Inspection on 06/09/05 for Peat Lane House

This inspection was carried out on 6th September 2005.

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

Peat Lane House 06/09/07

Peat Lane House 07/02/07

Peat Lane House 26/06/06

Peat Lane House 20/03/06

Peat Lane House 16/03/05

Peat Lane House 29/09/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Peat Lane House Sandylands Kendal Cumbria LA9 6AA Lead Inspector Liz Kelley Unannounced 06 September 2005 10:30 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 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 Stationary 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. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Peat Lane House Address Sandylands Kendal Cumbria LA9 6AA 01539 773073 01539 773073 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cumbria Care Care Home 19 Category(ies) of LD - Learning Disability registration, with number PD - Physical Disability of places LD(E) - Learning Disability, over 65 Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. An application in respect of a registered manager for this home must be received by the National Care Standards Commission within 28 days of the date of this notice 2. The matters detailed in the attached schedule of requirements must be completed in the specified timescales. 3. The staffing levels for the home must meet the Residential Forum Care Staffing formula for Younger Adults by 1st April 2004. 4. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. 5. The statement of purpose should clearly set out the physical environmental standards met/not met by the home in relation to standards met/not met by the home in relation to standards 24.2;24.9;25.3;27.2;27.4;28.2, and a summary of this information should appear in the service user`s guide. 6. Eighteen people with a learning disability (18LD); one person with a learning disability over 65 years of age (1LD(E)) of whom five may have a physical disability (5PD). Date of last inspection 16 March 2005 Brief Description of the Service: Peat Lane House is registered as a Care Home for 19 people with learning disabilities of whom five may also have a physical disability. The registered provider is Cumbria Care, who were previously the Local Authority care provider. The living accommodation is arranged into five separate flats accommodating between two and five people. Each flat had its own sitting room, fully fitted kitchen, bedrooms and bathroom facilities. The larger flats also have a separate dining room. A central laundry was available for some flats that do not have their own laundry facilities. The flats are linked by communal corridors and accessed via a shared entrance door and entrance hall, off which are staff offices. There is a staff sleep-in room situated upstairs. The Home also had a large separate communal lounge, which can be used by any of the service users. A recent development has been the installation of a sensory room. The Home has a respite facility, which is located in a separate flat that accommodates up to three people. The home has its own large car park.Each flat has its own dedicated staff team who offer support, supervision and personal care. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by Liz Kelley and Elaine Brayton from 10.30 am until 3.30 pm. The focus of this inspection was the proposed move to a Supported Living model and the appropriateness of this change. The majority of service users were out at day placements and this gave the inspectors the opportunity to focus on the building and administrative procedures. The organisation currently has an application pending regarding the registration status of the home which would mean that it is no longer run as a care home and is de-registered. This would be replaced by a style of accommodation termed “Supported Living” whereby residents would become tenants and this could lead to increased opportunities to exercise choice and control in their own homes. What the service does well: What has improved since the last inspection? What they could do better: It was becoming increasingly obvious that the home has had no major investment and the building both externally and internally was looking run down. As mentioned in previous inspections two long established flats that house highly dependent residents were having difficulties in meeting individual needs due to the different approaches required for each person and the fact that not Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 6 all these residents are compatible. The size and layout of these flats also adds to the difficulties in providing care for these residents. Staff time in these flats is rightly taken up by care of residents, but staff have no additional support for cleaning and household duties. Consequently these flats were not as clean as they should be. To rectify these shortfalls the manager must determine with the new landlord, Impact Housing, who is responsible for maintaining which areas of the home, and then draw up a plan of improvements for the home. 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. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 standard(s) 2,4,5 The home has good procedures to introduce new service users and to ensure that they are compatible with other residents in each flat. Residents are introduced in a planned way and information and opportunities are given to the individual to help them in making an informed choice. EVIDENCE: Resident’s files demonstrated that information and assessments were available which assisted in ensuring successful placements. The home had close working relationships with social workers and other professionals to ensure that placements are reviewed closely over a trial period. Work was currently underway to draw-up contracts with individual residents and the new landlord, Impact Housing. Following this a review of the homes Statement of Purpose and Service Users Guide will be required. