Inspection on 07/02/07 for Peat Lane House

This inspection was carried out on 7th February 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Peat Lane House 06/09/07

Peat Lane House 26/06/06

Peat Lane House 20/03/06

Peat Lane House 06/09/05

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 6LA Lead Inspector Liz Kelley Unannounced Inspection 7th & 13 February 2007 10:00 th Peat Lane House DS0000036525.V324823.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 Peat Lane House DS0000036525.V324823.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. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Peat Lane House Address Sandylands Kendal Cumbria LA9 6LA 01539 773073 01539 773073 peat.lane@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care 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) Mrs Heather Margaret Dixon Care Home 19 Category(ies) of Learning disability (18), Learning disability over registration, with number 65 years of age (1), Physical disability (5) of places Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 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. The home is registered for a maximum of 19 residents to include: up to 18 residents in the category of LD (Learning disabilities) of whom 5 residents may have a physical disability (PD). 1 person in the category of LD(E) (Learning disability over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection to manage one home only. 26th June 2006 2. 3. 4. Date of last inspection 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 are the Local Authority care provider. The living accommodation is arranged into five separate flats accommodating between two and four people. Each flat had its own sitting room, 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 has a large separate communal lounge, which can be used by any of the residents. The Home has a respite facility, which is located in a separate flat that accommodates up to three people. Each flat has its own dedicated staff team who offer support, supervision and personal care. The current scale for charging is £501.81, and the level of contribution is determined through a financial assessment carried out by a social worker. This covers board, amenity bills, council tax and staffing costs. Residents are Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 5 expected to pay for transport, personal items, toiletries, clothes and social activities. A Handbook is available for prospective residents, the latest Commission for Social Care Inspection report is made available on request. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key Inspection in a year, which was necessary due to concerns raised at the last inspection regarding the poor service being offered to service users. Two Inspectors, Liz Kelley and Cath Wilson, re-examined all the key standards. Inspection visits were made on the 7th and 13th February. On the first visit we concentrated on checking progress towards the homes Improvement Plan, interviewing the manager and reviewing paperwork. On the second visit time was spent with residents in the evening to find out what they felt about living at Peat Lane House and to determine their quality of life. On both occasions staff where also interviewed, and relatives where sent feedback cards. Additionally a visit was made by the Pharmacy Inspector, Angela Branch on the 11.01.07 at which the handling of medicines was judged to have significantly improved and had moved from providing a poor service to now offering a good service in this area. The last year has been a period of considerable uncertainty and change for everybody at Peat Lane House. The application to change the status of the home to allow Supported Living model to be put in place was withdrawn after Commission for Social Care Inspection (CSCI) assessed the building as being unsuitable for this model of care. Following this the home had a major Inspection, June 2006, at which it was judged as providing a poor service by CSCI. Since then a major review has been initiated by Cumbria Care with Impact Housing to consult with all residents, and relatives about their future and what type of support they would like. Since then, good progress has been made overall with the majority of targets being met and others being worked towards. There was a definite culture change noted with a more positive atmosphere both about the building and in staff and residents. What the service does well: The home has developed a good Improvement Plan and has carefully monitored progress towards improving the quality of care given to residents and to strengthen the administration of the home. One of the strength’s of the home continues to be the relationships that have developed between staff and residents. Staff have knowledge, skills and training that enhances their work with residents. Residents said “ I like spending time with staff” and “I like the people I live with, my room is nice”. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 7 The stability and supportive nature of the staff group has helped them through a difficult period of change and given residents continuity of care. Staff said “ We have always been good at supporting one another and covering for each other to make sure that residents are not affected. What has improved since the last inspection? What they could do better: Whilst most care plans have been reviewed and a good job has been done to make each person’s file better organised, there is still a lot to do in further consulting with residents and reflecting their wishes in the new style care plan. This is especially the case in making sure that any risks identified for residents are clearly set out in these new plans. They need to have a higher profile to ensure staff and residents are clear on the ways to minimise these risks. The progress of plans has been hampered by staff not