Inspection on 18/07/06 for Shieling The - Coach House The

This inspection was carried out on 18th July 2006.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shieling The - Coach House The 10/07/07

Shieling The - Coach House The 15/11/05

Shieling The - Coach House The 18/11/04

Shieling The - Coach House The 15/06/04

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 Shieling The/ Coach House The 58 Harlow Moor Drive Harrogate North Yorkshire HG2 0LE Lead Inspector David White Key Unannounced Inspection 18th July 2006 09:30 Shieling The/ Coach House The DS0000007909.V302852.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 Shieling The/ Coach House The DS0000007909.V302852.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. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shieling The/ Coach House The Address 58 Harlow Moor Drive Harrogate North Yorkshire HG2 0LE 01423 508948 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) www.craegmoor.co.uk Parkcare Homes (No. 2) Limited Miss Joanne Metcalfe Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: The Shieling provides residential personal and social care for 11 adults aged between 18 and 65 years old who have learning disabilities and may present other complex needs. The home is a large semi detached property situated close to Harrogate town centre and with good access to its services and amenities. The registered provider is Parkcare Homes Ltd a subsidiary of Craegmoor Healthcare UK Ltd. The registered manager is Miss Joanne Metcalfe. The current fees for the home range from £450 to £1550 per week. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on the 18th July 2006. This visit was carried out by one Regulation Inspector and took 7 hours with 6 hours preparation time. Since the last inspection of the home there had been some concerns raised by a professional who had been visiting the home at the time of an incident relating to some of the care practices. This resulted in a strategy meeting being held on 5th May 2006 and this was attended by representatives from the local Social Services team, the Management of the home and the Commission to discuss the concerns raised. These matters were referred to in the body of the report. The home was able to return the requested information before this site visit, and surveys were sent out to relatives and other professionals who had contact with the home. Comment cards were received from three relatives, a GP and three other healthcare professionals. The site visit comprised of a full inspection of the premises. The care records of three service users were looked at which included service users assessments, care plans and medication records. Staff rotas and health and safety documentation were inspected. Time was spent talking to three service users, two members of staff, the maintenance worker and the manager of the home. The activity in the home and the interaction between service users and staff was observed. Information was also used from the Regulation Inspector’s inspection record, which detailed the history of the home and relevant information about what had been happening in the home since the previous inspection visit. The focus of the inspection was on a number of key standards and inspecting the case records of a number of service users to establish whether they corresponded with their experiences of life in the home. The manager was available throughout the inspection and the findings were discussed at the end of the inspection. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There had been some past concerns about how some adult protection matters had been handled by other Craegmoor homes. As a result of this all staff had since received some abuse awareness training. All staff had received training in health and safety and food hygiene to promote food safety practices and some staff had attended a diet and nutrition course and from this had introduced healthy eating options for service users’ in the home. Four members of staff had undertaken an English course at college to improve on their language and literacy skills to be able to communicate verbally and be able to write records in English to a standard that ensured service users’ needs could be met. The manager had introduced systems for evaluating whether staff had understood the training they had received to ensure that staff were equipped with the skills and knowledge to meeting the needs of the service users’. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 7 Staff had all been issued with a front door key and were asking unknown visitors to the home for identification before allowing them into the home, and these practices safeguarded service users’ from harm. 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. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 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 the following standard(s): 2 and 3. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The home had not admitted any new service users’ since the previous inspection, however in the past failure in some cases to obtain all the appropriate pre-admission information could not ensure that all the service users’ needs would be met. EVIDENCE: The home had not had any admissions since the previous inspection visit, however three service users’ files were looked at including those of the most recently admitted service user. The care records showed that individual assessments had been carried out by the home prior to admitting service users’. However prior to the current manager being in post information had not always been sought from other sources such as placing authorities and this had caused problems in the past such as staff not having proper information to be able to know how to manage service users’ difficult behaviour. The care records of the most recently admitted service user identified that staff at the home had collected information from a number of sources prior to the person’s admission into the home so that they were able to make an informed decision as to whether the needs of prospective service users’ could be met. There was also evidence that this service user had been able to visit the home before making a decision about moving there. