Inspection on 20/01/09 for Pathways North West

This inspection was carried out on 20th January 2009.

CSCI found this care home to be providing an Excellent service.

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.

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pathways North West 12 Oswald Street Oswaldtwistle Lancashire BB5 3JF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kevan Royston     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Pathways North West 12 Oswald Street Oswaldtwistle Lancashire BB5 3JF 01254829216 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pathways North West Limited Name of registered manager (if applicable) Mr Clive Raymond Horton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Female Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 7 Date of last inspection Brief description of the care home Pathways is a specifically designed resource, providing assessment and interventionto peoplewith complex mental health needs. The home provides residents an opportunity to engage in a programme of mental health and daily living rehabilitation. The home is registered for 7 people eithre gender between 18 and 65 years of age. The home is situated in a residential area of Oswaldtwistle close to the town centre with bus links available. The home is a large end terraced house. There are two floors with bedrooms situated on either floor. There are three lounges and a kithcen dining area on the ground floor. There are bathroom and shower facilities to suit the needs of Care Homes for Adults (18-65 years) Page 4 of 28 care home 7 Over 65 0 7 Brief description of the care home residents. A copy of the Statement of Purpose and Service User Guide is available for anyone making enquiries about the home. The written information explains the care service and what residents can expect if they decide to live at the home. The fees for the home range from £850.00 to £1,900.00 . Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home unannounced on 20/1/09 as part of the inspection process. The visit lasted approximately 5.0 hours. We spoke to residents, staff and the manager to get their views of the home. Also we looked at care records, documentation which helped in the running of Pathways and had a walk around the building with the manager. As part of the inspection process we talked to residents and asked staff about those residents needs. We looked in their rooms, checked care records and daily diary notes, this is called case tracking. Other residents are invited to pass their opinions to us if they wish. We sent survey/comment cards to staff and residents for there views on how the home is run. The comments were positive and some are included in this Care Homes for Adults (18-65 years) Page 6 of 28 report. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide, also to make an assessment of the quality of their service. This document is called anAnnual Quality Assurance Assessment (AQAA). We use this information, in part, to focus our inspection activity. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 28 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission and assessment procedures are clear to ensure the care and support needs of residents can be met. Evidence: We spoke to a resident about how they came to Pathways and the admission process, she said, Yes I liked it from the start. Assessment information looked at for residents case tracked had excellent information provided by Pathways before the resident moved in. There was evidence of trial visits to ensure people liked the home and felt comfortable. A Staff member spoken to said, We encourage trial visits. Social Services assessments and mental health information was available to staff and the manager before a resident moves in.The manager said, We make sure we have all the information in place from Social Services before a decision is made. Staff spoken to and responses from staff surveys confirmed they have a clear understanding of how the assessment procedures work and are part of the process to ensure they can meet the needs of people coming to live at the home. One staff Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: member wrote, Relevant and precise information is needed when residents are admitted. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to make decisions,which help them in daily life whilst taking risk into account. Evidence: We case tracked two residents and looked at their records to support individuals during the rehabilitation programme at Pathways. Care records clearly identified the physical and mental health needs of both residents ensuring the get the right support. Staff spoken to had a good knowledge of what support and care is required to help residents achieve an independent life as possible whilst they live at Pathways where decisions about lifestyle are supported through a risk assessment framework. One staff member said, We develop a daily plan with person and help build their confidence. A resident spoken to said, I am not just saying it but the staff are brilliant. Following the assessment of the resident staff work closely with residents using an approach called Wellness Recovery Action Plan (WRAP) which is a framework to Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: develop a workable approach to overcome distressing symptoms which in turn helps overcome the problems. One staff member said, Its a good way of helping residents. A resident said, It has helped me living at the home. Records looked at show risk assessments are completed for each resident and reviewed on a regular basis and where needed are updated, to ensure risk taking is part of the rehabilitation plan to improve confidence and independence. Residents are involved in decision making within there individual care plan to build confidence. One resident said, I made the choice to go out shopping a lot. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for development are provided through residents individual rehabilitation plans. Meals are managed well and provide a wholesome nutritious diet. Evidence: We looked at care records, spoke to residents and staff and confirmed opportunities to take part in the local community is available according to each residents planned rehabilitation and recovery programme. One resident said, They have really helped me to go out and feel confident. One member of staff said about supporting residents to take part in activities outside the home, We have one person who has attended college. The manager tells us in the AQAA how they support residents find work or attend college and how the staff are aware this is a key aspect of recovery and rehabilitation of there mental health problems. The manager says in the AQAA how they have used a local scheme run by Lancashire County Council, Workstep to try and Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: help a resident who wishes to return to work. One staff member wrote in a survey, We are always there to give support. We watched during the day relaxed and structured routines being followed as part of each persons activities, One resident spoken to who had just returned to the home after being out with a member of staff, Yes I like going out. We sat in the kitchen area whilst lunch was being prepared, which was home made soup. One resident said about food, I make choices about food. A member of staff spoken to about meals said, We shop and cook together at times it helps as part of confidence building. There was evidence of fresh fruit in the home and fresh vegetables being used for lunch ensuring residents receive a nutritious diet. Pathways has a visitors policy which includes restrictions in line with individuals care plan and contact arrangements. The manager confirmed if residents are encouraged to have family and friends visit they are welcome at any time. