Inspection on 01/03/06 for Neville Court

This inspection was carried out on 1st March 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Neville Court 22/11/06

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

CARE HOME ADULTS 18-65 Neville Court Neville Avenue Kendray Barnsley South Yorkshire S70 3HF Lead Inspector Mrs Sue Stephens Unannounced Inspection 1st March 2006 13:15 Neville Court DS0000064280.V276066.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 Neville Court DS0000064280.V276066.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. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Neville Court Address Neville Avenue Kendray Barnsley South Yorkshire S70 3HF 01709 565822 01709 565 824 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) Barnsley Healthcare Ltd Mrs Winnie (Mawarire Nee) Chitanda Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20), Physical disability (20) of places Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection None Brief Description of the Service: Neville Court is a purpose built home providing care for people with physical and mental disabilities. The ground floor accommodates the entrance area, a visitor’s lounge and a physiotherapy room. The upper two levels are the Bretton and Cannon suites; each wing accommodates 10 people. The wings are spacious and can accommodate wheelchair users; there are two lounges and a dining area on both wings. The bedrooms are purpose built; they are spacious and include en-suite facilities. There is access to all levels by stairs or passenger lift. There are security keypads to doors and the lift for the residents’ safety. The home stands in its own grounds, with gardens and parking space. It is well located to access local shops and pubs and there is public transport close by. The home is situated in the Kendray area of Barnsley; it has easy access to the town, collage, and leisure facilities. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Neville court registered in June 2005; this was their first inspection. The inspection was unannounced and took place over 5 ½ hours. The inspector consulted with residents and staff; and checks were made on samples of records and the homes environment. The registered manager and care manager assisted in the inspection. The inspector thanks the residents, staff and managers for their kind welcome and support during this inspection. What the service does well: The residents said they were happy with their care. One resident told the inspector: “I like it”, “I love it here”. Staff and the managers were caring and attentive. They had a good understanding about the residents needs, and treated the residents with dignity and respect. The assessments and care plans were very well documented. The leisure and activity events suited the needs of the residents. The home provided good quality and nutritional food; and drinks and snacks were available. Staff understood about individuals’ personal and health care needs, this was reflected in the well written care plans. Staff received training in adult protection. The home was clean, warm, comfortable and furnished in a homely manner. Staff received good training including induction and areas specific to the residents’ care. Recruitment processes were thorough. The home was well managed and good recording systems and quality audits were in place. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Neville Court DS0000064280.V276066.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 Neville Court DS0000064280.V276066.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): 2 The homes assessments ensure residents needs and aspirations can be met. EVIDENCE: There was good evidence in the plans to show that the resident’s needs were assessed before they came to live at the home. The assessments were full and detailed and included any potential restrictions on freedom and choice. The assessments identified nursing needs. The home had developed good care plans using the outcomes of the assessments; and where it was suitable for the resident, they had been involved in the assessment process. Where residents needs had changed this had been identified in the care plans. Neville Court DS0000064280.V276066.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): 6,7 and 9 The home developed very good plans of care; these reflected the residents’ needs and goals. The residents received positive and respectful support to help them make decisions about their lives. EVIDENCE: The residents had very well designed care plans. They contained good and relevant information about the person. Information in the plans was easy to find and it gave staff clear instructions about how to care for individuals. The plans included very thorough risk assessments. Where it was appropriate for the person, they were invited to be involved in their plans, including attending reviews and expressing their preferences. The plans were clear and concise about specialist requirements. For example when dealing with challenging behaviours and complex needs. Staff recorded in the care plans using positive language. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 10 The inspector noted that staff were very respectful when dealing with residents, they encouraged the residents to make decisions and think about what they wanted to do. When a resident changed their mind staff continued to be supportive and helpful. Staff communicated with the residents in a very effective manner. They showed that they were aware of, and understanding about people’s communication difficulties. The staff were patient and gave residents time to communicate and express their needs. Neville Court DS0000064280.V276066.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): 12,13,15,16 and 17. The leisure, community and activity opportunities suited the needs of the residents. Residents and their family and friends were treated with dignity and respect. Residents could choose a healthy diet and their choices and preferences were respected. EVIDENCE: There was a good selection of activities. Staff consult with residents about what the resident wants to do; and when needed a resident would get one-toone support to carry out their activity. Included in the activities programme the home had daily papers, residents meetings, trips to local markets and shopping, cinema, sports night and videos. The home had employed an activities coordinator who developed the activities and leisure programme. