CARE HOME ADULTS 18-65
Prince Bishop Court 3 Eureka Terrace Tan Hills Chester le Street DH2 3PZ Lead Inspector
Gavin Purdon Unannounced 30 August 2005
th 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. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Prince Bishop Court Address 3 Eureka Terrace Tan Hills Chester le Street DH2 3PZ 0191 371 8860 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) Positive Approach Services Lts Mr Neil Hardy CRH - Care Home 12 Category(ies) of LD - Learning Disability - 12 People registration, with number LD(E) - Learning Disability - Over 65 - 2 Places of places Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The category LD(E) is awarded to allow continuation of care for those service users who have reached the age of 65 years. Date of last inspection 8th March 2005 Brief Description of the Service: Prince Bishop Court is a private sector care home for up to 12 adults with learning disabilities,2 of whom may be over the age of 65. It is situated in the village of Kimblesworth, halfway between Durham City and Chester le Street. The premises consist of what was originally 2 adjacent houses, converted into 1 and extended to the rear. The home has some outside space to the side and rear, for parking and leisure use. Prince Bishop Court has ground and first floor facilities. It does not have a lift but is not intended for service users with additional physical disabilities. The homes plan to divide into 2 units of 5 and 7 service users each has been delayed but is about to go ahead. It is thought that this division will support better outcomes for the more dependent and more independent service users living at Prince bishop Court. The development is looked forward to by management staff and service users and remains a major talking point in the home. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, carried out by one inspector, and took place over 4 and a half hours. The home was mainly represented by Mr Neil Hardy, manager of Prince Bishop Court. The inspector met informally with 5 of the home’s service users and spoke in more detail with 3 other service users, about life at the home. Prince Bishop Court’s service users have a wide variety of needs. Some of these needs have remained the same, and some are changing as particular service users have become more dependent and others more independent. The home is actively looking at how best to deal with this change of circumstance. As well as speaking with Mr Hardy, the inspector discussed the care of service users with a senior member of care staff on duty and a junior member of care staff who has been recently recruited. The inspector also looked at residents’ written care plans, review findings, and care notes. The focus of this inspection was on how the care needs of service users are assessed, how care is planned and provided, and the general arrangements for daily living at the home, including how the home promotes individuality and the wellbeing and protection of its residents. The overall findings were that the home works hard to provide a good standard of care and succeeds in doing so. The general view was that whatever the level of dependency the home tries to make service users safe, happy, and comfortable. Care is made as individual, as enjoyable and fulfilling as possible by using the good level of understanding of service users’ needs, likes and dislikes, built up by the staff over time. What the service does well:
The home sees itself as being particularly good at planning and providing a full programme of activities with a wide range of options for its service users to choose from. These options are things that service users want to do, that they are interested in, and have chosen for themselves. The home believes that people take part in activities because they enjoy them and get a lot out of it.
Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 6 That being said the home accepts that not everyone wants or needs to do the same thing for the same reasons. The home is well staffed and the staff are very well briefed to support different activities for different service users, in different parts of the home, and outside of the home, at the same time. The service also considers itself to have a particularly skilled and well motivated workforce that has benefited from extensive training and that works well together to meet the needs of Prince Bishop’s service users in a smooth running, well planned and flexible way. From discussion with service users, management, and staff, and from records seen, the inspector noted that the home has a very clear commitment to consulting with service users and making sure things are seen from the service user’s point of view and that their point of view is well understood, recorded, and acted on. Personal care plans are written in terms of what the service user hopes to achieve by living at Prince Bishop Court and how they will go about reaching their personal goals. 1 service user told the inspector, “ I like it here, I’ve got my own bedroom. I’m getting a new television, a bigger one. I like to watch it. Sometimes I go out to the centre during the day. We do different things there. I’m helping with the tea today. We’re going on holiday soon. We go to different places. We went to Blackpool. That was good. This time we’re going to Skegness.” What has improved since the last inspection?
No requirements or recommendations were made at the last inspection in March 2005. Over time some service users at the home have developed their skills others have become a little more dependent. In response to this Prince Bishop Court has its own plans to rearrange its services and is on the verge of a significant development talked about at the last inspection. The home is about to divide its 12 service users into 2 groups using different parts of the home, with 1 group of 5 and 1 of 7 service users, to allow the more dependent and more independent service users to live with other service users who have similar needs to their own.
Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 7 2 of the home’s service users told the inspector, “We’ll be more independent, we’ve talked about it for a long time, and it’s about to happen. We’ll do more things for ourselves and not have to depend as much on staff.” and “ That will be good.” 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. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 8 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 Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 9 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. As part of its pre admission process the home gathers a wide range of information about the needs of potential service users from as many sources as possible. In doing so, the home makes sure that there is a good understanding of those needs from various points of view, including the potential service user’s, and a sound plan to meet these, which suits and benefits potential residents. EVIDENCE: The home’s manager discussed 2 typical examples of assessments carried out on the needs of potential service users with the inspector. These assessments were detailed and contributed to by professionals from outside of the home who might continue to be involved in providing support and assistance to potential service users after their admission to Prince bishop Court. 1 other service user at Prince Bishop Court with particularly complex needs that require support from specialists based outside the home was also discussed. The manager was able to show how the home worked in partnership with other professionals to ensure that those care needs are being well provided for. The senior carer on duty and the home’s manager described a careful process of introductory visits, discussion, and observation that made sure the potential service user was comfortable with the staff of the home, other service users, and the general idea of living at Prince Bishop Court.
Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, & 9. Service users have care plans based on their original assessments and any changes in need since their original assessments were made. As such care staff have clear directions about what care service users currently need and how to provide that in a way that service users are most comfortable with. Service users have varying levels of dependency and complexity of needs, and the home works hard to understand, record, and respond to these in a way that service users are comfortable with. Service users benefit from the fact that staff will support their likes and dislikes and individual choices in a way that they are safe and comfortable with, but gives them an opportunity to experience new things and learn from these. EVIDENCE: The personal care plans and review documents seen were set out in a largely understandable and accessible way, with a vivid pen picture, covering background history, needs preferences and required actions, detailing what
Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 11 help service users needed, and how that would best be given. The personal care plans seen were set out very clearly in a set of statements that tries to give a direct voice to the service user. This “I want” “I like” “I think” “I need” type of format is quite a powerful way of presenting plans. Separate discussions with the manager, two service users and a senior member of care staff confirmed that the people living at Prince Bishop Court have a lot of say about how their care is provided and about what they do, where they go, and who they go with. This is well recorded, but also confirmed on an everyday, week to week basis, as the home recognises that people’s needs and preferences are not necessarily fixed or predictable. Written evidence was seen of the home’s combined efforts to support service users’ independence, and protect them from harm, through the use of risk assessments. It was clear that the home has tried to limit information in care plans to identified significant risks and measures to reduce these risks, rather than including information on less significant matters not relevant to the care of a particular person. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16, & 17. The home recognises that its service users are adults and supports their access to activities and experiences in the community, the neighbourhood, and further afield, that other adults enjoy. The home makes sure that service users at Prince Bishop Court are a known and accepted part of the local community. The home supports service users to stay in contact with family and friends. Service users’ individuality is respected in the home and service users have their own particular ways of life built around what is safe and comfortable for them. Service users enjoy meals they like in homely surroundings, and benefit from specialist advice and guidance on food where that is necessary. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 13 EVIDENCE: The opportunity for structured outside entertainment activity and occupation is a major feature of life at Prince Bishop Court. Service users are involved in a variety of day centre and work placements away from the home. Being elsewhere, with other people, and away from the home is a significant part of daily life for service users at Prince Bishop Court. The home’s service users are often out and about with staff, themselves, or with each other, in the local village, at the various shops, pubs and clubs. Service users’ leisure interests are well described in care plans and staff organize and coordinate activities to ensure that everyone benefits from the opportunity to stay at home or to go out. The majority of service users at Prince Bishop Court have links with families and friends outside the home. Prince Bishop Court actively supports these links in terms of helping to maintain contact, involving families in care planning and consulting them as part of the review process. The home is happy to support service users in doing what they prefer to do. It can provide from a range of options and run more than one of these at any one time for service users to choose from. If some people want to stay in and some want to go out, that is not a problem. If people decide to do something and then change their mind, that is not a problem. The home is very much aware of what kind of experiences might benefit its service users, but the starting point is very much what service users themselves are happy with. One service users told the inspector that, “ The food here is good and its healthy. We get plenty to eat and it’s nice, not too much fat and pastry. You don’t want piles of stuff. We get pasta and fruit and things like that. It’s home made pizzas for tea tonight. I like to see to my own food as much as I can and not to always have to ask staff and wait for other people, which I think is a good thing.” Another service user who had helped prepare the tea, told the inspector what ingredients had been used to top the pizzas. The inspector saw that where specialist dietary advice was needed, that this had been obtained and followed as part of the care plan. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, & 20. Service users benefit from being cared for by a staff group who have a good understanding of service users’ care needs, interests, and preferences. Service users benefit from the support and understanding of Prince Bishop’s Court care team and from easy access to good general and specialist health care services. Trained staff ensure that service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: From discussion with management, staff and service users and from information contained in care plans it is clear that staff have developed and use their good understanding of service users’ needs, likes and dislikes and use that good understanding to support service users in a way that is comfortable and of benefit to the service user. The home’s manager, the senior carer on duty, and a new support worker told the inspector about the role of named key workers, who have a special responsibility in the home for individual service users. From discussion with
Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 15 care staff and examination of care plans it was clear that all areas of care, including health, had been well considered and a practical plan drawn up to meet these. It was also clear that these plans were kept up to date with the help of key workers and service users, and adjusted and operated flexibly where necessary. The inspector discussed medication and healthcare arrangements with the home’s manager. The manager confirmed that the home has good support from their pharmacy and local healthcare practitioners. The home’s manager described how the pharmacy, the local GP practice and other specialists provided a well established and smooth running service that was also quick to respond to any changes in service users’ needs. A new member of staff told the inspector that they were not yet fully trained in the safe handling of medication, although that training was underway. The new member of staff did not have responsibility for administration of medicines which was handled by the trained senior carer on duty. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, & 23. Service users have their own opinions. They are happy to make these known, and expect to be listened to. Policies and procedures are in place that are designed to protect service users from abuse. Staff at Prince Bishop Court are very aware of the need to provide well planned and well delivered care as the best means of protecting service users. EVIDENCE: From discussion with staff and service users it was clear that consultation between them is an important and regular event and very much the way that decisions are arrived at and plans agreed. These meetings can be public group meetings or private discussions between two individuals. The home has established policies and procedures regarding adult protection. The manager discussed an incident that took place away from the home and showed Prince Bishop Court would take action to support and protect its service users in line with local adult protection protocols where that was necessary. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 17 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) Not assessed on this occasion. EVIDENCE: Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 18 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) 33. Service users are supported by the good combination of well developed staff skills, well established team work, and a big enough care team to provide support with flexibility and choice for service users. EVIDENCE: The manager of the home, and the senior and junior care staff spoken to said that there was very good teamwork and mutual support in the staff group. All 3 thought the staffing levels and deployment of staff very beneficial to service users. Working together the team can ensure that close oversight of more dependent service users is provided, general daily care tasks such as the preparation of meals are attended to, and individual personal care plan activities are provided, without disruption or delay. Staffing levels for the home’s 12 service users are 1 member of staff on waking night duty plus 1 member of staff sleeping over on the premises. On weekdays there are 3 members of staff on morning duty, and 4 members of staff on afternoon/evening duty. At weekends there are 4 members of staff on duty throughout the waking day. These arrangements are in excess of the Staffing levels set out in the Residential Forum’s guidance for care homes for younger adults. This allows for care staff to work with separate groups and with individuals, in the home and out of the home at the same time, which
Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 19 supports service user choice and flexibility of activities. A member of the home’s management team is on duty on each of the 7 days of the week, with senior advice available via an on call system at any time. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 20 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) Not assessed on this occasion. EVIDENCE: Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 21 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 4 x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x 4 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 4 4 x 3 4 3 Standard No 31 32 33 34 35 36 Score x x 4 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Prince Bishop Court Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 22 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 Regulation none Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations Whilst care plans significantly exceed the minimum standard, as they are, the home should consider reviewing them to revise any terms or phrases that could be put more simply and might be more readily understood by a wider audience. Prince Bishop Court B54 S7498 Prince Bishop Court V235473 300805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection No 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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