Inspection on 24/10/06 for Hudson Street

This inspection was carried out on 24th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hudson Street 06/10/08

Hudson Street 08/03/06

Hudson Street 29/06/05

Hudson Street 12/01/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hudson Street 24 Hudson Street Whitby North Yorkshire YO21 3EP Lead Inspector Mavis Pickard Key Unannounced Inspection 24th October 2006 09:30 Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 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 Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 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. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hudson Street Address 24 Hudson Street Whitby North Yorkshire YO21 3EP 01947 603367 01947 600199 alison.graham@milewood.co.uk 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) Milewood Healthcare Limited Mrs Alison Graham Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users must be fully ambulant and require minimal physical care. Date of last inspection 8th March 2006 Brief Description of the Service: 24 Hudson Street, home to 6 Adults under 65 years of age who have a learning disability is located in a terraced property in a residential area of Whitby close to all of the main community facilities including the public transport network. There are 6 single bedrooms some of which have en-suite facilities. The private rooms are situated over 3 floors with communal space such as a sitting room, dining room and a kitchen being on the ground floor. There is no passenger lift. Information received from the home on 4 September 2006 advises that current fees are £1361.91a week. Additional charges are made for hairdressing, chiropody, toiletries, papers and magazines. Information about the services provided are made available in the home’s Statement of Purpose, Service Users Guide and through published inspection reports available from the home. The home does not provide nursing care. Should such care be required on a short-term basis, it will be provided by the community healthcare services. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The service has a registered manager Alison Graham who is experienced in the management of such services and competently runs the home. The outcomes for service users were evidenced from the observation of and/or speaking with service users and staff during this visit and from the examination of care plans and other documents relating to service users. Further information was obtained from asking people such as health and care professionals, care managers and others who have an interest in the welfare of people accommodated. Accumulated evidence was also provided by past inspection reports and other details about the service stored within the Commission for Social Care Inspection [CSCI] records. It was found the home was running well and that people who live at the home are supported to lead active, fulfilling and interesting lives. What the service does well: What has improved since the last inspection? There were no identified shortfalls in this service at the previous inspection visit therefore no improvements have been identified. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 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 Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. Service users and their representatives have the information they need to make a choice about being accommodated. The service provides people accommodated with the opportunity and support to be able to aspire to and fulfil their potential. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of 2 service users were examined where it was found that records evidence appropriate assessments had been undertaken. The manager said that she had visited all people prior to admission, that she took advice from their care managers, consultants and all appropriate professionals before the prospective service user was invited to visit the service. The manager said all people accommodated had planned admissions that took place over a considerable time, “as long as it takes,” the manager said to ensure as far as possible that the placement would be successful. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 9 Surveys received confirmed that good practice takes place at the service and that the manager and staff are equal to the job of managing a community of very challenging individuals who never the less aspire to live safe, happy and fulfilling lives. It was clear from direct and indirect observation and from the examination of case files that service provides people accommodated with the opportunity and support to be able to aspire to and fulfil their potential. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. Service users have appropriate plans that reflect their changing needs and provide staff with sufficient information by which they are able to support service users’ to lead fulfilling lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users have a plan and a range of the plans were examined. The manager said that the way in which individual plans are to be recorded is changing. The organisations new operations manager is in the process of supporting managers and staff of the organisation to make the changes for all people accommodated. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 11 An example of the new plans was examined which showed it gives greater detail and a more comprehensive overview of individual support to be provided. Although the current plans are appropriate it is noted that the new style plans will expand the detail of records and enable staff to record all the information required in a much more systematic way. All plans are regularly reviewed. Service users are party to regular management reviews of their support and they can invite whom they wish to the review. The group would usually include the key worker and close family along with the individuals care manager and the service manager but can include friends or anyone they wish. Staff spoken with confirmed that the plans, reviews and all other documentation gives them good guidance to enable them to support service users appropriately. It was evident from discussions with the staff that they endeavoured to be proactive in addressing behavioural problems displayed by service users and have made maximum use of the external professional support available to the service users. In order to provide a degree of continuity each service user had been allocated two ‘key workers’ one of which was a senior member of staff. The key workers have direct involvement in the monitoring and reviewing of service users’ care plans. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is excellent. Service users are supported to enjoy their lives in the way they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This visit concentrated on meeting with and observing service users and the way they live their lives within this community. It was clear that service users are supported as individuals and, as the manager said to “lead as usual a life as anyone living in the wider community would want”. All service users have 2 key worker’s who they can rely on to support them with their personal care and with identifying opportunities that make their lives happy and fulfilled. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 13 Key workers plan with service users their daily, weekly and longer-term aims and goals and support people in achieving these. All service users take part in jobs within the home on a rostered basis. People told me about the jobs they do and presented as being proud of their achievements in ensuring that their home is a nice place to live. One service user asked during this visit if he could clean the ground floor windows and was supported to do so. Another person was vacuuming the communal areas and said that “it is her job and she likes to do it every day”. It was clear that the service users sees this job as hers’ and enjoys the responsibility. All people have planed education and leisure throughout the week. All are enabled and supported by staff when necessary to be spontaneous in respect to the daily choices they make regarding their lifestyle. Friends and family members can visit whenever the service users want them to. People are encouraged to make arrangements with the service user about visiting and not to just arrive. There are few restrictions and where restrictions are in place either communally or individually these are discussed with the relevant people including service users, and an agreement made. Service users make decisions about their lives with support from the home’s staff, their individual care manager and others who have an interest in their welfare. Risk is seen as a part of ‘normal life’. Risk seen by others as being unacceptable is not restricted so long as the service user has been able to make an informed choice about it. Support staff assists service users in the preparation and cooking of meals in the home. A range of menus were examined that show a balanced diet is provided that service users choose and enjoy. Overall the service presents as enabling and supporting people who live at Hudson Street to be part of the local and wider community and to live fulfilled and ordinary lives. This is to be commended. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. Appropriate personal support and health care is provided to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was observed that staff are sensitive and flexible when supporting service users. The service accommodates 5 men and 1 woman the staff gender mix reflects this situation. Although the intimate personal care needed by service users is generally limited to bathing support, where possible a person of the same sex provides it. All service users are registered with a local GP and have input from health professionals according to their need. The community learning disability team are involved with service users and have provided the Commission with very positive feedback about how the service performs. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 15 Service users are provided with information they need in a style they can understand regarding their personal health care. Picture bank symbols are observed to be being used in care plans and throughout the service for 2 service users who need this type of communication. Written information is provided for others who want to receive their information in this way. Medication records show that the service has a safe system. However there were gaps in the medication record signing sheets when people had refused their medication. The manager said that she would ensure that if medication were not given for any reason this is clearly indicated in the record. The service does administer medications that are considered by the Commission as being controlled drugs. Presently these medications are recorded separately in a hard backed notebook. However Standard 20.11 of the National Minimum Standards for Younger Adults states that care homes should keep additional records of the receipt, administration and disposal of controlled drugs in a controlled drug ‘register’. This is explained in the Royal Pharmaceutical Society’s guidance as ‘a bound book or register with numbered pages’. The manager was agreed to obtain such a register and to instruct support staff in its use. Staff spoken with understood the medications they administer and understand the homes policy regarding medication. The service has an aging and death policy that meets current standards. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. The service has an appropriate complaints policy and that procedures are routinely followed. People accommodated are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no recent complaints recorded at the home or within the Commissions records. The service has a good and comprehensive complaint policy and staff spoken with understands the procedures should someone raise a complaint, concern or allegation. It is clear from observing and speaking with service users that they understand that they can complain if they want to and that the manager and staff will listen and take notice of their concerns. Staff understands and have received training in respect to the safeguarding of adults. Staff spoken with could say what the procedures would be if such issues were raised and whom they would report to. The service accommodates service users who exhibit very challenging behaviours. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 17 The Commission receives regular notices in respect to staff having dealt with such issues. Records received often refer to staff having applied ‘Full team control’. This terminology can be alarming if the detail of the restraint needed and the procedures used are not explained. The manager was asked to ensure that staff write clearly and give a detailed explanation in respect to any notices sent to the Commission as required under Regulation 37 of the Care Standards Regulations 2001. There are no concerns about the training that staff receives regarding restraint. It is evidenced in the services training matrix and in individual training files that staff receives very comprehensive training that is regularly updated. The local learning disability team and other health professionals who have an interest in the service and its users are satisfied with the service in respect to any form of restraint, which is used as a last resort. Overall it is clear from observing service users and staff, from records examined and from information received from external organisations that service users at Hudson Street are safe. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. Service users are provided with a clean, safe, comfortable environment that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A short tour of the home was undertaken. The service is situated in a terraced house that is home to 6 people. All service users have single bedrooms that are big enough for their needs and furnished, in the way that they wish. Some people said that their rooms could be visited, those seen were individually personalised by the occupant, clean and well maintained. People spoken with said that they ‘love their rooms’. The service has communal rooms, a large sitting room and smaller dining room. There is a general office that is a walk though to the back yard area Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 19 that everyone who smokes uses. This situation is not ideal but people say its OK. There are sufficient toilets, showers and bathing areas. Presently no one needs mobility equipment and the manager said they could not admit a wheelchair user, as the home would not accommodate this need. There are many local amenities available for service users. The house is situated on Whitby’s west cliff, a short walk from the sea front, the cliffs, the shops and local pubs. The bus and railway stations are about 1 mile walk down hill from the home. All service users spoken with like their home and would not change it. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is good. The service employs sufficient competent and experienced staff to meet the needs of service users who are protected by recruitment and selection procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The recruitment files of 2 most recently employed people were examined. Although both had 2 satisfactory written references the references for 1 were from within the organisation. The manager was advised that it is good practice to seek references from outside the organisation. All other checks were appropriate. All staff had a job description and contract of employment. There is a robust training programme in place and the manager ensures that she routinely checks that all staff have updates when required. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 21 Staff spoken to have knowledge of the client group and are enthusiastic about the role they have in the service. One person said that ‘its great working here’. Another that ‘I love it here’. The staff team on duty were impressive. They were observed interacting with service users with each other and with the manager in a respectful, professional yet friendly and homely way. Service users were observed to react well to the staff as a group and with individuals. The rota suggests that there are always plenty of staff around and the manager said that they would come into the home if others were sick or if the manager needed extra support for a short time. All staff has formal 1-1 supervision that is recorded and where action is taken in respect to training needs etc. people spoken with said that they could rely on the manager to ‘keep them on track’. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. Quality in this outcome area is excellent. The service is managed effectively by a competent manager who ensures that service users benefit from an open and positive atmosphere. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager, Alison Graham, communicates a clear sense of direction to service users and to staff in an unhurried and unfussy way. Alison was observed interacting with a service user who had recently exhibited challenging behaviour toward her and others, in a calm professional way that was warm and inclusive. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 23 The service user was shown the utmost respect whilst being advised and reminded that their behaviours had been unacceptable. The openness and clarity of the interaction evidenced that although the behaviour had been unacceptable Alison was reinforcing that the service user remained a valued member of the homes community. Alison has been successful in achieving a sense of ‘ordinariness’ in the home for service users and staff that gives people confidence that even when plans sometimes ’go wrong’ all will be well. This is not always easy to achieve and is impressive. The service has a quality assurance system evidenced by records of survey results and by actions taken to put systems in place to meet any identified need or shortfall. The service’s policies and procedures are appropriate and regularly updated to reflect an ever changing and evolving service. The records seen evidenced that good systems are in place and that the home and working practices are safe. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 24 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 X 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 4 3 X X 3 X Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) and [Royal Pharmaceutical Society’s guidance] 37 (1)(e) Requirement The receipt administration and disposal of controlled drugs must be recorded in a controlled drug register that is a bound book with numbered pages. The records maintained by the service and provided to the Commission when restraint of service users has taken place must give clear detail of how and why the technique was applied. Timescale for action 30/11/06 2 YA23 30/11/06 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 YA34 Good Practice Recommendations 2 written references for prospective staff should be sought from outside the organisation. Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Hudson Street DS0000061659.V317607.R01.S.doc Version 5.2 Page 27 - 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. 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