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 standard(s) 6,7,8,9 Residents assessed needs are in good detail and clearly expressed in care plans. Residents are empowered to be involved in setting goals while also making them aware of risks involved. This has led to the home achieving a good balance between resident’s rights and their duty of care in ensuring wellbeing and safety. EVIDENCE: Staff at Peat Lane House have employed varied strategies, which engaged residents in playing an active role in drawing up care plans. These plans were clear, concise and a system was being introduced to ensure that they were regularly reviewed. The Home had a strong emphasis on respecting individual’s rights and this had been demonstrated in a recent consultation process whereby pertinent questions had been asked, in appropriate formats. Such as “Where would you like to live?” “Who would you like to live with?” “Are you happy with your care?” “Would you like to change your carers?”. The approach taken for those service users who were assessed as having limited capacity to make informed choice was to develop a “circle of support” made up of relatives, significant others, social workers, carers and advocates. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 10 Some residents had restrictions imposed for their own safety, for example some kitchens and fridge’s were locked. These restrictions were clearly documented and based on risk assessments. Risk assessments for a temporary resident were discussed and the senior for this flat agreed to draw-up risk assessments for smoking and self-medication. To ensure residents safety a recommendation was also made to contact the local Fire Officer, as previously the Home had been non-smoking and the flat used by the smoker had not been used for residential use for a number of years. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 standard(s) This standard will be assessed at the next inspection when more residents are available to check this out. EVIDENCE: Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 standard(s) 19,20 Good systems are in place to monitor individual’s health and effective links are in place with local health care professionals. Staff were experiencing teething problems with a new medications policy which had led to some recent errors. EVIDENCE: Service users were registered with a GP of their choice and had access to other members of the Primary Health Care team. Staff were able to demonstrate comprehensive records and systems to monitor service-users health care needs. A small number of service users self-medicate and staff appropriately monitor compliance and safety issues. Medication reviews were taking place and a number of residents had recently had significant changes in medications which had required careful monitoring by staff. The home was currently accepting deliveries of medication for smaller supported living homes locally and this system will need to be reviewed. These homes need to make their own arrangements. The medication cabinet was examined and found to be orderly and MAR sheets accurate. However, the system for auditing diazepam needs to be reviewed to ensure consistent methods are used and that unused tablets are returned promptly to the pharmacist. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 standard(s) 23 Staff awareness of the Adult Protection procedure had recently improved. Staff take appropriate measures to safeguard residents from harm and receive training in Adult Protection and challenging behaviours to help them in this role. EVIDENCE: A recent Adult Protection referral had ensured that staff were reminded of the procedures and the importance of the timescales. It was also a timely reminder that it is social services duty to investigate, while the home takes appropriate immediate action to safeguard residents. In this instance the home had acted in the best interests of the residents and went onto put longer-term measures in place that were agreed upon by a multi-disciplinary Adult Protection Strategy group. The home has a copy of the latest Adult Protection Guidance. The area of complaints was not looked at in any depth on this inspection, although no formal complaints had been received either to the home or directly to Commission for Social Care Inspection. This area will be examined at the next inspection. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 standard(s) 24,30 The home was looking run down both externally and internally. Some flats were not as clean as they should be and these factors gave the building an air of neglect. EVIDENCE: Externally the building requires painting as many areas were badly flaking. The entrance way looks neglected and rather like the entrance to an office than a home, containing a large photocopier, old office chairs and used as storage for boxes. Derwent flat has a claustrophobic feel with one long corridor and no natural light. The shared areas were in need of decoration with evidence of heavy wear and tear. Old metal windows were rusted and painted over badly and were in need of replacement. The kitchen was looking “tatty” with worn work surfaces and broken doors and handles. Although fridge temperatures were being recorded, the fridge was disorganised, with some open unprotected packets of food and generally needed cleaning. The fridge was not large enough for the number of residents in the flat, and an over spill fridge was used at the other side of the building. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 15 The sitting room was small for the number of challenging residents. There were insufficient electric sockets with a number of exposed extension leads in use. The bathroom was very small and was in need of up-grading, for example bath seals were old and black. There was some evidence to suggest that toiletries were being shared, and the manager agreed to reinforce with staff that this practice was not acceptable. Grasmere, similarly requires redecorating and cleaning to more acceptable standards. The practice of having the drier and soaking washing in the kitchen must be reviewed and a more hygienic alternative put in place. The bathroom was also in need of up-grading with cracked tiles and old seals. Rydal Flat, used for respite, also had a kitchen which required attention with broken doors. The bedroom furniture did not match and was old and dated, with missing handles. Bedroom carpets were also old and dated. The manager spoke of planned investment for the respite flat, particularly the bathing facilities. The other flats had a more homely feel and were kept to better levels of cleanliness. This discrepancy could be partly explained by less dependent residents who as part of promoting independence skills were involved in keeping their flats clean and tidy. The manager has had meetings with the new landlords, Impact Housing, and some areas have been prioritised namely the homes heating system and electrics which both require up-grading. The manager needs to determine with Impact the other areas, some identified in this report, and who is responsible and submit a plan of improvements for each flat, and Peat Lane House in general, to the Commission for Social Care Inspection. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34,36 The recruitment practices of the organisation and the home ensure that residents are safeguarded and that staff have the qualities and aptitudes to work in social care. EVIDENCE: The Home followed the recruitment procedure of Cumbria Care. The central personnel service of Cumbria Care had recently been delegated to individual Homes and managers. Staff files now held in the home contained all the relevant documentation and were clearly sectioned and well organised. The selection procedure included obtaining two written references, a formal interview and an informal interview involving service users, wherever possible. All staff had CRB disclosure checks. Upon appointment staff were issued with a handbook, which includes job descriptions and terms and conditions. Appointments are subject to a six-month probationary period. Cumbria Care had a code of conduct and all members of staff had a statement of terms and conditions. These are all good practices and procedures that benefit residents by being cared for by a carefully selected and vetted staff team. Supervision records will be looked at in more detail at the next inspection following the introduction of a new audit system. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,41 Due to the uncertainty of the registration the manager post and leadership roles in the home have experienced numerous changes and consequently staff have felt unsettled. EVIDENCE: The manager post had seen numerous changes over the last 18 months, however, Operations Manager, Nancy Douglas, had been line managing the Home over this period. A recent arrangement for two seniors to job share the post had ceased, and now one of these seniors is to submit an application to be the registered manager. The Home has a team of experienced senior supervisors who had provided continuity over this unsettled period. The home does not have a designated deputy and for accountability and clarity of roles in the absence of the manager this should be considered. The Home operated to Cumbria Cares Quality Assurance standards that included physical aspects of running the Home as well as monitoring the Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 18 delivery of service. The provider, Cumbria Care carried out regulation 26 monitoring visits and sent a copy of these into the Commission for Social Care Inspection. The records examined on the day of the inspection were deemed to be well ordered, relevant, appropriate and up-to-date for the smooth running of the Home and in meeting the needs of the residents. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 2 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Peat Lane House Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x 3 x x F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 20 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. 1. 2. Standard 24 6 Regulation 23 12 Requirement The respite facility must be upgraded (previous dead line 31.10.04) Compatibility issues for service users in Grasmere flat must be addressed and future actions sent into the Commission for Social Care Inspection (Previous dead line 30.11.04) Compatibility issues for service users in Derwent flat must be addressed and future actions sent into the Commission for Social Care Inspection (Previous dead line 30.11.04) The manager must develop a plan of improvements to the building Flats must be kept clean and hygenic An applciation for a registered manager must be submitted Risk assessments must be put in place for the temporary resident Timescale for action 31.03.06 31.10.05 3. 6 12 31.10.05 4. 5. 6. 7. 8. 24 24 37 9 23 23 8 13 30.11.05 30.09.05 30.09.05 16.09.05 Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 21 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 37 42 Good Practice Recommendations The home should review the need for a deputy manager The Fire Officer should be contacted for advice on the change in circumstances in accomodating a resident who smokes. Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP 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 Peat Lane House F58 F10 s36525 peat lane house v236922 060905 ui stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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