Inspection on 17/10/06 for Northcroft

This inspection was carried out on 17th October 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

Northcroft 31/01/06

Northcroft 03/10/05

Northcroft 10/02/05

Northcroft 18/05/04

Northcroft 19/11/03

Northcroft 23/06/03

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

CARE HOME ADULTS 18-65 Northcroft Barrows Road Cheddar Somerset BS27 3BD Lead Inspector Judith McGregor-Harper Unannounced Inspection 17th October 2006 4 pm Northcroft DS0000015982.V315745.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 Northcroft DS0000015982.V315745.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. Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northcroft Address Barrows Road Cheddar Somerset BS27 3BD 01934 744734 NO FAX 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) ORCHARD VALE TRUST MISS CHRISTINE ANN KINGHAM Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: Northcroft is a large semi-detached Victorian property situated close to the centre of Cheddar. The home is located within easy access of community facilities. Northcroft is registered with the Commission for Social Care Inspection to provide care for up to eight service users who have a learning disability. All service user rooms are single occupancy and three have en suite facilities. The home has been decorated and furnished to a good standard. There is a garden at the rear of the property that is accessible to service users. The Registered Manager is Miss Christine Kingham. She has many years experience of providing care to adults with a learning disability and has obtained the Registered Managers Award. The Registered Provider is Orchard Vale Trust. Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out by one inspector and took place over one evening for a total of 3 hours. Three weeks prior to the inspection the inspector had also spent the day mixing with several of the residents whilst they were engaging in day activities at a sister home that has a range of arts and crafts workshops. Seven residents were at the home on the day of the inspection. One person had gone away to visit relatives on an overnight visit. There are currently no vacancies at the home. The inspector was able to see and spend time interacting with the residents. The two staff on duty were able to give time to speak with the inspectors. The registered manager Miss. Kingham was not scheduled on duty and the inspector was assisted during the visit by the senior staff member on duty Mrs Neale. The inspector would like to thank the staff on duty for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and professional. Prior to the inspection the Commission forwarded service user surveys to the home inviting comments on the service. Comment cards were also sent to health and social care professionals in contact with the home. At the time of writing this report no replies have been forthcoming. It is clear that at Northcroft residents are given opportunities and support to express their views on the conduct of the service through regular consultation by the organisation as well as being able to approach staff and management at the home informally. Records examined during the inspection were one care plans in detail and seven briefly, quality assurance processes, medication management records, staff training records staffing rosters, building and resident risk assessments, service user menus, fire safety records and information provided by the home to prospective admissions. Prior to the inspection the home completed and forwarded a CSCI pre-inspection questionnaire. The aim of this inspection visit was to inspect key National Minimum Standards as part of the Commission’s ‘Inspecting for Better Lives’ strategy. Inspectors focus on outcomes for service users and measure the quality of the service under four general headings. These are - excellent, good, adequate and poor. The judgement descriptors for the eight chapter outcome groups are given in this report. Any standards where a requirement or recommendation was made at the last inspection were also inspected. Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 6 What the service does well: 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. The summary of this inspection report can be made available in other formats on request. Northcroft DS0000015982.V315745.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 Northcroft DS0000015982.V315745.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, 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their families are provided with appropriate information to make a decision regarding admission to the home. The home has developed a suitable admissions procedure. Service users are provided with a written contract which states the terms and conditions of their stay. EVIDENCE: The home has a Statement of Purpose and Service User Guide that provide details of the services and facilities offered at Northcroft. The documents are presently under review and the Registered Manager has agreed to send copies of the revised documents to the Commission when published. The home has an admissions policy. A comprehensive assessment of need is completed prior to any service user moving into the home. There have been no new admissions for several years. Service users are provided with a written statement of the terms and conditions of their stay. This was seen within the service user plan inspected, Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 9 signed by both parties. All resident contracts were also inspected at the previous inspection. Northcroft DS0000015982.V315745.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, 8, 9, and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has developed an appropriate care plan for each service user. Service users are supported to exercising choice. Care plans are regularly reviewed and updated. Records relating to service users are stored securely. EVIDENCE: Care plans are maintained for each service user. One care plan was examined in detail; seven others were inspected briefly. Care plans provide details of service users needs, daily routines and preferences. Service users are able to keep their day-to-day care plans in their rooms and can access any of their other records at their request. Care plans include evidence of service user consultation and promote independence. Risk assessments are completed as required. Care plans are reviewed monthly and updated appropriately. Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 11 Service users are encouraged to exercise choice regarding their daily routines and social activities. Residents gave testament at the inspection to the range of choices they exercise in day-to-day living and life planning. Regular resident meetings are held. Service users are supported by their key coordinators. There is a notice board in the kitchen displaying which members of staff will be on duty. Northcroft DS0000015982.V315745.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): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in a wide range of activities, and access facilities within the local community. Service users are supported in developing life skills and are able to maintain contact with family and friends. Service users are provided with a well balanced diet. EVIDENCE: Service users participate in all aspects of running the home, and are supported in developing and maintaining daily living skills. Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 13 Service users attend work groups at East Court, which is a larger home owned by Orchard Vale Trust. The facilities available at East Court include a bakery, weavery, pottery, vegetable gardens, and batik workshop. Additional workgroups include printing and upholstery / woodwork. Service users are also able to attend Further Education Courses held in Adult Community Centres in the area. Service users at Northcroft enjoy trips out to the cinema, bowling or restaurants. Service users from the home are on the committee for the local Gateway Club. One service user attends church each week. On the evening of the inspection three service users were going out to participate in leisure activities. Service users stated that enjoyed regular evening and weekend activities away from the service if they choose. Service users decide whether or not to participate in activities, and are able to spend time relaxing in the home within communal rooms or their bedroom. Service users confirmed that friends and family members are made welcome at the home. Service users are involved in choosing and planning trips away from the home. These have included days out, visits to family and holidays. Service users participate in menu planning, produce shopping and food preparation. Healthy eating is promoted, and fresh produce is used from the large vegetable gardens at East Court. Service users stated that they enjoyed the meals provided. Northcroft DS0000015982.V315745.