CARE HOME ADULTS 18-65
Rainbow Lodge 15 Trinity Road Scarborough North Yorkshire YO11 2TD Lead Inspector
David Blackburn Unannounced Inspection 27th January 2006 09:30 Rainbow Lodge DS0000007689.V262964.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 Rainbow Lodge DS0000007689.V262964.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. Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Rainbow Lodge Address 15 Trinity Road Scarborough North Yorkshire YO11 2TD 01723 375255 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) Ms Catherine Sleightholm Ms Catherine Sleightholm Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Rainbow Lodge is a large semi-detached property occupying three floors. It gives accommodation, on the upper floors, in three single rooms for adults with learning disabilities. Communal space is provided on the ground floor. The property is the private home of Mrs Sleightholm who, together with members of her family, provides the care and accommodation for a maximum of three residents. They are accommodated as members of the family. Mrs Sleightholm and members of her family provide personal care, meals, laundry and a domestic service. They are the only staff. Residents are encouraged to be involved in all aspects and activities of daily living according to their individual abilities and capabilities. Mrs Sleightholm provides a variety of inhouse activities. Residents also attend day care placements and a number of activities organised outside the home. A large private garden is used for outdoor activities. Residents have easy access to the towns facilities and amenities through the homes central location and use of the registered providers motor vehicle. Full use is made of the local health services including doctors and dentists. Access to more specialised health and social care services is accessed through the doctor or Mrs Sleightholm. Rainbow Lodge DS0000007689.V262964.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 four hours including preparation time. The focus was on those parts of key standards that were subject to a requirement or recommendation at the first inspection in July 2005. A small number of other standards were reassessed. Three care plans were examined together with other records and some policies and procedures. The communal areas and three bedrooms were seen. Discussions were held with the registered provider, who was also the registered manager, a visiting social care professional and the three residents presently accommodated in the home. Discussions with the residents were partly held in confidence. All the comments made by the residents and the visiting professional were very supportive of the registered provider and the manner in which care and services were offered in the home. What the service does well:
Good and consistent care planning systems were in place that ensured residents’ needs were recorded and acted upon. Residents said they “were well looked after.” The visiting social care professional expressed her complete satisfaction with the way care was offered to her clients in the home. Risk assessments were in place and showed evidence of updating. Proper procedures were in place to eliminate or minimise known risks to ensure the overall safety and welfare of residents. The routines in the home enhanced residents’ right to choice, freedom of movement and independence. Residents said they were free to come and go, to decide on their own activities and attendance at day care placements. Proper procedures and systems, including those related to medication, were in place for the promotion and maintenance of residents’ healthcare. The complaints procedure and adult protection procedures gave residents the confidence that they would be protected from harm. The premises were well maintained giving residents a comfortable place in which to live. Residents said they “were very happy with their rooms.” The small staff team provided a consistency of care that meant residents’ needs were met. Residents were very complimentary towards the registered provider and small staff team. The visiting social care professional praised the work that the staff did in the home to meet residents’ assessed needs.
Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 6 The home was well managed with attention paid to matters of health and safety to ensure a safe and secure environment for the residents. 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. Rainbow Lodge DS0000007689.V262964.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 Rainbow Lodge DS0000007689.V262964.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: Rainbow Lodge DS0000007689.V262964.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): 6, 7 and 9. The clear and consistent care planning system in place adequately provided the information needed to satisfactorily meet residents’ needs. EVIDENCE: The file of each resident was examined. They continued to be well organised, indexed and sectioned. The original care plan was on file together with updates following reviews, usually held annually with the placing or funding authority. The registered provider continued with the monthly evaluation and review. These had been signed by the individual resident. Care plans showed strengths and needs and how those needs were to be met. A calendar of significant events was seen on each file. The registered provider remained the appointee for one resident. The visiting social care professional said this was in agreement with the funding authority. A new system of recording the money held was to be introduced. This should be done as soon as possible. The bank account was held in the resident’s name. The resident said she was happy with these arrangements. Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 10 A risk assessment was available for each resident. These detailed the areas of concern and how they were to be eliminated or minimised. They had been recently reviewed. The visiting social care professional said risk assessments were discussed at the annual review. Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. Routines and house rules promoted residents’ rights, choice, independence and freedom of movement. EVIDENCE: There were few rules and regulations. Those in place were for the safety and benefit of the residents. Any restrictions were clearly recorded on the care plan and risk assessment. Each resident had their own room seen as their personal and private space. They were free to use them at any time. Following assessment two residents had been given bedroom and front door keys. One resident said she was free to come and go as she pleased. She was observed to go shopping during the inspection. Residents helped about the home in accordance with their care plans and abilities and capabilities. Rainbow Lodge DS0000007689.V262964.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. Residents’ health needs including medication were well met with evidence of multi-disciplinary working taking place. EVIDENCE: Residents’ healthcare needs were recorded in their care plans, monthly evaluation and calendar of events. These clearly detailed any acute needs and how they were to be resolved. Longer-term conditions were equally well recorded with clear indications as to the actions being taken to minimise their effect. Referrals to general medical practitioners (GP) and specialist medical professionals were recorded with outcomes. All residents were registered with a different GP. One resident made her own appointments and attended them unaccompanied at her request. Residents had an annual health check. They were registered with local dentists and opticians. Proper systems and procedures were in place for the receipt, storage, administration, recording and return of medication. The registered provider had obtained a copy of the Royal Pharmaceutical Society’s protocol on the management of medication in care homes. It was recommended she undertake further medication training.
Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The complaints process in the home was good with evidence that residents concerns would be acted upon. Adult protection was good with appropriate training and understanding of the issues that protected residents from risk of abuse or exploitation. EVIDENCE: A revised complaints procedure was in place. This detailed how to complain to whom and gave timescales for any response. Clear reference was made to the regulatory body. Residents had been given a copy and this was displayed in their room. They said if they were unhappy they would talk to Cath (the registered provider) someone at their day care placement or their care manager. The visiting social care professional confirmed that residents were aware of the procedure. The registered provider had produced an Adult Abuse Policy (protection of vulnerable adults). This was comprehensive in showing the types of abuse and how to recognise them. It was supported by a number of other relevant policies. The registered provider was able to describe her actions should abuse be suggested, alleged or suspected. She and her staff member had undergone adult abuse awareness and conflict management training. The certificates were seen. It was recommended that the registered provider obtain a copy of the revised multi agency protocol on the protection of vulnerable adults.
Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The standard of the environment in this home is very good providing residents with an attractive and homely place in which to live. EVIDENCE: A tour of the premises was undertaken accompanied by the residents. All bedrooms were seen, two on the first floor and the third on the second floor. Communal areas were on the ground floor. All rooms were spacious, light and well ventilated. Bedrooms were well furnished, in good decorative order and carpeted. All bedrooms were well personalised. One had been re-decorated, re-furnished and provided with a new carpet. None of the bedrooms had an en-suite facility. There were however sufficient communal facilities. All had suitable privacy locks. Residents said they were “very happy” with their rooms. “Mine’s nice and I like to keep it tidy.” “I’ve got new furniture and carpet.” The home was clean, warm, tidy and odour free. Proper procedures were in place for the laundry of items with good attention given to infection control and the elimination of cross infection.
Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 15 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): 33 and 34. Residents’ needs were well met by the consistent care given by the small staff team. EVIDENCE: The registered provider together with three family members formed the staff team. No other people were employed. The registered provider and her daughter provided the personal care while her son and son-in-law attended to maintenance matters. All family members had enhanced disclosures from the Criminal Records Bureau. The registered provider’s daughter had a National Vocational Qualification in care to level 3. The certificate was seen. She continued her work towards the Registered Managers (Adults) NVQ4 award. Both the registered provider and her daughter had many years experience of working with people with disabilities. The visiting social care professional expressed her total confidence in the registered provider, her family and care regime on offer in the home. She said her authority was looking to make a further placement at the home. Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 16 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): 37, 41 and 42. The home was well managed with proper attention given to matters of health and safety. The registered provider must undertake the identified training to ensure residents continue to live in a safe and secure environment. EVIDENCE: The registered provider had no formal qualifications. She was aware of the need for any manager to obtain a National Vocational Qualification in care and management to level 4. She discussed her intention to propose her daughter as manager when she had completed the Registered Manager’s Award. Some records were seen. They were all being completed in a proper manner. A number of safety records were also seen including the fire logbook. Recent visits from the Fire Officer and Environmental Health Officer (regarding a variation in the conditions of registration) had proved satisfactory with recommendations only being made about training. These recommendations must be actioned. The registered provider had achieved a First Aid certificate.
Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 17 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 3 2 X 3 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 X 3 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Rainbow Lodge Score X 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 X X X 3 1 X DS0000007689.V262964.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? NO. 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 YA42 Regulation 9 Requirement The registered provider must act on the advice of the Fire Officer with regard to fire safety training and the Environmental Health Officer with regard to food hygiene training. Timescale for action 31/03/06 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. 2. 3. 4. Refer to Standard YA7 YA20 YA23 YA37 Good Practice Recommendations The new system of recording residents’ money held in the home should be implemented as soon as possible. The registered provider should undertake external training in relation to the safe handling of medication. The registered provider should obtain a copy of the multi agency agreement on the protection of vulnerable adults. The registered provider is reminded of the need for any manager of a care home to have obtained a National Vocational Qualification in care and management to level 4. Rainbow Lodge DS0000007689.V262964.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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