Inspection on 24/01/07 for Karline Care Home

This inspection was carried out on 24th January 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Karline Care Home 13/11/07

Karline Care Home 25/01/06

Karline Care Home 07/11/05

Karline Care Home 16/02/05

Karline Care Home 24/06/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Karline Care Home Karline Care Home 23 Dickens Street Spennymoor Durham DL16 6AZ Lead Inspector Ms Kathy Bell Unannounced Inspection 24 January 2007 10:00 Karline Care Home DS0000007598.V303939.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 Karline Care Home DS0000007598.V303939.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. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Karline Care Home Address Karline Care Home 23 Dickens Street Spennymoor Durham DL16 6AZ 01388 810617 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) karensnowdon@aol.com Miss Karen Snowdon Miss Karen Snowdon Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (3) of places Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2006 Brief Description of the Service: Karline is registered to provide care (but not nursing care) for three adults with learning disabilities, over 18 years: the registration was varied to allow the home to accommodate a resident who was over 65 but all three current residents are under 65. The building is a semi-detached house, near the town centre of Spennymoor with a single bedroom for each resident and one for the owner/manager who is the main carer, and her partner. There is a good-sized lounge, dining room, kitchen, utility, bathroom/toilet and a separate toilet. A garden at the back of the house provides space for a number of family pets. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during one day in January 2007. It was the one inspection planned for the year from April 2006 to March 2007. During the visit, the Inspector talked with the owner/manager, Karen Snowden, and the three residents. She received survey forms from three relatives and all three residents, although two had needed help from the manager to complete the questionnaire. What the service does well: What has improved since the last inspection? What they could do better: The manager must keep care plans up-to-date. This is such a small home that she and the other member of staff are confident that they always know how to look after people. But care plans are a way for homes to make sure they are meeting all of each residents needs. They are also very important, if, for example, staff are off sick and somebody else needs to help residents. The care plans must include more guidance on how to avoid residents behaviour becoming difficult. The manager must write down how she has considered whether any resident can stay in the building on their own, and she what she will do to make this as safe as possible. She should do the same thing for residents going out alone. She should discuss all of these things with residents care managers to make sure that everybody agrees she is doing the right thing. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 6 She must decide how she is going to make sure that the home is always running the way she and residents expect it to, and then get the system up and running. She should include in this, getting the views of residents and relatives. 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. Karline Care Home DS0000007598.V303939.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 Karline Care Home DS0000007598.V303939.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were assessed before they were admitted to make sure the home would be able to meet their needs. EVIDENCE: All the residents were assessed by a care manager before they were admitted. The files contain copies of these assessments. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 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): Standard 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provided much detailed information on the care each person needs but did not give enough information on how to avoid and respond to behavioural problems. This is usually essential to make sure that staff behave in a consistent way. But it is less important in this home because there is only the manager and one other member of staff so they can share knowledge easily. Generally, residents can make choices about their day-to-day lives. When these are restricted, the reasons are explained in behavioural guidelines but these should be discussed with care managers or other people who can look after the interests of residents. This would protect residents, and protect staff from criticism about how they had acted. The manager has considered situations where residents could be at risk and put in sensible safeguards, without restricting residents unnecessarily. But she should involve care managers in making decisions. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 10 EVIDENCE: Each resident has a care plan which explains the help they need. These cover most aspects of their lives, describing if they need help with personal care, if they can go out on their own etc. The care plans include any areas where peoples choices are restricted, for example going out without staff. The care plan for one resident did not include detailed guidance on how to avoid behavioural problems developing, and enough detail on how to respond if they did. The manager should draw up guidelines and ask the care manager responsible for this resident to confirm if they agree with them. This would protect the resident and also protect staff from criticism of their behaviour. One care plan was not up to date but the information was easily available in daily records. Because the home is only staffed by the manager and one other person, and they have got to know all the residents well, they do not have to rely on the written care plan as much. The manager had not recorded that she had reviewed the care plans to make sure they are up-to-date. All the residents confirmed in their surveys that they could make decisions about their daily lives. One resident talked about the college course she chose to go to. The inspector saw one resident making choices about videos etc. One resident is a member of a forum for service users and carers, to enable them to express their views and influence decision-making. The manager can justify why at times she does not offer a choice, if this would create anxiety or difficult behaviour. There are written behavioural guidelines which explain how staff should respond to difficult behaviour. However when a resident does not have the ability to agree or disagree with these guidelines, the manager should discuss them with his care manager, relative or anyone else appropriate who can act as an independent voice in his best interests. This would act as a good protection both for the resident and staff who may act in a restrictive way. The manager has written down any risks to residents she has identified and put in place measures to protect them, while still respecting their rights to make choices. She still needs to do a specific risk assessment for a resident going out alone. If a resident is ever left alone in the building, a risk assessment should be done for this. The manager must confirm with this persons care manager that this is agreed as a safe and reasonable thing to do. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 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): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a varied lifestyle and can follow their individual interests. They use local community facilities such as shops and pubs. They can keep up and develop family links and friendships. Residents rights are respected but sometimes restricted to minimise behavioural problems. Residents seem to have a satisfactory diet and can make choices about what they eat. EVIDENCE: Residents attend day placements arranged by care managers. One attends college for vocational training in an area she has chosen. One resident spends more time in the home and he is taken out on his own. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 12 Residents have been able to maintain contact with their families and friends can visit the home freely. Residents can choose how to spend their time , have privacy when they want it etc. At times, staff may tell a resident to spend some time in their room as a way of calming them down, or may tell them to concentrate on one activity at a time. This is acceptable, providing that the reasons are clearly stated in behavioural guidelines and have been agreed with care manager, relatives etc. Residents who can comment have said that they like the meals and they can say what they like and dont like. The manager described how they had tried to help a resident with a reducing diet. The Inspector looked at the menus with the manager, and a resident who is sometimes a vegetarian seems to have a satisfactory choice of meals. Residents were choosing what to have for their evening meal while the Inspector was there. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 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): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the personal care they need and can maintain their independence wherever possible. The home make sure that residents receive medical attention when they need it. Staff handle medication safely. EVIDENCE: The care plans explained how much care each person needs and it is clear that, wherever possible, they are able to be independent. Records showed that the manager made sure residents received medical help when they needed it, had regular checks of long-term conditions and dental care etc. The manager described how she has been working with health professionals to try and find out what is the cause of a health problem for one resident. The manager and staff have had training in handling medication. Records are kept which show a safe system for looking after medication. The home tried to Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 14 support one resident to look after her own medication. This is good practice where residents can handle their own medication safely. They kept records so they could tell if this resident was able to take her medication without them telling her to. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 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 the following standard(s): Standards 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory formal complaints procedure and residents say they can tell if they are not happy about something. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure which explains how people can complain and who they can go to. In their surveys, residents said that they could tell staff or their care managers if they were not happy about something. Residents seemed to have a confident relationship with the owner and one said that the staff listen to what we say. The home has satisfactory procedures about what staff should do if they suspect someone has been abused. The manager and the care worker have both had training in identifying and preventing abuse. Proper records are kept of money handled on behalf of residents so they are protected from financial abuse. When staff have been recruited in the past, the manager has checked that they are suitable people to work in a care home. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 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 the following standard(s): Standards 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable place to live in a domestic house. It appears to be kept clean. EVIDENCE: The home is decorated and furnished in a domestic way and the manager takes the safety precautions expected of a responsible householder. Each resident has their own room, and they arrange their rooms as they want to. There is a shared living room, a dining room and kitchen, shared with the owner and her partner. There is a bathroom upstairs and a downstairs toilet. The owner/manager has bought the house next door which she plans to turn into living space for herself and her partner . The houses will be connected through a bedroom on the first floor. This will mean that two residents will move to different bedrooms. The resident who is moving to a smaller room said she is happy with the move because this room will be quieter, away from the noise of the street. The new house will have an office, which will be good, because, at the moment, there is nowhere to work on care plans, records etc apart from the dining room table and the managers own bedroom. This will Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 17 also make it easier for the manager to talk to anyone in private if she needs to. The home seemed clean on the day of inspection. One resident said in a survey, this home is nice and clean and it has a fresh smell. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 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 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): Standards 32, 33, 34 & 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is one person on duty when residents are in the building which meets their needs. Before new staff have started, the manager has checked they will be safe to work with vulnerable adults. Staff have had the training they need to look after people safely but the care worker should work towards a qualification in care. EVIDENCE: The home is staffed at the moment only by the owner/manager, who lives in the home, and one employee. Between them they cover the times when residents are at home, with one on duty at a time. Two of the residents do not need help with their personal care and one goes out independently so this arrangement seems to meet their needs. The manager is a nurse specialising in learning disabilities and has updated her training as necessary. She and the care worker have undertaken core training such as food hygiene , moving and handling, first aid , protection of vulnerable adults and fire safety. They continue to make use of any relevant training Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 19 offered, for example, recently doing a dementia awareness course. The care worker has not yet achieved the qualification which is recommended for care workers, the NVQ 2 in care. The managers partner is not officially a member of staff but because he lives there he is part of the lives of residents. He has shown his commitment to the home by doing training in health and safety, food hygiene and the protection of vulnerable adults himself. He is also doing an NVQ 2 in care. No new staff have been recruited since the last inspection. But when the Inspector has checked records of new staff before, she found that the manager had checked references and obtained a Criminal Records Bureau check to make sure that new staff are fit to work with vulnerable people. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 20 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): Standards 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the skills, qualifications and experience to run the home. She is developing ways of making sure that the home is running properly. She has not carried out surveys of residents and relatives views to find out what they think of the home. But she does get day-to-day feedback from residents about what they are happy or unhappy about. The home is a safe place to live. EVIDENCE: The manager is a qualified nurse who has specialised in learning disabilities. She has achieved the NVQ 4 in management which is the recommended qualification for managers of care homes. She is doing a part-time degree but still has enough time to carry out the management side of her role as well as providing day-to-day care for residents. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 21 She is working on a system which will help her and her staff member keep the home running to the standards she expects. However she hasnt yet put this into operation. She has not tried to obtain the views of residents and relatives in a systematic way to make sure that she finds out what they think of a home. But she does receive day-to-day feedback from them. Equipment etc in the home is regularly serviced and and the fire detection system is checked regularly. The checks required by food hygiene regulations are carried out. The manager has thought about how she can make sure residents are safe at night when she moves in to the house next door and plans to set up a baby monitor so she will hear if people get up in the night. She will also ask advice from the fire officer about fire precautions for two connected houses. Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 22 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 2 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 x Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Guidelines on preventing and responding to challenging behaviour must be discussed with care managers and relatives. Care plans must be kept up-to-date. The manager must record a risk assessment for a resident who travels independently and who could be in the house on her own for short periods. She should ask care managers to record whether they agree with the residents taking these risks and with the safeguards put in place. She should send a copy of the next review with a care manager and any other evidence to show that requirements 1 & 2 have been met. Timescale for action 30/06/07 2. YA9 13 30/06/07 Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Karline Care Home DS0000007598.V303939.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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