having any dedicated time to carry these out, and have to find spare opportunities to do this. Following on from these new plans the healthcare records could be further strengthened by clearly identifying the chain of events from a health related problem being identified, a referral to a health care professional and the outcome of the appointment or advice given. The staffing levels of the home are not currently adequate to meet the social and recreational needs of residents. A number of flats are only given two or three opportunities a week where staffing is increased to allow residents to go out. This has to be in small groups of residents and often involves carrying out chores like shopping for food. One flat, due to the more complex needs of residents requiring more staff support, were sometimes unable to go out at all at the weekend. The home is currently working with Adult Social Care to resolve this problem by bringing in a new style of funding termed “In Control”. This is designed to allow individual budgets for residents allowing them to have more choice and opportunities for a better quality of life. It would be beneficial to explore ways of keeping relatives also updated and briefed in a timely fashion to enable them to respond to any consultations. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 8 A period of consolidation is now required to allow new systems to take effect to bring about a consistently better service for residents. 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. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 9 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 Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 10 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): 2,3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment and introduction of new residents to the home has improved and as a result recent placements have been very successful. EVIDENCE: The home has recently introduced a new system whereby it carries out its own assessment of residents prior to individuals being offered a permanent placement. This is in addition to an assessment carried out by the social work team. Both documents on a person’s needs are used to draw up a plan of care. This has given the home more say and control over admissions and has helped with getting to know the person in much greater depth. Two new residents were case tracked and both had a thorough introduction to the home, with a series of planned visits. Evidence of information and advice from relatives was also evident in planning the introduction. Both residents had a successful six-week review meeting and had made a smooth transition into the home. Other residents within the home were also consulted and their views sought. These placements have proved much more successful than the emergency ones taken previously, and on this occasion the compatibility of residents is working well. Relatives have reported favourably on how this was handled. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Where new style plans have been introduced these are a great improvement in identifying residents individual needs and interests. EVIDENCE: Residents support plans have had a major overhaul, with a new style care plan introduced to ensure clarity of information to staff in how to support people and to focus plans on being person centred. These were examined and where they had been completed they were found to provide a very effective tool in delivering care in a supportive and enabling way. A good example of this is the work staff are doing to remove locks on a fridge in one flat where this had been necessary to protect residents. Staff have worked closely with the Behaviour Intervention Team at more positive approaches and this all helps to reduce the institutional nature of the care and the building. Whilst most care plans have been reviewed and a good job has been done to make each person’s file better organised, there is still a lot to do in further consulting with residents and reflecting their wishes in the new style care plan. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 12 This is especially the case in making sure that any risks identified for staff and residents are clear on the ways to minimise these risks. It would be beneficial if risk assessments became an active practice in all elements of the care planning system. The progress of plans has been hampered by staff not having any dedicated time to carry these out, and they have to find spare opportunities to do this. It was recognised that person centred planning takes more time and commitment. Staff have made good use of different styles of plans, such as more pictorial ones, use of symbols and diagrams showing relationships and circles of support. Where the first person narrative is used this works better in making each plan individual and person centred. Central to these new plans is the importance of supporting individuals to make decisions. Evidence was found of individuals being encouraged to lead more healthy lifestyles with choices offered, and agreement sought, the residents had signed that they agreed with their revised care plan. Access to care plans for some staff is problematic. One flat keeps care plans in the staff room, along a corridor. A relief member of staff was on duty and could not recall details of the plan, which included strategies to managing challenging behaviour. These plans need to be held where staff can have quick and easy access to enable them to support residents effectively. The manager needs to continue to develop and strengthen the care planning system, giving staff time to work on these. