CARE HOME ADULTS 18-65
Flax Cottages, 1/2 Scotland Gate Choppington Northumberland NE62 5SR Lead Inspector
Deborah Haugh Unannounced 25 April 2005 9.30 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. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Flax Cottages, 1/2 Address Scotland Gate Choppington Northumberland NE62 5SR 01670 530247 01670 394000 N/A Northgate & Prudhoe NHS Trust 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) Miss Jacqueline Land CRH 9 Category(ies) of LD Learning disability (5)LD(E) registration, with number Learning disability - over 65 (4) of places Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 25/04/05 Brief Description of the Service: Flax Cottages is a purpose built home for nine people with severe learning disabilities who have moved into the community from Northgate Hospital.The home is located in Choppington, approximately two miles from the town centre of Bedlington and is in close proximity to local shops, pub and community centre.The home comprises of two connecting bungalows for nine service users in total. One bungalow contains five bedrooms and the second contains four bedrooms. All service users have their own bedroom. Both bungalows have their own lounge, dining room, kitchen and bathroom and toilet facilities.There are two large gardens to the rear of the premises that are fully accessible to the service users. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was un-announced and took place over 3 hours. The Assistant Team Leader, Carol Wilson was in charge. There were 9 residents at the home. Time was spent looking around the home to check the cleanliness, maintenance and decoration. Residents and staff were spoken to. Many of the residents are unable to express their views so observations were made of the contact between residents and staff. 2 Care Plans for residents care were examined as well as the home’s Accident Book and the Fire Log, which records training and checks. The manager has transferred to the Trusts Training Section for 6 months from 11/04/05. CSCI need to be informed of the arrangements which the Trust will put in place without delay. Following this inspection CSCI wrote to the Trust about this. The staffing levels were appropriate for the needs of the residents What the service does well:
The staff are able to describe in detail the needs and wishes of the residents. This is important because most of the residents find it hard to communicate their needs. The inspector observed good relationships and interactions between residents and staff. Staff are able to anticipate the needs of residents. The residents were observed to be comfortable and they chose where they spend their time. Two residents like to embroider and showed the inspector their work. Later in the day one of the residents said she would like to knit and make the pudding for the evening meal with the Assistant Team Leader. The home was found to be clean and well maintained. Four of the bedrooms have been decorated and residents have chosen their colours. New bedding, curtains and carpets have also been provided where needed. All of the rooms were looked at and where permission could be sought staff asked residents. All of the bedrooms are homely, personalised and clean. The two bathrooms have new baths and tracking. There are plans to decorate both bathrooms and the two WCs. The home is good at keeping records of the care they have provided to residents. The care plans provide detailed information and are reviewed and evaluated. Resident’s health is monitored by staff and they contact doctors and other specialists where necessary. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 6 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. Flax Cottages, 1/2 CS0000000644.V219921.R01.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 Flax Cottages, 1/2 CS0000000644.V219921.R01.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 who move into the home have their needs assessed by both care professionals and the home EVIDENCE: Two care plans were examined and all admissions to the home involve a resettlement officer and care management assessments are received for all service users. Residents and their representatives are involved in this process. The home carry out its own assessment with the aid of various assessment tools to assess the service user’s abilities and needs. Comprehensive copies were viewed on the case files Flax Cottages, 1/2 CS0000000644.V219921.R01.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 are consistent care planning systems in place, which adequately provide staff with the information they need to satisfactorily meet resident’s needs. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 10 Two care plans were examined and the inspector spoke to staff members and observed practice. Residents have an individual plan that includes personal details, assessed needs, means of communication, likes and dislikes, past history, health details etc. A photograph of the resident and key workers are included. The plans were found to be well organised and up to date. The key worker evaluates the plan on monthly basis and reviews are held every six months involving the resident and any other interested parties. The residents are encouraged to become involved in their care plans and they participate according to their individual capabilities. Residents are invited to attend their own review meetings and are encouraged to participate. Staff members respect the resident’s rights to make decisions in all aspects of their lives and make every effort to ensure they have information to make informed choices. Information is recorded in the care plans with regard to decisions that are made and any limitations of choice to safeguard the residents are fully recorded. Through talking to the staff and by reading the care plans it is clear that residents require supervision both inside and outside the home but stated they are encouraged to take risks if the benefit outweighs the risk. The residents care plans include risk assessments and management strategies. Flax Cottages, 1/2 CS0000000644.V219921.R01.