks are reduced by this system whilst promoting the ability of service users to learn and develop with help, guidance and support from staff. Staff are kept aware of changes during detailed shift handovers. The home has a clear policy for actions to be taken in the event of any unexplained absences. Information is kept securely and staff are aware of the units confidentiality polices. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 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) 11, 12, 13 and 14. Tenants are encouraged and supported to join in with appropriate social, leisure, educational, work and day to day living activities. EVIDENCE: Tenants are enabled and supported to go to college and attend work placements. Many of the tenants meet with the local Headway group and join in with their programme of social activities. Staff support and help the tenants to go out. This includes joining the local library and video shops, shopping trips, trips to the cinema, bowling and places of interest to them. Staff and tenants grow and use organic vegetables in their own garden and have recently been allocated a local allotment. The unit is actively involved with other groups in the community and they regularly organise fundraising activities. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 12 The manager makes sure that the tenant living at the home long term is able to go on at least two holidays a year. She said that they enjoy going on activity holidays, which include climbing and abseiling. Appropriate risk assessments are in place. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 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 and 19. Tenants physical, personal and health care needs are met. EVIDENCE: Staff help and support tenants with personal care as required in the way that they prefer and as identified by their individual plans. Clinical and medical files are kept for each tenant. These are kept up to date as changes occur and new assessments are carried by members of the multidisciplinary team. Tenants are supported to see their GP as required and to attend hospital appointments. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 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 and 23 Clear and detailed complaints and adult protection procedures are in place which protect tenants. EVIDENCE: Tenants have a copy of the complaints procedure in their room along with clear, detailed information on how to make a complaint. The manager said that she has not received any complaints since the last inspection. The manager said that all tenants know when the Regulation 26 visits are due so that they can talk to the Responsible Individual and raise any concerns or issues with them directly. Tenants have a copy of a booklet ‘Say No to Abuse’. This has been specially produced for people with a brain injury and provides clear information in large print and pictures about the types of abuse they are at risk from and what they should do. This is very good practice. Staff are aware of the homes policies and procedures around abuse and would not hesitate to report actual or suspected abuse. Training about abuse awareness is part of the training programme. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 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, 25, 26, 27, 28, 29 and 30. Tenants live in a clean, tidy and well maintained unit which is appropriate to their needs. EVIDENCE: The unit was clean, tidy and well maintained. It was clear that work was in progress to upgrade some of the communal bathrooms. The manager said that there is continual rolling programme of redecoration and refurbishment. The tenant representative gave a guided tour of the building. This showed that: • • • • • All bedrooms are single, spacious and comfortably furnished. All bedrooms are en-suite with walk in shower facilities. There are communal areas for all tenants to use, including a TV room and dining room. Specially adapted and equipped kitchens are provided for tenants to make their own meals as part of their individual rehabilitation programmes. Specialist equipment is provided for individuals in order to promote and increase their independence.
20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 16 Daniel Yorath House The tenants individual rehabilitation programmes encourage and involve them with keeping their own rooms clean and tidy, doing their laundry and helping to keep the communal areas clean. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 17 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) 31, 32, 33, 34, 35 and 36. Tenants are supported and protected by robust recruitment procedures. Staffing numbers and skills make sure that tenants’ needs are met. EVIDENCE: A training programme is in place, which enables staff to fulfil their roles as support workers to the tenants. One of the support workers said that they enjoyed working at the home because there was a good team spirit, everybody knew what was expected of them and they care about what they were doing. The support worker said that since they had started working at the home in December 2004 they had: • Completed the basic brain injury training course, including the induction training. • Completed the intermediate brain injury training course after 6 months employment. This course was intense and took 4 days. • Received training on epilepsy, fire safety, physiotherapy, health and safety, moving and handling, crisis prevention intervention, behavioural training and abuse awareness. • Been enrolled on NVQ 2. • Given feedback about the training courses they had attended. • Received monthly formal supervision.
Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 18 This care workers records showed that: • An application form had been completed. • A formal interview had taken place and 3 people sat on the interview panel. Records were kept. • Three written references were in place. • A letter offering employment had been sent out. • There was confirmation that enhanced CRB disclosure and POVA checks were in place. • The start date had been delayed until the unit received confirmation that all required checks were in place. • Training records were kept. Staffing levels in the unit were appropriate to the needs of the tenants. The manager said that through the day there are 5 support workers on duty, the management team and domestic staff. Monday to Friday the staff team also includes the clinicians who provide specialised support to the tenants. This includes: • Physiotherapists, • Occupational therapists, • Speech and language therapists, • Psychologists. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 19 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) 38 and 43. The unit is well managed. The interests of the tenants are seen as very important to the manager and staff and are safeguarded at all times. EVIDENCE: Team meetings are held regularly. Staff said that they find these useful and that is nice to know that they can air their views and opinions and be listened to. They said that they felt the unit was well managed; that the management team were approachable, supportive and would listen and take appropriate action if it was needed. The manager acts as appointee for one resident. Clear and accurate records were seen of financial transactions and the tenant is involved with these and any decision made about which interest bearing accounts are to be used for their savings. The other tenants have their monies and allowances paid into bank accounts and staff support them to deal with these as part of the money management rehabilitation programme. Small amounts of money are held in
Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 20 safekeeping for them in the unit to access at any time. All transactions are recorded and residents sign to acknowledge receipt of their money. Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 21 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 4 4 4 3 x Standard No 22 23
ENVIRONMENT Score 4 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 4 4 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 4 4 4 4 x x x Standard No 31 32 33 34 35 36 Score 3 3 4 3 3 4 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Daniel Yorath House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x 3 x x x x 3 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement No requirements were identified during this inspection. 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. 1. Refer to Standard 37 Good Practice Recommendations The registered manager should be qualified to NVQ level 4 in Management and Care. ( This standard was not assessed during this inspection and has been carried forward.) Daniel Yorath House 20051020 Daniel Yorath J52 V246509 S1443 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds, LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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