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 12 The home encouraged good relationships with families and friends; the managers and staff were supportive to visitors and assisted residents to visit their family and friends in the community. Residents said they were happy with their daily routines, one resident said he spent the day how he wished and was satisfied with the activities the home offered. Residents could keep pets if they wished, providing the other residents and the manager agreed to this. The care plans recorded the residents’ dietary needs and their food preferences. The residents said they were satisfied with their meals. A kitchenette was provided in each suite were residents could help themselves to drinks and snacks. Staff were available to assist the resident with this if they needed. Menus were available at the home for residents, staff and visitors to refer to. Neville Court DS0000064280.V276066.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): 18,19, and 20. The residents said they were satisfied with the care they received; they received good personal support and health care. The medication system was safe and well managed. EVIDENCE: Records relating to residents health care needs were consistent and thorough. It was evident from the care plans that staff monitored individuals’ health needs and they took action when a resident’s health changed. The manager said they had good relationships with G.Ps and other specialist health care professionals. The inspector checked the medication system on Bretton Suite. The storage, administration and records were all in order. Advice on medication was available for reference; and important information was clearly on display in the nurses’ station. The home sought the residents consent to administer medication to them, and this was recorded in the individuals care plan. Neville Court DS0000064280.V276066.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): 22 and 23 The residents were protected by the homes complaints and adult protection policies and procedures. EVIDENCE: The home had a good complaints system. The complaints procedure was on display and a book invited residents and visitors to add comments and compliments. Residents were able to raise concerns in their monthly meetings. One resident said he felt he would be able to tell staff if he was not happy about anything. Staff had adult protection training during their induction. One member of staff confirmed this and stated that the training was informative. Neville Court DS0000064280.V276066.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 and 30 Neville Court was homely and comfortable and furnished in a manner that met the needs of the residents. EVIDENCE: The environment was checked at the point of registration and met with the relevant standards. The home was clean, comfortable and homely. A variety of furniture was provided to meet the needs of the residents. This included specialist furniture and fittings for the residents’ comfort and support. Bedrooms were spacious and personalised. Records were kept of cleaning schedules. These were well recorded and covered all aspects of the homes cleaning routines. Staff had signed the records and the managers checked the records regularly. The records reflected the good hygiene at the home. Some walls in communal areas were scuffed and needed repainting. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 16 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): 32,33,34 and 35. The homes good practices in training and recruitment enabled residents to receive safe, professional and consistent care. EVIDENCE: Staff received good training. One staff said the training was excellent; and all staff received an induction before starting work. The induction included training about the complex needs and specific conditions of the residents. The induction package met the requirements of the sector skills council. Induction also included dealing with people who may display challenging behaviours. The home also held regular training events for staff, and included good basic care practices for example: scalding prevention, temperature taking, fluid consistencies and infection control. Sufficient staff were available to meet the needs of the residents. The rotas confirmed this and the staff interviewed said there were enough staff to meet the needs of the residents. Three carers had achieved a National Vocational Qualification in care. Other staff were completing induction before commencing onto NVQ training. The home carried out thorough recruitment checks; these included criminal record bureau checks, references and checking identity. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 17 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, 38, 39 and 42 Residents benefited from a well managed home. The homes health and safety and quality audits protected the resident’s health and welfare. EVIDENCE: The home was well managed. There was evidence of this in records, positive resident and staff feedback, and the manager’s positive manner towards the residents and staff. The registered manager and care manager had high standards and spent a lot of time with residents and observing staff to make sure care practices were good. The inspector noted that both managers communicated with the residents and staff very well. They were attentive and listened. There were excellent quality assurance systems in place. These included resident feedback, cleaning, care, health and safety and staff monitoring. The managers did regular audits and followed up practices that needed to improve. Further evidence of good quality systems was seen in the good record keeping and allocation of specific jobs to staff. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 18 Staff carried out health and safety checks daily. The fire drills did not identify who had carried out the drill. Two agency staff had written to the home and said: “There are no set routines, clients can choose if and when they do anything” and “the managers lead by example because they are always up and down the building making sure everything is done to perfection.” The home had regular provider visits, and the commission received the reports. Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 19 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 3 33 3 34 3 35 4 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 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 3 4 X X 3 X Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NA 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 24 42 Good Practice Recommendations The walls should be painted with suitable paint that is hardwearing. Fire drill records should identify who carried out the drill Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Neville Court DS0000064280.V276066.R01.S.doc Version 5.1 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!