Inspection on 21/02/06 for Floshfield

This inspection was carried out on 21st February 2006.

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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Floshfield 19/06/06

Floshfield 13/07/05

Floshfield 28/10/04

Floshfield 16/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Floshfield Cleator Moor Cumbria CA23 3DT Lead Inspector Gordon Chivers Unannounced Inspection 21st February 2006 09:45 Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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 Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Floshfield Address Cleator Moor Cumbria CA23 3DT 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) 01946 810987 West House Miss Doreen Holding Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 13th July 2005 Date of last inspection Brief Description of the Service: West House provide the service and care at Floshfield, a home for six people who have a learning disability. The home is a dormer style bungalow set back off the main Cockermouth to Egremont road, next to the Ennerdale Country House Hotel. Floshfield is close to the centre of Cleator and blends naturally into the surrounding area. Accommodation is comprised of kitchen, lounge and dining room on the ground floor. Sufficient bathing, shower and toilet facilities can be accessed on both the ground and upper floors. Single occupancy bedrooms are provided on both floors, with the office and staff accommodation on the first floor. Car parking facilities are available to the front of the home and garden areas are to the front and rear of the building. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, commencing at 09.45 and lasting six hours. The inspection took place in the presence of the Manager, Ms. Doreen Holding, and included interviews with one member of staff. Four of the service users were in the home for various periods of the inspection. The inspection focused upon those standards which drew forth a requirement or a recommendation, and some of the standards which were not assessed, by the last inspection. The inspection involved looking at case files and other documents, a look at parts of the home, and observing the service users and staff. The manager made notes of issues as they arose through the course of the inspection. The inspector would like to thank the service users and staff of Floshfields for their welcome and cooperation during this inspection. What the service does well: What has improved since the last inspection? The system of relating care plans to assessed needs and action plans. All the staff have had training on the protection of vulnerable adults. Risk assessments have been carried out on the bedroom radiators. The dining room floor has been replaced. The manager has been confirmed in post and registered with CSCI. An annual Development Plan to improve the service has been produced. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 6 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. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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 Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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 The home provides plenty of information for prospective service users. There is evidence that it would assess a prospective service user’s needs and aspirations. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. Both are well presented and contain a lot of information about the home and about Westhouse. These should assist any prospective service user to make a decision about whether to live there. Westhouse’s admission procedure requires a full assessment of need to be undertaken for new service users. Floshfield has not had any new admissions for many years. All the case files examined had full assessments of health and care needs and risk assessments. These are reviewed regularly and updated. The home is also developing its person centred planning process. These plans contain information about service users’ wants and desires in life as well as their needs. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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): 6,10 Service users’ needs and goals form the basis of the care plans. These are reviewed regularly and changes will trigger a revised care plan. Information about service users is respected and controlled. EVIDENCE: The home has developed its process of making care plans. These are now clearly linked to the service users’ assessed needs. The assessed needs and care plans are reviewed on a six monthly basis. If the needs have changed the care plans are changed accordingly. The home is beginning to review its effectiveness in meeting the goals of the care plan and this focus should be further developed. The manager and the staff acknowledge that there are some important pieces of detailed information such as how service users like or do not like their personal cared to be provided which have not been recorded in the case files and which should be. Each person centred case file has a picture of the service user on the front so that they can recognise their own file. These are kept in a locked cupboard in a welsh dresser in the dining area. The case files are kept in the upstairs office. This information must be kept in a locked cabinet or the door to the Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 10 office must be kept locked when it is not in use. Access to personal information about service users is restricted to permanent members of staff. Service user permission is required before any information is shared with anybody else, including families and inspectors. Staff appear very aware about the importance of the principle of confidentiality and data protection. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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): 12,16,17 All of the service users undertake a range of activities, but they are currently limited in what they can do at weekends. Service users’ rights are promoted and they are reminded of their responsibilities. The service users are provided with a varied and balanced diet. EVIDENCE: The home does not have a dedicated Activities Organiser. This role is shared amongst all of the staff. Four of the six service users go to day services for varying periods during the week. All of the service users have weekly activity plans in the files which demonstrate the wide range of activities they enjoy between them. The two male service users clearly enjoy and benefit from a male relief support worker who takes them out every week. The service users are currently restricted in the activities they can engage in the weekend because two permanent members of staff are absent on long-term sickness. The manager has submitted a proposal to Westhouse to engage an Area Support Worker as a permanent member of staff. In her view this would enable the home to support the service users to undertake more activities at the weekends. The staff are very aware of protecting and promoting the rights of the service users. Some of the strategies which the home has developed to manage Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 12 challenging behaviour contain references to reminding them of their responsibilities towards other people as the basis of socially acceptable behaviour. Weekly menus are planned by the staff in consultation with the service users. However, menus are not based solely upon service user choice as staff are aware of the necessity of providing a balanced and healthy diet. Staff have guidance from Westhouse on these issues to refer to. The menus are balanced and varied. Staff stated that all the service users enjoy plenty of fruit. None of the service users have special dietary prescriptions. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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): 21 The home manages the health needs of the service users very well. EVIDENCE: The staff have attempted to support the service users to indicate their preferred funeral arrangements. In some cases the families have supported them to express a preference. Some of the service users have not wanted to deal with this issue. All of the service users have a section in their case files given over to health issues. These contain full health records and current actions to meet their health needs. One of the service users has contracted Alzheimer’s Disease and as a result has been behaving in ways which challenge the service. During the inspection the manager had a meeting with the specialist consultant psychiatrist and community nurse to discuss an action plan to manage the symptoms of the early stages of Alzheimer’s disease and contact is being arranged with the Alzheimer’s Association to inform the staff about this disease and its management. Another service user is prone to seizures and the home has a health action plan in place to support her. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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): 23 Staff have received useful training in the protection of vulnerable adults. EVIDENCE: All of the staff have undertaken recent training in the prevention of abuse and neglect of vulnerable adults as required by the last inspection. The staff said it was a good course because it gave them insights and understandings which apply to the wider aspects of care and support. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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): 24,27,30 The home is comfortable and homely and safety precautions are attended to. There are sufficient bathing and toileting facilities, although some will need refurbishment in due course. The home is kept clean and hygienic. EVIDENCE: The home is spacious, homely, well decorated and well furnished. Each service user has their own bedroom. Fire extinguishers, smoke alarms and emergency lighting are in place. The radiators in the bedrooms and in the communal rooms have no guards around them. Risk assessments have been undertaken in respect of the radiators in the bedrooms. Each service user has been assessed as to the level of risk these unguarded radiators pose to them, and a decision has been made that guards do not need to be installed on the basis of these risk assessments. The dining room floor has been replaced and looks good. The kitchen units are looking ‘tired’ and the manager is in discussion with Westhouse regarding their possible replacement. The home has a bathroom with shower and separate toilet on the ground floor, and a bathroom and separate toilet on the upper floor. The downstairs bathroom will need refurbishment in the not too distant future, and the manager has developed a proposal to replace the shower cubicle with a walk in Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 16 shower. There is a fixed hoist to support one service user to use the bath. The system of ventilation in this room is not effective, causing condensation. The home is clean and hygienic. Some of the service users have continence issues but there are no unpleasant odours. Cleaning materials are kept in a locked cupboard in the utility area attached to the kitchen. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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 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): 33,35,36 The current staff team are well trained and supervised. The number of permanent staff should be reviewed to ensure the home meets the changing needs of the service users. EVIDENCE: Four of the five permanent members of staff (excluding the manager and two members of staff on long-term sickness) have attained NVQ level 2 in care. The home is covering the staff sickness absences by using an Area Support worker and bank relief staff. However, the manager considers this to be insufficient to meet the changing needs of the service users and has submitted a proposal to Westhouse for an additional 36 support hours per week. The manager discusses the staffs’ training needs with them in their individual supervision sessions. These are then referred to Westhouse central training manager. All staff receive annual refresher training in lifting and handling and physical intervention. Staff interviewed said that there is more training now. Records of training is kept in a file by the manager, although the file could be better organised. Staff have had five formal supervision sessions since March 2005. All staff have an annual appraisal. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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): 37,39,43 The home is well run. The manager has produced a Development Plan but it does not draw upon the views of the service users. The home manages the moneys of the service users well and is accountable to the service provider. EVIDENCE: The manager, Ms. Doreen Holding, has been confirmed in the post and registered with CSCI since the last inspection. She is currently undertaking the NVQ level 4 in management course and aims to complete by March 2006. One response from a professional involved with home commented upon the negative effects of the frequent turnaround of managers in recent times, but that the current manager is overcoming these effects. Staff interviewed also stated that the manager had brought stability and that systems and ways of doing things had improved. The manager has produced an annual Development Plan to improve the service which the home provides. It has eight objectives and is to be reviewed on an ongoing basis. However, there is no evidence that any part of this plan has been informed by or drawn from the views of the service users or their representatives. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 19 The home maintains a system which records the income and expenditure of all the service users. One of the service users is very involved in this system and makes most of the decisions regarding her money. The home keeps all records and receipts of purchases, and each service user has a bank book. The records are audited by Westhouse finance administrators. Some of the service users have quite large bank balances and the home should ensure that they derive maximum benefit from their money. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X 2 LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X 3 3 X 2 X X 3 x Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 21 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. 2. Standard YA10 YA27 Regulation 4,5,6 23 Requirement Personal information about service users kept in the office must be secure at all times. The registered person must ensure that the ground floor bathroom is effectively ventilated. The registered person must review the existing staffing arrangements to ensure that they meet the changing needs of the service users. The manager must base at least part of the Annual Development Plan on the views of the service users or their representatives. Timescale for action 01/03/06 30/04/06 3. YA33 18 30/04/06 4. YA39 24 30/04/06 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 YA6 Good Practice Recommendations Reviews of the effectiveness of the home’s actions in meeting the goals of the care plan should be further developed. DS0000022553.V280076.R01.S.doc Version 5.1 Page 22 Floshfield 2 3 4 5 YA6 YA12 YA24 YA27 All important detailed information about the service users should be recorded in their files. The registered person should ensure that the service users have the opportunity to engage in activities throughout the whole week. The registered person should review and update the risk assessments in respect of the unguarded radiators throughout the home on a regular basis. The registered person should give consideration to refurbishing the ground floor bathroom. Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Floshfield DS0000022553.V280076.R01.S.doc Version 5.1 Page 24 - 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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