CARE HOME ADULTS 18-65
Karline Care Home Karline Care Home 23 Dickens Street Spennymoor Durham DL16 6AZ Lead Inspector
Ms Kathy Bell Announced Inspection 25th January 2006 11:00 Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 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.V264433.R01.S.doc Version 5.0 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.V264433.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Karline Care Home Address Karline Care Home 23 Dickens Street Spennymoor Durham DL16 6AZ 01388 810617 01388 420915 karensnowdon@aol.com 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) 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.V264433.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th February 2005 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. 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.V264433.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place during one day in January 2006 and all three residents returned to the home during the course of it. The inspector talked to the manager and the residents and looked at some records. Some residents are not able to comment directly upon their care but one who can, continues to be satisfied with her placement in this home. Two relatives sent written comments and were very satisfied with the home, both felt that their relatives were very happy. What the service does well: What has improved since the last inspection?
Some improvements have been made to the house: double glazing has been installed and new carpets laid which make the house more comfortable to live in. Better written guidelines have been recorded, explaining how best to respond to one residents behaviour. The manager feels that working with her care worker during a recent holiday has enabled her to explain better the reasons for responding in particular ways. This will help them both act in a consistent way. Work has begun on developing a system to make sure that the home is running well but the manager needs to get this working.
Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 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. Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 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.V264433.R01.S.doc Version 5.0 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): These standards were not assessed during this inspection. EVIDENCE: Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 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): 7&9 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. The manager has considered situations where residents could be at risk and put in sensible safeguards, without restricting residents unnecessarily. EVIDENCE: A resident described how she chooses her evening routine. She has control of spending her personal allowance, although the manager tries to offer guidance on this. She goes to a college course which she is interested in. 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.
Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 10 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 . Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 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): 16 & 17 Residents rights are respected but sometimes restricted to minimise behavioural problems. Residents who could say, were happy with the meals. Although the menus seen showed a reasonable diet, they seemed to rely quite a lot on ready prepared meals. EVIDENCE: 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. There seems to have been more use of convenience food recently and choices are sometimes limited for a resident who is vegetarian. The home should consider how it can involve residents more in the preparation of meals.
Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 12 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): None of these standards were assessed during this inspection. EVIDENCE: Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 13 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): 22 & 23 The home has a satisfactory complaints procedure but residents may not always feel confident about complaining. However their relatives said they knew how to complain if they wanted to. Residents are protected from abuse and self harm although the manager must seek advice on the proper use of residents personal allowances. EVIDENCE: The home has a complaints procedure which explains how people can complain and who they can go to. However, residents seem to see the manager as a powerful person but also someone whose approval they want. This is difficult to avoid in a small home of this kind and is not a criticism. Residents abilities to complain can also be affected by past experiences. However it means that it can be difficult for residents to tell the manager about any important things they are not happy with. The manager is aware of these issues. Their relatives confirmed that they were aware of the home’s complaints procedure. The home has satisfactory procedures about adult protection and the manager and the care worker have both had training in identifying and preventing abuse. Anonymous allegations have been made about the home in last year but the Social Services Department found no evidence of abuse when they investigated. The manager cooperated with their enquiries. Proper records are kept of money handled on behalf of residents but the inspector queried whether some payments should be made out of the homes funds or residents personal allowances. The manager must check the contractual arrangements about these matters.
Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 14 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): These standards were not assessed during this inspection. EVIDENCE: Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 15 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): These standards were not assessed during his inspection. EVIDENCE: Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 16 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): 39 & 42 The manager is developing ways of making sure that the home is running properly. She has not carried out surveys of residents and relatives views which is essential to find out what they think of the home. Arrangements for protecting the health and safety of residents are satisfactory for this kind of home in almost every way. The exception is that further training on fire safety is needed. EVIDENCE: The manager 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. Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 17 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 only area of concern is that, although residents regularly experience the smoke detector sounding, this tends to happen when smoke from cooking sets it off. Residents have learned to respond to this by opening doors to let the smoke out. This would clearly be the wrong response if there was an actual fire and the manager needs to work on residents understanding of what to do in case of fire. Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 18 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 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Karline Care Home Score X X X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 3 X DS0000007598.V264433.R01.S.doc Version 5.0 Page 19 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. The manager must record a risk assessment for a resident who travels independently. The manager must check whether she or residents should be paying for meals and the costs of transport to day placements. The manager must check that a resident will be safe when he spends time at the home of her care worker. She must try and develop the understanding of residents about what they should do if a fire alarm sounds . Timescale for action 31/03/06 2 3 YA9 YA23 13 13 28/02/06 28/02/06 4 YA42 13 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 20 No. 1 Refer to Standard YA17 Good Practice Recommendations Residents should be given the opportunity to be more involved in the preparation of meals. More thought should be given to the choices available for the vegetarian resident. Karline Care Home DS0000007598.V264433.R01.S.doc Version 5.0 Page 21 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
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