Inspection on 07/12/05 for Phylward House

This inspection was carried out on 7th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Phylward House 29/06/07

Phylward House 05/07/05

Phylward House 05/10/04

Phylward House 11/05/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Phylward House 9 Cavendish Avenue Harrogate North Yorkshire HG2 8HX Lead Inspector David Blackburn Unannounced Inspection 7th December 2005 10:30 Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 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 Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 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. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Phylward House Address 9 Cavendish Avenue Harrogate North Yorkshire HG2 8HX 01423 502644 01423 522810 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) The Wilf Ward Family Trust Miss Nicola Mary Spencer Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 9 Service Users with Learning Disability some or all of whom may also have a Physical Disability 5th July 2005 Date of last inspection Brief Description of the Service: Phylward House is a large detached building standing in its own grounds. It is situated in a residential area of the town. A former private dwelling house it has been extended and adapted to provide accommodation for a maximum of nine service users. It occupies three floors. The lower two provide the accommodation and facilities for the service users. The upper floor is used for staff accommodation and administrative purposes. A day care unit is housed within the main building. This is separately staffed and managed. Phylward House was originally used as a respite centre but in recent years has accepted long stay service users. The home caters for adults with a learning disability and associated physical health and behavioural needs, including challenging behaviour. The staff seek to provide a holistic care regime offering personal care, help, advice and guidance with daily living skills and activities, a catering service, a laundry service and domestic and cleaning services. Activities are offered both on and off site. All service users are registered with local general medical practices. The doctors arrange access to other National Health Service provision. The home has links with local Community Resource Teams (for people with learning disabilities) who provide advice, guidance and access to specialist services. Phylward House is owned and managed by the Wilf Ward Family Trust, a registered charity. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection upon which this report is based was the second to be undertaken in the inspection year April 2005 to March 2006. It was carried out over five hours including preparation time. The focus was on those key standards not assessed at the first inspection in July 2005 together with those parts of other standards that were subject to a requirement or recommendation. Some care plans were examined together with some policies and procedures. An analysis of a recent questionnaire to families and visiting professionals was also seen. Any relevant comments within that report have been included. Only the communal areas of the premises were seen. Discussions were entered into with the registered manager, assistant manager and staff on duty including support workers and the cook. Some service users were spoken with though their ability to communicate was very limited. Their feedback was mainly one-word answers, gestures or facial expressions. A number of service users were at day care placements. What the service does well: The staff team showed a commitment to giving priority to the needs, choices and wishes of the service users. Their independence, choices and freedom of movement were always encouraged and promoted. Service users although suffering severe multiple disabilities were fully involved in life at the home. They were well supported to take advantage of community resources. Staff were observed to interact well with service users ensuring they made as many decisions and choices as possible. Observation throughout the inspection showed a very good relationship between residents and staff. Relatives also commented that “staff and service users had a good rapport and communicated effectively.” Proper attention was given to the healthcare needs of service users ensuring their continued general health and welfare. Service users were assured of protection from harm through good policies and procedures designed to safeguard them. Staff had a good understanding of adult protection issues that further promoted service users’ safety. Service users continued to live in a homely environment. Service users could feel confident their needs would be met by a competent, able, motivated and trained staff group. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 6 Good attention was being paid to matters of health and safety. Staff were aware of their responsibilities to maintain a safe and secure environment for service users and visitors. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 None of these standards was assessed. EVIDENCE: Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7. Service users had the right to make decisions and were well supported in this by staff ensuring their choices, preferences and wishes were met. EVIDENCE: Three case files were examined. Each contained information about care needs and how the individual service user expected them to be met. This information covered most activities of daily living. A statement about choice and duty of care was on each file seen. These statements made it clear that service users had the right to make choices and decisions in their everyday lives. Observation throughout the inspection showed staff to be conscious of and adhering to this principle. Service users were given choices in activities, food and drink and outings. Proper arrangements were in place for handling service users’ personal money. Bank books were held in service users’ names. Relatives in response to the questionnaire expressed their general satisfaction with the way personal money was handled. The registered manager said that during forthcoming service user reviews the financial procedures would be fully explained to all relatives and their agreement sought to the present methods. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Personal support was offered in a way that promoted and protected service users’ privacy, dignity and independence. The meals in the home were good offering choice and variety and catering for special dietary needs. EVIDENCE: Staff said there were few rules or regulations in place. Those that were promoted and maintained services users’ independence, choice and freedom of movement. Routines, in place for each service user, were clearly designed to ensure the overall comfort, welfare and safety of the individual. Relatives commented that they felt “personal care needs were met to a high standard.” They said “service users were given opportunities to develop new skills and try out new activities.” Further positive comments were made about service users’ right to choose who provided support and care. Service users chose and bought their own clothes with staff or family support. Relatives said they felt “service users exercised a lot of choice in what they wore.” Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 11 Although bedroom doors could be locked none of the service users had a key. The registered manager said none was able to understand the concepts of keys and locks. This had been recorded on each file. Observation showed staff talking with service users and engaging them in discussions about the programmes for the day. All actions taken were fully explained, for example when helping a service user put on outdoor clothing. Service users were able to take part in communal activities, for example painting, individually, for example jigsaws or to seek the solitude of their bedroom to watch television or listen to music. The cook said she devised the menus around the known likes and dislikes of the service users. Different options were often tried and the service users’ reactions dictated whether a particular item remained on the menu or was deleted. A cooked option could be taken at all mealtimes. The lunchtime meal was observed. Food was plated but attention had been given to presentation and the serving. Assistance and encouragement was given quietly and unobtrusively with staff sitting with those who required help. The appropriate adapted cutlery and crockery were available and in use. Relatives felt that dietary needs were met through “a good choice and variety of food.” Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 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 the following standard(s): 19 and 20. The healthcare needs of service users including medication were well met with evidence of multi-disciplinary working taking place. EVIDENCE: The case files seen detailed any particular healthcare needs and the manner in which these were to be met. Re-assessments and care plan reviews recorded any revisions to needs and how they should be addressed. Observation showed staff were diligent and alert to the signals, whether word, sound, movement or gesture, made by each service user. They were able to understand these signs and responded quickly and appropriately. All service users were registered with a local general medical practitioner. There was evidence on the files of the involvement of specialist health professionals including occupational therapists, physiotherapists, district nurses and members of the Community Resource Team. Staff had undertaken specialist training for example in relation to epilepsy management, including its control by oral medication, and the safe taking of blood sugar levels. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 13 Recent assessments by occupational therapists had led to revisions in nighttime care practices. A number of service users had been assessed as needing little care intervention. Their recorded checks were undertaken on a less frequent basis than those requiring on-going care. This was proving very successful in the initial stages with some service users enjoying less disruption and better sleep. The registered manager said this system was to be reviewed but the benefits for those not needing to be disturbed were quite evident. There had been one or two incidents with regard to medication, for example administration of the wrong drug and incorrect receipt of drugs. The registered manager had clearly and firmly reminded all staff of the procedures that were designed to eliminate such occurrences. Staff said they had been instructed that the medication procedures in place were to be followed without exception. Replies to the questionnaire stated that all were satisfied with the way their relative’s “health needs were being addressed and met.” Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Residents and guests were assured their concerns would be acted upon through a relevant complaints procedure. They were protected from harm by staff’s understanding of adult protection policies and procedures. EVIDENCE: A complaints procedure was available in written and pictorial form. It detailed how to complain, to whom and gave timescales for response. It showed the name and address of the current regulatory authority. Relatives said they “comfortable with the complaints procedure.” An “abuse” policy and procedure was seen. It was written with specific reference to dealing with disclosures concerning people with disabilities. Staff confirmed training in adult protection was given at induction and when undergoing LDAF training (Learning Disability Award Framework). The registered manager said staff undertaking National Vocational Qualifications in care had to complete a compulsory unit on adult protection issues. Staff appeared confident in the procedures to be followed should abuse be suspected or alleged. The registered manager had a copy of the original multi-agency agreement on adult protection. She was advised to obtain a copy of the revised protocol, discuss this with staff and then implement its’ recommendations. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The standard of the environment was good and provided service users with a safe, comfortable and clean place in which to live. EVIDENCE: All parts of the premises remained in good condition internally and externally. Proper attention was given to general upkeep with re-decoration, refurbishment and re-carpeting carried out as necessary. Some bedrooms had been re-decorated. The summerhouse had now been fully transformed into a sensory room. Those parts of the premises seen were clean, tidy and odour free. A new cleaning schedule was introduced earlier this year. Relatives said the communal areas appeared “clean and looked after.” Appropriate systems were in place for the laundering of bedding, linen, towels and personal clothing. Proper attention was given to matters of hygiene and infection control. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 33. Staff morale was good resulting in an enthusiastic workforce that worked positively with service users to improve their quality of life. EVIDENCE: Staffing remained problematic in that of the allocated 732 weekly hours, 223 were vacant. The registered provider and registered manager had secured the use of relief and agency staff to cover the shortfall. The majority of cover was provided by relief staff known to the service users and thus able to continue to give a consistency of care. Staff were therefore able to meet the current needs of service users. The registered manager spoke of the difficulties in recruiting staff in the area. Staff came from a variety of backgrounds and brought with them different skills, knowledge, training and expertise. Although a number of relief staff were employed the registered manager felt the balance of ages, experience and gender was good. Male and female staff were employed so care could be given by a person of the same gender. Regular staff meetings were held. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 17 Staff said they had an induction into the home, initial training given off-site by the registered provider and the opportunity of working towards a National Vocational Qualification. Currently five staff had achieved this award to level 2 or 3. Three others were working towards the award. The staff team was therefore moving towards the 50 target. Relatives were complimentary in their remarks about staff. They described them as “approachable, very kind, helpful and polite.” Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41 and 42. The systems for consultation were good with evidence that service users’, families’ and visiting professionals’ views were sought and acted upon. Service users were able to live in a safe and secure environment. EVIDENCE: The registered manager had circulated a questionnaire to families and visiting professionals earlier in the year. The analysis and evaluation together with action plan as a result of that questionnaire were seen. Service users were approached individually by staff to discuss their views on the care and services on offer. Given the severe disabilities experienced by service users, the feedback could be limited. The registered manager was however adamant that efforts continued to secure service users’ views. The staff sent out an occasional newsletter with information about the home, service users, staff and activities. This complimented the Trust’s newsletter “Trust Topics” sent to all families. The home was also subject to visits from a Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 19 senior manager who completed a report for the Commission for Social Care Inspection in accordance with Regulation 26. Those records seen were being maintained in an appropriate manner. Staff files had been seen earlier in the year at the registered provider’s headquarters. They were found to be satisfactory. The appropriate notification of significant events in the home as required by the Care Homes Regulations 2001 was being sent by the registered manager to the regulatory authority. Proper attention was being given to matters of health and safety. Staff confirmed attendance on a number of courses food hygiene and fire safety. There was an urgent need to update the training for staff in moving and handling. Hot water temperatures were tested to a number of outlets. All were found to be around 43° Centigrade. The registered manager said an engineer had been employed to look at the feasibility of installing thermostatic valves to hot water taps. A number of safety reports and certificates were examined. They were found to be up-to-date and relevant. Phylward House DS0000007838.V271015.R01.S.doc Version 5.0 Page 20 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 X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Phylward House Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X 3 1 X DS0000007838.V271015.R01.S.doc Version 5.0 Page 21 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 Standard 42 Regulation YA42 Requirement Staff must have regular up-todate training in moving and handling to ensure the continued safety of service users. Timescale for action 28/02/06 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. Refer to Standard YA23 Good Practice Recommendations The registered manager should obtain a copy of the revised multi-agency protocol on adult protection, discuss this with staff and implement its recommendations. 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