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) 14,16 & 17 Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices as well as special dietary needs. Residents are able to participate in a variety of activities, which are reviewed. The rights of residents are respected. EVIDENCE: Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 12 The inspector examined the activity schedules for the residents. The activities are reviewed to ensure service users are given the opportunity to access activities of their choice. Since the last inspection in December activities have been home based due to weather conditions. Music and arts and crafts sessions are held in the home and one service user enjoys knitting. During the inspection the service users were spending time in their own bedrooms and accessing various parts of the home. Staff were seen to be respecting the service users’ privacy and dignity. They were also observed to be interacting with the service users. Six weekly menus are operated and an alternative is offered at every mealtime. The likes and dislikes of the residents are recorded and staff try to introduce new food to the menus. Pictorial menus are also used to ensure all service users are given a choice of food at every mealtime. Nutritional advice is available from the Trust and the manager confirmed that the assessments are regularly reviewed. The service users visit the supermarket with the staff and are able to make their own choices. Flax Cottages, 1/2 CS0000000644.V219921.R01.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 The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: Routines in the home were observed to be flexible and staff were consulting the residents with regard to their preferred activities. The staff team are stable ensuring consistency and continuity in supporting the people who use the service. The staff work closely with health care professionals to ensure the personal and health needs of the residents are fully met and this information is recorded in the care plans. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 14 The residents are reliant on the staff team to monitor their health needs and this is recorded in the care plans. Routine health checks are carried out and recorded and there was evidence to show that residents are assisted to attend appointments with relevant health care professionals. Copies of the OK Health Checks were available on the case files. Weight charts are maintained. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 15 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) x These standards will be examined at the next inspection. EVIDENCE: Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 16 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) 24,25,26,27,28,30. The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: The inspector looked around the home with the Assistant Team Leader and found the home to be clean, well maintained and decorated. Four of the bedrooms have been decorated and residents have chosen their colours. New bedding, curtains and carpets have also been provided where needed. All of the rooms were looked at and where permission could be sought staff asked residents. All of the bedrooms are homely, personalised and clean. The two bathrooms have new baths and tracking. There are plans to decorate both bathrooms and the two WCs. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 17 Each bungalow has its own lounge, dining area and kitchen. Service users were seen to be accessing these areas or spending time in their own bedrooms. Separate gardens are available to the rear of the premises, which are easily accessible to the service users. These are large, secluded and well maintained. Garden furniture has been provided. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 18 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) 33, 34, Staffing numbers are appropriate to the assessed needs of the residents, size and layout and purpose of the home. Recruitment arrangements have not been inspected, as the Trust does not keep records in the home, they are available at Head Office. EVIDENCE: On the day of the inspection the staffing levels were as previous agreements of 4 care staff on duty during the waking day and 2 waking night care staff. The home has enablers and a domestic who works 10 hours a week. Two new staff have been recruited, one is awaiting checks prior to commencing work. At the moment staff are continuing to cover the rota and maintain staffing levels. The inspector was again unable to examine staff recruitment records as these are held by the Trust at Head Office. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 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) 37,39,42. On the whole the home is well run with residents wishes and needs being met. There are some issues which need addressing concerning health and safety and management. EVIDENCE: The Inspector was informed that the manager has transferred to the Trusts Training Section for 6 months from 11/04/05. CSCI need to be informed of the arrangements which the Trust will put in pace without delay. The staffing levels were appropriate for the needs of the residents. The monthly visits by a representative of the Trust have now recommenced and reports for January and February were available. The home did not have a copy of the March or April reports but the Inspector was informed that the visits had occurred. The Fire Log book was examined and fire instruction to staff which should be 6 monthly for day staff and 3 monthly for any staff who cover night shifts have not occurred for a long period since August 2003.
Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 20 The fire door guards, which hold the doors open and close when the fire alarm is activated have not been fitted so staff continue to chock doors, open. This requirement was made in April 2004 and must now be dealt with immediately. No other hazards were identified during this inspection. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 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 x 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x x x 3 x 3 3 Standard No 31 32 33 34 35 36 Score x x 3 1 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Flax Cottages, 1/2 Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 1 x CS0000000644.V219921.R01.doc Version 1.30 Page 22 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. 2. Standard 34 42 Regulation 17 Schedule 4(6) 23(4) Requirement Staffing files to be made available for inspection in the home. Outstanding 31/1/05, Self-closing door devices linked to the fire alarm must be fitted at appropriate locations.Staff must fire instruction at appropriate tinmescale (3 monthly night staff, 6 monthly day staff) Timescale for action 30/5/05 30/5/05 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. 2. Refer to Standard 33 Good Practice Recommendations Programme to continue to ensure at least 50 per cent of the staff team achieve NVQ Level 2 or above by 2005. Flax Cottages, 1/2 CS0000000644.V219921.R01.doc Version 1.30 Page 23 Commission for Social Care Inspection Northumbria House Manor Walks Cramlington, Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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