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 10 The manager said that all the necessary pre-admission information would be obtained and proper pre-admission procedures were in place to ensure that people would only be admitted into the home if following thorough assessment it was decided that their needs could be met by the home. Each pre-admission assessment looked at the individual needs of the service user and a planned action of care was drawn up from this information. The home had a number of people whose behaviour could be challenging and at the previous inspection the manager was asked to look at the compatibility of the service user group. At the time of inspection the five service users’ who were in the home could be seen interacting and being pleasant to each other and two service users’ confirmed that everyone at the home “got on together”. Regular care plan reviews were taking place to review and address any changing needs and these reviews involved relatives and other professionals where the service user had agreed to this. Shieling The/ Coach House The DS0000007909.V302852.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Care plans were clearly detailed and provided staff with the information to meet service users’ assessed needs. EVIDENCE: Service users’ said that they felt they were “well cared for” and one service user said, “I can choose what I want to do and have my independence”. Another service user commented that staff were “helpful and supportive”. The care plans of three service users’ were looked at. These were informative and detailed clearly what actions were needed to meet a person’s assessed needs. Individual risk assessments had been carried out to promote independence and safety and these were agreed with the service users’. A number of service users’ could exhibit challenging behaviour and there had been a recent incident in which a service user had become aggressive. The care records for this service user provided clear management strategies and guidelines for staff in how to manage any identified risks from this behaviour. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 12 Staff said that they were clear about what actions to take in response to individual service user’s behaviour and said that the care plans were “easy to follow”. One care plan gave specific information about the trigger factors for one of the service user’s behaviour and guidance on which behaviours were acceptable and which ones needed to be addressed and how this was to be done. Guidance was provided on de-escalation techniques to deal with difficult behaviours and the risks from lone working with one particular service user were considered and addressed within the care planning process. All the staff had attended some Crisis Prevention Intervention (CPI) training to provide them with the knowledge and skills to be able to implement de-escalation techniques to minimise risks to service users’ and others from potential conflict. A comment card received from a care manager stated that they felt the home was good at managing the challenging behaviour of a service user whom they had involvement with. The care plans contained information about service users’ likes and dislikes and service users’ preferences about how they wished to live their life. Through discussion with the service users’ it became clear that they were able to make their own decisions about their daily routines. Monthly house meetings were held and recorded and this enabled service users’ to have their say in how the home was being run and gave them an opportunity to plan activities and outings. Minutes from these meetings were on display in the home and the manager was clear that these records were not to include any personal details about the service users’. Service users’ confirmed that they sat down with their key worker and reviewed their care plan on a monthly basis where this was possible. Shieling The/ Coach House The DS0000007909.V302852.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users’ enjoy a range of activities both in and outside the home to meet their social and leisure needs. EVIDENCE: Each service users had an individual programme of activities aimed at developing their skills and service users’ interests and social needs were recorded within their care plans. Most of the service users’ attended the Vocational Skills Centre (VSC), which was run by Craegmoor and provided a good range of activities. A service user said that the Centre was “enjoyable” and offered some structure to their daily routine. Service users’ were able to access the local colleges to enhance their educational skills and learning and most of the service users’ used the local community facilities such as the swimming baths and pubs. Other service users’ attended the PHAB club, which was a local social club. Day outings were arranged in accordance with service users’ wishes and one service user said they had particularly enjoyed a recent day trip to Blackpool. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 14 Most of the service users’ were going on a planned holiday to Skegness with the exception of one person who did not wish to go. During a tour of the environment it was observed that service users’ had their personal belongings in their bedroom and some had chosen to have their own television and music systems. The home had a communal television and had video and DVD facilities. Visiting arrangements were flexible and service users’ could see family and friends whenever they wanted and had access to a telephone in the house. Some of the service users’ had their own mobile phone. Service users’ planned their menus with the staff in advance and said that there was always plenty of choice and this was observed during one mealtime at the time of the inspection visit. Service users’ said that they enjoyed having a takeaway meal on a weekend. Since the previous inspection all staff had received food hygiene training and some of the staff had attended a diet and nutrition course to promote their awareness of healthy eating options and service users’ had been encouraged to eat more fruit as part of their daily diet. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 15 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): 18,19 and 20 Quality in this outcome area was good. The personal and healthcare needs of the service users’ were met with good access available to specialist services when required although improvements were needed to medication recording procedures to minimise the risk to service users’ from medication errors. EVIDENCE: Staff aimed to promote the independence of the service users’ and staff could be observed to be providing support in a dignified manner. A service user said “I am pleased with the care I receive” and another said the care was “very good”. Comment cards received from three relatives, a GP and a care manager expressed satisfaction with the care provided by the home. The GP commented that the home communicated well with the GP surgery to make sure service users’ healthcare needs were addressed and the care manager felt that standards in the home had improved within the last 2 years. Each service user had access to specialist healthcare services and some of the service users’ were seeing a psychologist for specific support. One service user experienced mental health problems and a psychiatrist within mental health outpatient services was monitoring this. Records were made of any input from specialist services so that the care staff could be kept informed about the care being provided. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 16 The home’s medication system and facilities were inspected. The Medication Administration Records (MAR) were on the whole accurate and up to date although in two instances there were omissions on the MAR charts of two of the service users’. The manager said that in one of these cases the service user had refused one particular type of medication and so the medication was not administered, however the reasons why the medication had not been given were not recorded. In the other case the manager explained that the omissions on the MAR chart were because the service user was no longer requiring the medication, however it was still prescribed. A random check of the medication supplies was made against the MAR sheets and these tallied with the records. Staff had all attended some medication training to update their skills and knowledge. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Clear complaints and adult protection policies were in place and understood by staff to safeguard service users’ from abuse. EVIDENCE: The home had a complaints procedure that was openly on display in the home and was available in written and picture formats. Service users’ spoken to knew who they needed to speak to if they had a complaint and felt confident that any concerns would be addressed properly. One verbal complaint had been received by the home since the last inspection and the manager was dealing with this matter. Three comment cards received from relatives stated that they were not aware of the home’s complaints procedure. The manager said that the complaints procedure was accessible within the home, however consideration would be made as to how the complaints procedure was made available to relatives who did not visit the home. In the past previous incidents in relation to adult protection matters within other Craegmoor homes had been managed poorly and the Regional Director at Craegmoor had instigated a training programme for all staff on adult protection matters to safeguard service users’ from abuse. All the staff at the home had attended adult protection training and abuse awareness was covered within induction training for new members of staff. Staff were clear about adult protection procedures and what actions to take if abuse was suspected or had happened. Since the previous inspection a service user had made an allegation of abuse concerning the behaviours of two members of staff. This matter had been referred to the correct authority and following investigation no further action was taken. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The environment needed to be improved to promote the comfort and safety of the service users’. EVIDENCE: A concern had been raised by a professional visiting the home that during one visit to the home the staff had been unable to find the right key to unlock the door and had then been let into the home without being asked for any identification, so potentially placing service users’ at risk from harm. On the day of inspection the member of staff present asked the inspector for identification before allowing access into the home and the manager said that all staff had now been issued with a front door key. At the time of the visit the home was warm and clean for the service users’. All the service users’ were mobile and could access all parts of the home however there was no ramped access to and from the home for people with mobility problems. Bedrooms and communal areas were clean, tidy and offered sufficient space. There was a garden and paved patio area to the rear of the building where service users’ could sit and there were lounge areas for service users’ to sit in if they chose to do so. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 19 The home had a sufficient number of toilets and bathrooms for the number of service users’. One of the bedrooms had en-suite facilities. The kitchen area was spacious, there were sufficient food supplies and fridge and freezer temperatures were tested and recorded on a daily basis to maintain good food safety practices. There was a separate laundry room with a domestic washing machine and tumble dryer and COSHH materials were secure in a locked cupboard. Call bell systems were available within personal and communal areas of the home and service users’ said these were responded to promptly when used. There were some issues of concern with the environment. A random check of the hot water temperatures was made in a bathroom, a toilet sink and a service user’s bedroom and all exceeded safe limits. This was discussed with the manager who immediately contacted the handyman for the home and the necessary work was carried out at the time of inspection. A further check of the hot water temperatures was made after the work was completed and found to be satisfactory. The manager said that the water temperatures could be erratic and the water temperature monitoring records confirmed that on a number of occasions staff had needed to contact the handyman to regulate excessive water temperatures. The constant problem with the water temperatures was of serious concern and the manager immediately made arrangements for the matter to be investigated and dealt with by the appropriate people. The records also showed that the checks on the stored hot water systems had not been carried out since March 2005 and this needed addressing to prevent unnecessary health risks to the service users’. During a tour of the premises it was observed that some tiles had fallen off in the freezer storage room and needed replacing. A service user’s bedroom had been affected by water damage and was in need of refurbishment and redecoration and there were foul odours from a first floor toilet and on the second floor corridor. A carpet on the second floor of the home had a piece missing and this placed service users’ at risk from tripping. In the laundry room the ventilation system was partly blocked with dust and was in need of cleaning to prevent risks from cross infection. The manager said that plans had been put in place to deal with most of these issues, however action had been slow in addressing these matters. Some parts of the home had paintwork damage and the home in general was looking in need of re-decoration. The manager said that this was planned within the maintenance programme although it was not clear as to when the redecoration work would actually be carried out. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 20 At the previous inspection it was recommended that an automatic door closure be fitted to the lounge door as one of the service users’ did not like the door to be closed. The manager said that no action had been taken with regard to this matter and admitted that the door was wedged open on a number of occasions. This practice must cease as it places service users’ at risk to their safety and impacts on their privacy. At the time of the recent incident when a service user had become aggressive all the remaining service users’ had congregated in the small office area to protect their safety and some of them had been given cigarettes to reduce their stress. A professional who had been visiting the home at the time of the incident expressed some concern that the office was not very well ventilated. The manager said that the service users’ had taken their own decision to move into the office when the incident occurred, however since the incident contingency plans had been put in place as to where service users’ should be encouraged to go if there was to be a repeat of a similar incident. Also following discussions with the service users’ who smoked cigarettes it had been agreed that service users’ would only smoke outside of the home. It is recommended that the home have more dining room chairs to enable all the service users’ and staff to sit together at any given time if they choose to do so. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 21 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): 32,34 and 35 Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. Proper recruitment procedures safeguard service users’ from harm, however despite improvements in staff training there were shortfalls in staffing levels which meant that service users’ needs could not always be met. EVIDENCE: On the day of inspection there was initially one member of staff on duty looking after four service users’. The manager said that because most people went out in a morning a decision had been made that one member of staff in a morning was sufficient except in the case of one service user who needed to have two staff on duty when they were at home. However in recent weeks more service users’ had started to spend more time at the home in the morning and a decision had been made to reduce the staffing numbers in a morning without any consultation with the Commission. Staff said that the care at the home was good, however they felt there were not enough staff on duty in a morning to meet all the service users’ needs and the duty rotas showed that on some occasions there had been only one member of staff on duty between the hours of 9am and 4pm. A comment card received from a relative also expressed some concern about insufficient staffing levels. Staffing levels for other parts of the day and night were found to be adequate. Service users’ said that staff could always be accessed in a morning, however the member of staff working on their own could be observed to be under pressure. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 22 The manager confirmed that service users’ who needed staff to accompany them to be able to go out would not be able to do so when only one member of staff was on duty, as this would leave the home without staff. This was clearly not acceptable and the manager agreed to deal with this matter immediately. The staff files of two of the most recently appointed members of staff were checked although the home had an established workforce and had not needed to recruit anyone since 2003. The staff files showed that all the necessary preemployment checks had been carried out prior to the workers starting in post. There had been some improvements in the staff training programmes and each member of staff had individual training records to show what training they had undertaken. An induction programme was in place for new members of staff. Training records showed that each member of staff had received updated health and safety training as well as training relating to medications, adult protection, equal opportunities and Crisis Prevention Intervention. However the staff had received limited training in relation to the specific needs of people with a learning disability and staff said that this would have been “useful and was needed”. The manager did say that the organisation was in the process of rolling out a training pack on autism that had been developed by the British Institute of Learning Disabilities. One member of the care team had completed NVQ level 2 training whilst two other staff were currently undergoing the training. Four staff that had previously been identified as having problems with language and literacy skills had completed some English courses and English Skills Council literacy training. The manager said that this had been of benefit to all the staff who had attended the training and their skills had since improved, although one of the staff continued to have difficulties with language and literacy and further training was planned. The manager had put arrangements in place to measure staff’s understanding of training received by the use of written questionnaires and verbal testing. Staff present at the time of inspection were observed to be all communicating effectively with the service users’. Regular staff meetings were held and these were recorded and staff supervision systems were in place. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 23 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): 37,39,41 and 42 Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well run, however some health and safety matters needed addressing to safeguard the interests and safety of the service users’. EVIDENCE: The registered manager of the home had worked at the home as the manager for two years. She was undergoing the Registered Manager’s Award to enhance her management skills. The manager had worked hard to make improvements at the home and staff and service users’ both spoke well of her with service users’ saying she was “very approachable and helpful” and staff commented that the manager had improved standards within the home and was “very supportive”. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 24 Service users’ and relatives were given opportunities to comment on how the home was run. A recent questionnaire had been sent to service users’ and responses from the questionnaires were sent directly to the regional office where the information was analysed and then an action plan was requested from the home based on the findings from the questionnaire. The manager had audit systems in place to monitor various aspects of care and health and safety practices within the home. Staff and service users’ meetings were held on a regular basis in order to enable everyone to be involved in decision making about the home and minutes from these meetings were recorded. A number of health and safety certificates were looked at and were satisfactory. Staff had received updated health and safety and fire safety training and fire drills were carried out on a regular basis and a recent check of the home’s electrical installation systems had been carried out to ensure the service users’ safety. However there were some concerns about some health and safety matters. As previously mentioned in this report under the heading of environment, there were problems with the hot water system and the initial random check of the hot water temperatures all exceeded safe limits. The monitoring of the stored hot water temperatures had not taken place since March 2005. The lounge door was wedged open on a number of occasions and a loose carpet on the second floor put service users’ at risk from tripping. A service user’s bedroom had been damaged by a water leak and was in need of refurbishment and redecoration and some tiles needed replacing in the freezer storage area. There were unpleasant odours from both the toilet on the first floor and the corridor on the second floor of the home. There were also concerns about inadequate staffing levels in a morning and early afternoon. Although individual and the home’s records were in general good order, personal care records could be easily accessed in the office, which did not have a lock so the interests of the service users’ were not safeguarded. Service users’ monies were discussed and the financial systems used by the home were looked at. In the home each service user’s money was held individually and records and receipts were kept in respect of incoming and outgoing monies. Other service users’ monies were held in a Craegmoor account and individual records were maintained for each service user and interest was paid on each account. A random check of the monies tallied with the records. Service users could have access to their monies at any time. Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 25 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 2 3 2 4 X 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 2 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 3 X 1 1 X Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 26 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 YA20 Regulation 13,14 Requirement Medication prescribed for but no longer used must be referred to the General Practitioner in order that it can be discontinued. Reasons as to why prescribed medications have not been administered must be recorded on the medication records. The lounge door must be fitted with a door closure to ensure the safety and privacy of the service users’. The registered person must consult with the fire authority to ensure that action taken conforms to fire safety standards. The registered person must ensure that the service user’s bedroom identified as having water damage is refurbished and redecorated. The registered person must make arrangements for the cleaning of the ventilation system in the laundry room. Timescale for action 18/07/06 2. YA24 13,23 31/07/06 3. YA24 23 18/08/06 Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 27 4. YA24 16 5. YA24 13,23 6. YA24 23 7. YA33 18 The loose tiles in the freezer and dry food storage room must be replaced. The registered person is to make sure that all parts of the home are free from offensive odours at all times. The registered person is required to repair or replace the carpet on the second floor corridor so that service users’ are not at risk from tripping. The registered person is required to produce a detailed plan with timescales for the redecoration and refurbishment of the premises. The registered person is required to have at least two care staff on duty between the hours of 9am and 4pm to meet service users’ needs. The registered person must consult with the Commission about proposed changes to staffing levels before any action is taken to reduce staffing numbers. Personal information about service users’ must be kept in a secure place to safeguard the interests of the service users’. The registered person is required to review the hot water systems in the home and the arrangements for the monitoring of hot water temperatures to prevent service users’ from being at risk from scalding and legionella. 31/07/06 31/07/06 31/08/06 18/07/06 8. YA41 17 18/07/06 9. YA42 23 19/07/06 Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 28 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. 4. Refer to Standard YA22 YA24 YA35 Good Practice Recommendations The registered person should consider ways of making sure that relatives who do not visit the home are aware of the home’s complaints procedure. The home should have a sufficient number of dining room chairs to accommodate all service users’ in the home. Staff should be given more specific training to provide them with a better understanding to be able to meet the needs of the service user group. The registered manager should complete the Registered Manager’s Award to enhance her management skills and knowledge. 5. YA37 Shieling The/ Coach House The DS0000007909.V302852.R01.S.doc Version 5.2 Page 29 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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