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 13 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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the home has a strong commitment to enabling residents to develop independent living skills, some residents ability to have their chosen life style is still being compromised by inadequate staffing levels. EVIDENCE: The staffing levels in some of the flats are not currently adequate to meet the social and recreational needs of residents. A number of flats are only given two or three opportunities a week where staffing is increased to allow residents to go out. This then has to be in small groups of residents and often involves carrying out chores like shopping for food. One flat, due to the more complex needs of residents requiring more staff support, are sometimes unable to go out at all at the weekend. Staff report feeling under pressure during this time and issues with behaviour increase during this period. The cramped and claustrophobic environment of the flat in question further exacerbates this. Relatives have reported “no one Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 14 can get out even for a drive around leaving them looking at the same four walls.” The home is currently working with Adult Social Cares to resolve this problem by bringing in a new style of funding termed “In Control”. This is designed to allow individual budgets to increase choice and control for individuals to have a better quality of life. In the meantime arrangements need to be put in place to ensure that there are sufficient staff to allow residents to go out more often. The home needs to ensure that it continues to monitor these needs and identify any changing need so that appropriate referrals can be made to Adult Social Cares to amend the homes or individuals budget. Other residents who are less reliant on staff are enjoying a variety of opportunities in the local community, and are choosing meaningful college and work placements, using public transport, local pubs and leisure facilities. The home recognises the importance of promoting equality and diversity issues, although in practice the home is encountering difficulties and barriers in translating ideas into practice due to the afore mentioned staffing issues. Residents have the opportunity to develop and maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. Relatives said they are made to feel welcome in the Home and are made to feel a key part of the team caring for their relative. A relative commented “Every member of staff is courteous, caring and relates very well to relatives/friends of residents.” Details of family and friends are very much in evidence in residents care plans including key information, developmental issues, and frequency of contact. The Home has space to allow residents to see family and friends in private. Where appropriate residents are involved in the domestic routines of the home, they take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. The weekly menu is planned with residents and purchases for the menu carried out with residents, who take turns to help. Mealtimes are flexible and organised according to the residents’ activities. During the week packed lunches are taken to daytime activities, and a cooked evening meal is provided. Again residents help if this is part of an assessed care planning need. Service user also enjoyed a variety of take away meals and meals out. Specialist diets are catered for and from time to time dieticians are consulted. Details of residents being encouraged to have healthy diets were noted in care plans, and flats contain fresh fruit and vegetables. A resident spoken to was Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 15 aware of foods that were good and others that she should try to avoid, and she said staff helped her to make these choices. A number of different evening meals were observed and varied from pasta bakes to jacket potatoes with various fillings, all served with salad. A relative commented that “When I have been in at meal times the food has looked tempting and served attractively”. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 16 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. Provision and monitoring of healthcare for residents has improved particularly in the care of medication. EVIDENCE: The inspection carried out by the pharmacy Inspector in January found that residents were protected by robust systems for medicines handling and record keeping. The service has systems in place so that medicines are given safely and good records are kept. Regular audits of medicines are done to ensure they are handled correctly and ordered when necessary so that they do not run out. Residents are able to take their own medicines if they wish, and following assessment, and are supported to do so. The home is developing Health Care Record booklets for each person. These have the potential to be very user-friendly and fit well into person centred planning (PCP), making use of symbols and pictures to illustrate. As with PCPs, staff need to be given time to complete these documents, if they are to be useful working documents. Currently there are a number of different places that healthcare is recorded, including Health Care Booklets, and this can make it difficult to see what action Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 17 and follow up is required. There needs to be a clear trail from identifying a health issue through to seeking advice, appointments etc, and the outcomes. Where appropriate this information should be communicated to relatives and a robust system developed to ensure that all messages are passed onto each flat. Staff understand the key principles of giving personal support and are responsive to the varied and individual requirements of the residents. They recognised that the delivery of personal care is individual and must be flexible, consistent and reliable. Attention is given to ensuring privacy and dignity when delivering personal care and staff are sensitive to changing needs of residents. Whenever possible residents are able to have choice about who delivers their personal care. Where possible residents are supported and helped to be independent and responsible for their own personal hygiene and personal care, and this is detailed in care plans. Staff are aware of the need to treat people with respect and to consider dignity when delivering personal care. People who use the service are happy with the way staff deliver their care and respect their dignity. This was also confirmed by relatives who had positive comments to make about the level of staff commitment to caring for their relative. There was evidence that staff were accessing specialist training to help them support residents, for example from local support groups and from healthcare professionals. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. The homes policies and procedures are a good basis to ensure that residents are protected from harm. Practices do require tightening up to provide a consistent approach. EVIDENCE: The home has a complaints procedure that is up to date, clearly written, and is easy to understand. It can be made available on request in a number of formats to enable anyone associated with the service to complain or make suggestions for improvement. The complaints procedure is widely distributed, and has a high profile within the service. Residents and others associated with the home understand how to make a complaint and they are clear of what can be expected to happen if a complaint is made. Unless there are exceptional circumstances the service always responds within the agreed timescale of 28 days. After the last inspection when the area of safeguarding service users was highlighted as requiring strengthening, the home is now working much more closely with Adult Social Cares in jointly making decisions about incidents that may need further investigation by a social worker. The manager stated that these decisions are now being recorded however, they also need to be crossed referenced to service users files along with any amendments to care plans and risk assessments. This will ensure that care staff have full information to ensure they keep service users safe from harm. The home needs to further ensure that this includes all instances of physical aggression which is service user to service user, and where any injury occurs of unknown origin. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 19 Staff receive training in their induction period about how to safeguard residents from abuse and harm, and this is followed up by a rolling programme of further training to ensure that staff are up-to-date on these issues. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst there have been significant improvements to the building, the physical environment does not always meet the specialist needs of some residents with more complex needs. EVIDENCE: The layout and design of the building continues to present problems in meeting the needs of those with more complex needs. As mentioned in previous reports one flat in particular is over crowded, too small for its purpose and is of a poor design for anyone with mobility or behavioural issues. A series of reviews with social workers has commenced to try to find a solution to this issue. Even for those with good life skills the institutional nature of the building creates a barrier to integration into the community and labels individuals. All but one flat does not have direct access into the garden, and consequently this area is under used. However there have been significant improvements including: Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 21 • • • • The building inside and out has had significant improvements, including painting and decorating. Furniture and carpets have been replaced. An audit of each flat, and the building as a whole has been carried out, and actions identified and planned for. A newly introduced Quality Assurance measure gives responsibility to individual flat teams to carry out routine checks at the end of each shift, and seniors are responsible for reporting any repairs necessary. This has made individuals more accountable for their work practices and this is followed up by regular spot checks by the manager and operations manager. This has resulted in flats being generally cleaner, tidier and a safer environment for residents. As with other areas where new systems have been introduced seniors and the management of the home need to ensure that staff understand the importance of these measures and follow them. • One staff member report “ Its definitely a nicer environment to work in, and for residents to live in”. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 22 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): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with the standard of care they receive from staff, but there are times when staff are not able to support them, when they want support. EVIDENCE: The service recognises the importance of training, and tries to deliver a programme that meets any statutory requirements and is working towards meeting the National Minimum Standards (NMS). The service is also able to recognise when additional training is needed, and is usually able to arrange for this, as with the recent need to train staff further in Person Centred Planning and in the Care of Medicines. The home is steadily improving its number of qualified staff and now has 33 trained to at least NVQ level 2, this has moved from 25 at the last inspection. However this is still short of the target set by the NMS of 50 by 2005. The manager needs to develop a training programme and matrix for the home, so records can be easily monitored, checked and shortfalls identified. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 23 Residents feel that staff are competent, trained and are generally satisfied that the care they receive meets their needs. However, there are times when staff are not able to support them, when they want support. This has the most impact on people’s social life and these concerns have been expressed in the section relating to leisure and social activities. While funding reviews are undertaken the home must ensure that this situation is carefully monitored and that in the meantime there are sufficient staff in place to promote a decent quality of life through more choice. Staffing in the respite unit has been reviewed and now a regular group of relief staff are used, usually from the pool of staff already employed at the home, and this has improved consistency of care and ensures adequate staffing is provided to residents. Shortfalls in staff files and supervision session identified at the last inspection have been met or are almost met. Staff files are now are well organised and up-to-date. Staff communication and supervision have been targeted for improvement through regular individual supervision and team meetings that both have set agendas. This ensures that all important issues are covered by each flats team meeting and is used to disseminate information in a planned way. Supervision notes were examined and these worked best when the set agenda was followed, a few were biased towards residents updates, rather than staff support. One staff member said “ Staff morale is improving, communication and support have been better lately”. The service has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 24 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): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and systems of the home have been strengthened to help the home move towards being more efficient and well run. EVIDENCE: Management arrangements have been improved and strengthened. The manager now has sole responsibility for the home and the other service previously managed by her has now been allocated to a designated senior. The manager has also been given substantial support from her operations manager, they are both part of a senior management team set up to oversee the Improvement Plan. The home has developed a good Improvement Plan and has carefully monitored progress towards improving the quality of care given to residents and to strengthen the administration of the home. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 25 Newly introduced Quality Assurance measures now give a framework for close monitoring of the quality of care delivered, health and safety matters and on staffing issues. For example the Operations manager targets three polices per month to review and audit to ensure they are being put into practice. In addition to this support workers are asked to complete a daily checklist at the end of each shift, that cover areas of health and safety - COSHH, fire, food hygenine and general cleanliness. This is monitored by the supervisor allocated to each flat and spot checked by the manager and Operations manager. The manager demonstrates a commitment to improving the service, for example by playing an active part in groups that promote good practice such as the Person Centred Planning Champions group and the Health Facilitation group. The manager has introduced a number of systems to improve communication with staff; this has included more structured supervision sessions and team meetings that address important changes and proposals for the future. It would be beneficial to explore ways of keeping relatives also updated and briefed in a timely fashion to enable them to respond to any consultations. A number of incidents relating to the well-being of service users were picked up on the inspection which should have been reported to CSCI inline with regulation 37. Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 26 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 3 4 3 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 1 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 x 3 x x 3 x Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 27 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 17 Requirement Risk assessments must be regularly up-dated and readily available to instruct staff. (Previous deadline 22/11/06) Timescale for action 31/03/07 2 YA24 23 The premises must be suitable 30/04/07 (1)(a,b)(2) for the purpose of achieving the (a) aims and objectives set out in the statement of purpose. The physical design and lay-out must meet the needs of residents. (Previous deadline 30/10/06) 23 Coniston flat: a number of carpets need replacing. Kitchen unit drawer fronts in Ullswater flat need to be repaired to make them safe and useable. The handle on the kitchen door in Ullswater flat must be repaired. (Previous deadline 22/11/06) 30/04/07 3 YA24 Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 28 4 YA13 18 5 YA41 37 There must be sufficient staff on duty to allow for residents to follow individual activities and have choice in how they spend their time Incidents relating to the welfare of service users must be reported in line with regulation 37 31/03/07 31/03/07 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 3 4 5 Refer to Standard YA6 YA23 YA19 Good Practice Recommendations The home should continue developing person centre plans, ensuring that staff have time to support residents to develop them The home should report and record all instances of suspected abuse to Adult Social Cares and inform CSCI The recording of healthcare appointments and the outcomes should be more clearly documented to instruct staff Plans need to be developed to show how the home will met the 50 level for NVQ2 training for staff A training and development plan and matrix should be drawn-up to inform future planning YA32 YA36 Peat Lane House DS0000036525.V324823.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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. 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