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, and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with appropriate assistance to meet their personal care needs. The home supports service users in accessing healthcare services. All medications are stored securely. The recording of medications was found to follow good practice. EVIDENCE: Service users are provided with support as necessary to undertake personal care tasks. Service users spoke highly of the care offered by staff and confirmed that they are treated with dignity. Service users are assisted in accessing opticians, dentist, and chiropody services as required. A record is maintained of all professional visits. The home has a medications policy. Many of the service users at the home manage their own medication. Risk assessments have been completed as appropriate and secure storage arrangements provided. Medication Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 15 Administration Records were examined, and found to follow good practice. The home is not currently storing any medicines that require refrigeration. Northcroft DS0000015982.V315745.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 and 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 appropriate polices and procedures in place to safeguard vulnerable service users. Residents reported that they felt at ease approaching staff with concerns, worries or complaints. EVIDENCE: The home has a complaints procedure that provides details of external agencies that may also be contacted, including CSCI. There has been one concern raised verbally within the organisation since the last inspection. This was documented and a record was kept demonstrating that the home followed through the concern to the satisfaction of the person who raised the issue. The home has appropriate policies relating to the Protection of Vulnerable Adults and whistle blowing. Staff received refresher training in the Protection of Vulnerable Adults in March 2006. The home consults with other agencies and utilities a robust risk assessment approach to promote the health and safety of service users. Service users Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 17 confirmed that they would be able to approach the Manager or staff with any issues of concern. Northcroft DS0000015982.V315745.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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has been decorated and furnished to a high standard. There is sufficient communal space and bathing facilities to meet service users’ needs. Service user rooms have been decorated to reflect individuals’ tastes. The home is maintained to a high standard of cleanliness. EVIDENCE: Northcroft is located close to the centre of Cheddar. Communal areas comprise of a large lounge and dining room. All service user rooms are single occupancy and three have en suite facilities. Three service users showed the Inspector their rooms. Service users had been involved in choosing the décor for their rooms. New furniture has been purchased for some areas within the home. Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 19 The home has been pleasantly decorated and furnished. There are appropriate bathing facilities to meet service users needs. Two staff provide sleep-in cover each night. Currently there are no separate bathroom facilities for staff. This is under review by Orchard Vale Trust. There are no environmental adaptations required at present. The home would seek further advice should the needs of the current service users change. The laundry is tidy and well organised. Service users each wash and iron their clothes with appropriate support from staff members. Appropriate facilities to manage the risk of cross infection in the laundry have been installed since the last inspection. The home is maintained to a very high standard of cleanliness. Northcroft DS0000015982.V315745.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): 31, 32, 33, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to meet service users’ needs. Staff offer a high standard of care and are provided with the training required to undertake their role. Staff are provided with appropriate support and supervision. EVIDENCE: Duty rotas are maintained. There are generally two staff on duty throughout day, although this is flexible dependent upon the number of service users at home, and activities planned. Two members of staff provide sleep-in cover. Newly appointed staff are provided with a thorough Induction program that is mapped to Skills Council standards as well as being particular to Orchard Vale Trust and Northcroft as a service. All staff members receive regular updates in mandatory training. The organisation purchased a training package in 2006 that enables staff to cover a range of courses including fire safety, first aid and infection control. Staff are also encouraged to study for NVQ qualifications in care. Presently 63 of the care staff hold and NVQ care qualification to a Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 21 minimum of Level 2. Staff meetings are held on a monthly basis. Staff confirmed that they are provided with appropriate support, and receive regular supervision. The Registered Manager and Deputy Manager were not on duty during this unannounced inspection, therefore recruitment files could not be examined. The Inspector was advised via a post inspection follow up telephone call to the Registered Manager that there has been one new staff member employed since the last inspection and that the Care Standard Act 2000 requirements regarding staff recruitment were adhered to. Northcroft DS0000015982.V315745.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, 40, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager provides effective leadership to the staff team. There is a relaxed and open atmosphere within the home. Records relating to service users are stored securely. Appropriate actions have been taken to promote the health and safety of staff and service users at the home. EVIDENCE: The Registered Manager is Miss Christine Kingham. She is an experienced manager and has obtained the Registered Managers Award. Service user meetings are held each month. Service users confirmed that these were valuable and that their views were listened to. The home has appropriate Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 23 policies and procedures in place to safeguard vulnerable service users. All records relating to service users are stored securely in accordance with the Data Protection Act 1998. Regulation 26 visits are completed each month and records maintained. The home displays appropriate Employers Liability insurance. Fire safety records were examined. Fire equipment is serviced and tested as required. Staff are provided with regular fire safety training. Regular fire drills include staff and residents. Staff are provided with health and safety training. Accidents and incidents had been reported and recorded as required and risk assessments amended following any trends in incident/accident patterns. Northcroft DS0000015982.V315745.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 3 2 3 3 N/A 4 N/A 5 3 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 4 26 3 27 3 28 3 29 3 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 4 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 4 3 3 3 X Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard Good Practice Recommendations Northcroft DS0000015982.V315745.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Northcroft DS0000015982.V315745.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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