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is taken seriously and they have excellent systems to monitor residents health needs. Evidence: Residents at Pathways at the moment do not require a lot of support with personal care needs, however the manager tells us in the AQAA they have Staying Well Plans detailing the how residents prefer to be supported, their religious and cultural needs and the need for sensitivity and respect when supporting residents who require help with personal care. One resident spoken to said, Very good respectful staff. Care records looked at show there is excellent access to health care services within the community to ensure any health problems can be addressed. The manager informs us in the AQAA how every month residents receive a health check which involves the taking of blood pressure, pulse, weight and blood sugar levels to ensure health needs are continuously monitored. One staff member wrote in a survey, We keep fully up to speed in residents health so we can provide the best possible care. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: We watched how medication was administered and checked medication records of residents case tracked, we found good systems in place to ensure medicines are given out correctly and at the right time. A staff member said, Only trained staff administer. What the home does well, two people are responsible for giving out medicines and all medication is checked by a weekly audit to ensure residents have the right medication. The manager said, We have a weekly audit of all medicines. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for complaints are in place and handled well to ensure people feel listened to. Evidence: There is a complaints policy and procedure which is given to all residents when they arrive at Pathways and is also contained in the Service User Guide. Staff and a resident spoken to,comments from surveys returned confirmed people are aware of the procedure and what to do should they wish to complain. One resident said,No I have nothing to complain about. There is a procedure for dealing with allegations of abuse and all staff have received safeguarding adults training so they know the procedure. The manager tells us in the AQAA how staff receive training during there induction period. One staff member wrote, My induction covered abuse issues. another member of staff spoken to said, Yes I have completed aggressive behavior and safeguarding adults training. Staff and the manager spoke of how they have an open approach to encourage comments through daily discussions, resident and staff meetings, this goes some way in sorting out any concerns before they become formal complaints. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is kept clean and tidy and maintained well. Evidence: We had a walk around the building inside and out of the premises, we found it was kept clean and tidy so that it is a pleasant place to live. The manager tells us in the AQAA how they keep a detailed rota for cleaning for both day and night staff. One resident said, Its always clean. Although this is a small home there are areas for residents to see people in private and join in activities. We did notice walking around that walls in hallways and lounges were painted the same and did not have any pictures or mirrors around to make the place look homely. The bedrooms all had en suite facilities and there was evidence of personal belongings to ensure people felt at home. We spoke to staff and they informed us small repairs are attended to by themselves and the manager such as changing lightbulbs. Contractors are available should any major repairs need doing. Maintenance records looked reflected this. One staff member said, We attend to minor repairs. There is a laundry facility and policies in place for the control of infection. Residents Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: attend to there own laundry tasks as part of there programme, the manager told us staff are there to support if needed. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for the recruitment of staff are good ensuring suitable staff are employed. The availability of training and good access to courses means the staff are well trained and have the skills to support residents. Evidence: We looked at staffing rotas, spoke to staff and residents about staffing levels and found sufficient numbers of staff on duty to ensure the needs of residents are being met. On the day of the visit there was plenty of staff so that one to one support could be given if any resident needed it. One staff member wrote in a survey, We always have plenty of staff to help. One resident spoken to said, There is never not enough people around to talk to. Staff recruitment records examined show they have proper checks in place before anyone starts to work at the home so that suitable staff only are employed. There was evidence of staff induction training when they started work and copies of qualifications on staff files to show they have the skills to look after people living at Pathways. One staff member spoken to said, I learnt a lot from my induction training. Training records show staff members have access to a structured training and Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: development programme through the companys training co-ordinator to ensure staff develop there skills and competencies. Comments about training and access to courses were positive and included, Any training I want is supported here. And, The staff are highly trained people. The manager tells us in the AQAA over 50 of care staff have completed the National Vocational Qualification (NVQ) to level 2 which is a recognized qualification in care. One staff member said, I found NVQ training very useful. Staff spoken to said they are clear about their role and work well in a small staff team to ensure the individual and collective needs of residents are met. One resident said, They have been great to me. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run well with good systems in place for the protection of residents and staff. Evidence: The manager has experience in supporting people with mental health problems and is a qualified nurse. He has the competencies to run a care home.The manager has completed the Registered Managers Award which is a recognized qualification for managing a care home. We spoke to the manager who said, I am just waiting for them to sign off my work. The mangers approach within Pathways is relaxed and we watched residents following their individual programmes supported by staff if required. One staff member wrote, We run the home as we would ours. Another staff member said, The manager is good and helps us to run the home smoothly. Records looked at for residents we case tracked were found to be comprehensive,well Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: written and up to date, ensuring the information contained was correct and health and social care needs are continuously monitored. We looked at health and safety records and found a procedure in place for recording any accidents, regular checks on fire safety procedures and all equipment checked, ensuring the people who live and work at Pathways are kept safe. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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