Inspection on 09/10/07 for Skelton Court

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Skelton Court 26/10/09

Skelton Court 02/10/08

Skelton Court 26/07/06

Skelton Court 01/11/05

Skelton Court 14/06/05

Skelton Court 08/03/05

Skelton Court 25/10/04

Skelton Court 09/12/02

Similar services:

St Marys Nursing Home

Thornham Grove

Chater Lodge

Conifer Lodge

Tixover Care Home

Toynton College (Cluster Five)

Egerton Lodge Care Home

Cedar Court Nursing and Residential Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Skelton Court 41 Ryder Road Kirby Frith Leicester LE3 6UJ Lead Inspector Linda Clarke Unannounced Inspection 9th October 2007 09:00 X10029.doc Version 1.40 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 Skelton Court DS0000006312.V350675.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 Older People and 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. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Skelton Court Address 41 Ryder Road Kirby Frith Leicester LE3 6UJ 0116 2321834 0116 2321835 lynn.dickinson@lha-asra.org.uk www.lha.org.uk Leicester Housing Association 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) Lynn Dickinson Care Home 20 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (10), Mental disorder, excluding learning of places disability or dementia (20), Mental Disorder, excluding learning disability or dementia - over 65 years of age (20), Physical disability (10), Physical disability over 65 years of age (10) Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User Numbers in `Yellow Acre`. No person falling within categories MD, DE, MD(E) or DE(E) may be admitted in ``Yellow Acre`` when 10 persons in total of these categories/combined categories are already accommodated within `` Yellow Acre``. Service User Categories accommodated in `` Yellow Acre ``. No person of category MD or DE who is under the age of 50 may be admitted to `Yellow Acre`. Service User Categories accommodated in `Redwood` No person falling within categories MD/PD or MD/E, PD/E, ie dual disability may be accommodated in `Red Wood` when 10 persons in total of these categories/combined categories are already accommodated in `Red Wood`. Categories admitted to `Redwood` No person falling within the categories PD or PD/E may be admitted to `Red Wood` unless that person also falls within category MD or MD/E I.e. dual disability 26th July 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Skelton Court is a care home providing personal care and accommodation for people aged 50 and over with Mental Health problems. In addition Skelton Court Provides personal care and accommodation for people with Huntingdon’s Disease and Acquired Brain Injury. Skelton Court is situated on a modern housing estate within reach of a range of facilities, with a minibus providing additional transport. Skelton Court is single storey and horseshoe in shape; communal facilities consist of a smoking lounge, separate lounge, separate dining room and lounge/diner. All bedrooms are single and have an en-suite consisting of a toilet and wash hand basin. There is a central courtyard, which is partially paved with seating, a gazebo and mature plants and shrubs. Information is located on site detailing the range of services offered, which includes the Statement of Purpose and Service User Guide. Copies of the Commission for Social Care Inspections, Inspection Reports, are available by request at Skelton Court. The fee charged is dependent upon a financial assessment being undertaken to establish the individual’s contribution to care costs. A representative of the Local Authority funding the care carries out the assessment. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process consisted of pre-planning the inspection, which included viewing the previous Inspection Report, reviewing the Annual Quality Assurance Assessment (AQAA), which is a self-audit tool completed by the provider. We sent surveys to service users their relatives and the staff of Skelton Court; eleven service user, two relative and nine staff surveys were returned. The unannounced site visit commenced on the 9th October 2007 and lasted 1 day. The focus of the inspection is based upon the outcomes for the service users. The method of inspection was ‘case tracking’. This involved identifying service users with varying levels of care needs and looking at how these are being met by the staff at Skelton Court. Four service users were selected and discussions were held with two of them. In addition three other service users were spoken with. The method of case tracking included the review of service users’ individual care records, discussions with staff of various responsibilities within the home and reviewing records, training records and the minutes of service user and team meetings. What the service does well: Skelton Court provides prospective and existing service users with detailed information as to the range of services offered by the home. Service users benefit from a detailed assessment of their needs undertaken by health and social care professionals, and receive continued support by accessing a wide range of health and social care professionals. Service user meals are homemade, and those with specialist needs are catered for. Service users benefit from a staff team who are qualified and trained in delivering good care, meeting the individual and collective needs of service users. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of service users and relatives when asked what the home does well the following comments were made: • They hold activities for the residents and bring in additional care if they appear to be struggling. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 6 • I feel that all the staff are helpful and friendly to my relative, which makes them feel safe, and I know they have their best interest at hear, which makes me feel happy. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of staff when asked what the home does well the following comments were made: • • • • Provide good training to all staff Meet the needs of service users to a high standard Provide monthly outings for service users or celebrations within the Home I feel the service caters well for it users and staff What has improved since the last inspection? What they could do better: Information about a service users life prior to their admission to Skelton Court would benefit both the service user and staff. Information about an individuals education and work life, family and friends, along with any views they may have would enable staff to support the service user with their preferred choice of lifestyle, and ensure that staff have a greater understanding as to the needs of the individual. Service users may benefit by Skelton Court developing professional relationships with voluntary and employment agencies, which for some service users may provide an opportunity for them to widen their range of opportunities and experiences. Service users need to be consulted effectively and frequently, service users should be confident that their views and wishes are taken into account when decisions are made which will affect them. The way in which the service is managed needs to ensure that both service users and staff are kept informed, and that information and concerns are handled appropriately to promote the health and well-being of service users. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 7 The Commission for Social Care Inspection (CSCI) sent out surveys to a number of service users and relatives when asked what the home could do better the following comments were made: • Contact me more. I never receive any information about my relative’s care or any events going on. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of staff when asked what the home could do better the following comments were made: • • Taking the residents out more often. Also speaking to the service users better. I feel the service would do better with a manager that was more willing to support their staff, instead of always pointing them in someone else’s direction. Provide more one to one time with staff to allow in house trainingsupervision time and to allow quality time to talk to the service users. The manager needs to spend more time with the residents. The manager needs to spend more time with the residents. • • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 3. Standard 6 is not applicable, as intermediate care is not provided. (Older People) Standard 1 and 2. (Younger Adults) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to make informed choices through good information and a robust assessment process, which ensures that their needs can be met. EVIDENCE: Prospective and existing service users have access to brochures produced by Leicester Housing Association with regards to the facilities provided at Skelton Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 10 Court, these include information as to the referral process, access to services, accommodation, staffing qualifications and experience, activities provided, current service users views of the home and information on how to raise concerns. The records of four service users were viewed, three having lived at Skelton Court for sometime, and therefore their initial assessments were archived. One service user had recently moved into Skelton Court, their assessment and review as to whether Skelton Court was appropriate had been undertaken in part by representatives from Health Care. The assessment supplied by Social Services, although sent on the month of the service users admission into Skelton Court, had in fact been undertaken a year earlier, and in many instances did not portray a current description of the service users current needs and situation. In this instance this did not appear to have had a detrimental affect on the service users move into Skelton Court, but had the potential to provide conflicting information to care staff. Information supplied in AQAA detailed that service users are encouraged to visit several times including day and night visits, before making a decision about moving into Skelton Court, one person spoken with said they had visited several times before moving in. All prospective service users are assessed by the Registered or Assistant Manager, along with health and social care professionals. All service users have an initial six month trials time; during this time their placement is regularly reviewed. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11. (Older People) Standards 6, 9, 16, 18 and 20. (Younger Adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users health care needs are met, and they have good access to health and social care professionals, however information is not always shared accurately. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care plans and records of four service users were viewed, for two service users residing at Skelton Court due to their mental health and two service users who had a diagnosis of Huntingdon’s Disease. Service users are supported by keyworkers who have additional responsibility for ensuring that a service users needs are met, two service users spoken with were very unhappy that their designated keyworker had changed, and commented that they had been advised and not consulted. The care plans provided information as to the support an individual requires with regards to their physical and mental health and well being, and included if service users had a preference as to the gender of staff offering support. Service user files provide a detailed and comprehensive range of information. Care plans could be improved by incorporating information as to a service users life prior to their residence at Skelton Court, enabling staff to have a greater understanding as to the service users work and family history, their hobbies and interests and beliefs. There is flexibility to daily routines with regards to the time service users get up, eat their meals and go to bed, and whether they would like a bath, shower or to decline. Service users choices, dignity and promotion of independence are not always upheld. One service user spoken with said that a member of staff did not like the style of her clothing, stating some of their clothing was inappropriate. A service user said that they sometimes felt discouraged in ringing for assistance more than once, however they pointed out that once in bed they could not turn out the bedrooms lights independently as the light switch was not located near to their bed. Specialist equipment including hoists, walk-in showers, grab rails and technical aids such as devices which enables service users with a physical disability to smoke are available. One of the care plans was viewed with the service user, who was aware in the as to the content of their care plan. Care plans are reviewed monthly, and service users are encouraged to sign them. Discussions with service users, and the records viewed confirmed that service users have good access to health care services, with support being provided where necessary. Service users records confirmed that they receive their medication in a timely manner, and their care plans include information as to any potential side effects from prescribed medicines. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 13 Two professionals with links to Skelton Court, advised the Commission for Social Care Inspection that staff have raised on more than one occasion to concerns as to the day to day management of the home, their concerns being the lack of continuity and sharing of information. One professional advised that the Registered Manager during the review process of service users, has given incorrect information about the service user, which a member of care staff has had to argue against, this information was also contained in a survey received from a member of staff. Risk assessment are completed where areas of potential risk to the service user have been identified, this enables risk to be minimised which may include staff offering support, or by the adoption of other measures. Care plans detail the wishes of service users with regards to illness, death and dying, which ensures that people have control over their lives. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of service users when asked as to their views on the care and support they receive and whether staff listen and act upon what they say the following comments were made. • • Some staff do help. Not always. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. (Older People) 12, 13, 15 and 17. (Younger Adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for service users to further develop skills within the wider community could be improved. Service users benefit from a wholesome diet, and have their specialist dietary needs met. EVIDENCE: Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 15 Skelton Court employs a part time Activity Organiser; who organises visits to various destinations, which have included West Midlands Safari Park, Althorpe Hall, Skegness, Garden Centres, Pub Lunches, Shopping and the Cinema, in addition two holidays took place this year one to Butlins at Skegness, the second to a caravan park at Great Yarmouth, one service user spoke favourably about their holiday to Great Yarmouth, stating that the caravan had been equipped for wheelchair users. Two service users said they went to two day care facilities, one day a week, which were for individuals with a recognised mental health diagnosis, and that activities included, knitting, gardening and cooking. Information supplied by the Registered Manager in the AQAA details that their plans for improvement include the organisation of more varied activities, and making enquiries about evening classes for some service users if they are interested. Service users currently residing at Skelton Court do not access paid employment or voluntary work, and the member of staff in charge of the shift on the day of the site visit said that Skelton Court did not have any links with external organisations in relation to employment and voluntary work. On the day of the site visit two members of staff organised a quiz, which service users participated in, service users earlier however had said that on occasions bingo and trips out for coffee had been cancelled due to staff sickness. A trip to Twycross Zoo was planned for later in the week. Service users spoken with said they had contact with family and friends, this was confirmed within service user records. Two service users said they have visits home spending time with their families. All service users spoke positively about the meals, and confirmed that there were always choices available, and that they were asked what they wished to have from the menu. Service users eat in the one of two dining areas one dining area is specifically for those service users who require additional support due to their medical condition and their risk of choking. Service users who do not eat a traditional diet, but either have meal supplements or a soft diet are supported appropriately, and their individual requirements are detailed within their care plan and are supported by risk assessments. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of service users when asked as to their views activities arranged by the home and their view as to the meals the following comments were made: • • • Activities are available but I don’t enjoy them Like bingo and drawing. Would like more activities. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. (Older People) Standards 22 and 23. (Younger Adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have access to a complaints procedure, and are supported by systems and staff trained in recognising abuse, however their ability to make a complaint may be compromised by the lack of information for relatives. EVIDENCE: Documentation supplied by the Registered Manager prior to the site visit detailed that Skelton Court has received three complaints/concerns in the last twelve months, these were viewed as part of the site visit, and were found to have been documented, with an outcome of the concern recorded and evidence that the complainant had been advised as to the outcome. The Commission for Social Care Inspection (CSCI) in the last twelve months has not received any complaints or concerns with regards to Skelton Court. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 17 Information as to how concerns and complaints can be raised and how they will be handled is provided in documentation supplied to prospective service users, and displayed on the notice board in the home. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of service users relatives when asked if they were aware of how to make a complaint and whether they have been responded to appropriately the following comments were made: • • • Not really Not really, I would like to know what to do if I needed to. All the staff seem to pass the buck on to one another. They don’t listen to me. Those service users spoken with said they knew how to raise concerns, and that they were confident that they would be addressed. Staff receive training in how to look out for signs of abuse and how they are to respond if they have any suspicions or concerns. Policies and procedures detail the action that staff are to take should that have any concerns with regards to service user welfare. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 22, 24 and 26. (Older People) Standards 24, 26, 28, 29 and 30. (Younger Adults) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a warm, safe and clean environment. EVIDENCE: Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 19 Skelton Court has a small car parking facility to the front of the property, and access to the front door is an access level ramp. Mechanisms on the front door prevent individuals entering or leaving the building who do not have the access code. Service users sitting in the home near the lengthy and loud chime of the doorbell, when visitors arrive, service users do not answer the doorbell, but the noise may disrupt service users in whatever they are doing. Skelton Court has an on-going programme of refurbishment and maintenance. All accommodation and facilities are provided on the ground floor. Service users benefit from a central courtyard, with matures trees, shrubs and plants. The courtyard provides a relaxing environment incorporating seating and tables. Service users benefit from en-suite facilities consisting of a wash hand basin and toilet, bathing and showering facilities are adapted to meet the needs of service users with a physical disability, there is a central laundry for the laundering of service users clothing, and a hair dressing salon for the visiting hairdresser. A discussion with one service user was held in their room as requested by them, the service user stating they were happy with their room which was spacious enabling the service user to move around in their wheelchair. Internal doors in the home to corridors and bedrooms are not wider than standard doors, wheelchairs will go through the doors, but provide little space for those individuals who propel their own wheelchair. The bedroom of one service user was found to have a strong odour of urine, this was brought to the attention of the person in charge, who advised that this was known and that their were plans to have the carpet replaced. Service users with Huntingdon’s Disease or an Acquired Brain Injury are located in the area of the home referred to as Redwood, which houses service users bedroom facilities and lounge, whilst those service users with a diagnosis of mental health, reside in the part of the home referred to as Yellow Acre, which houses bedroom facilities, central dining/lounge area and the lounge now designated for the purpose of smoking. The recent implementation of legislation with regards to smoking has led to changes to the use of communal areas. Service users who have lost their lounge to smoking were in some instances unhappy, as they had enjoyed sitting in that area of the home. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 20 The Commission for Social Care Inspection (CSCI) sent out surveys to a number of service users relatives when asked whether if the home was fresh and clean the following comments were made: • • • When I sit in the courtyard the door to the smoke room is left open and you can smell the smoke. Could be done with refurbishing. It smells of bad urine Information supplied in the AQAA detailed that plans for improvement over the next twelve months, include a new call system, new lighting, a new carpet in the lounge/dining area, and an improved extractor fan for the smoking lounge. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. (Older People) Standards 32, 34 and 35. (Younger Adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive the appropriate support they require by staff that are experienced and trained, having their needs met in a safe and timely way this could be compromised if staff absence or specialist training needs are not addressed. EVIDENCE: Staffing at Skelton Court are divided into two teams, those supporting service users with a diagnosis of mental health this part of the home being referred to as Yellow Acre, with the second team supporting service users with Acquired Brain Injury or Huntingdon’s Disease in Redwood. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 22 The staffing rota was viewed, which detailed the staffing arrangements for the home, on the afternoon of the site visit, their were three members of care staff on duty supported by a Senior carer. On the day of the site visit two members of staff telephoned in stating they were ill, and the rota reflected staff who in some instances were on long term sick. Staff spoken with felt that sickness levels in the home had increased, this could have an impact on the quality and continuity of care. Information supplied in the AQAA detailed that Skelton Court employs twentytwo members of care staff, of which seventeen has a National Vocational Qualification (NVQ) representing 77 of the staff group. With regards to staffing the document states there are five care staff on duty in the morning and four in the afternoon, who are supported by the duty officer. The Registered Manager also acknowledges that there is a need for more in-depth training with regards to Huntingdon’s Disease and Acquired Brain Injury in order that staff have a greater understanding of service users needs, and the continued development of the service. Feedback from professionals involved in the home state that staff are not always visible to service users, and that the inability of some service users to have site of staff in some instances increases their anxiety. They also said that staff were always eager to learn and that they asked questions and sort advice and guidance when necessary. Staff were asked as to the training they had received whilst employed at Skelton Court, topics included Health and Safety, First Aid, Moving and Handling and training specific to the needs of service users and the promotion of their care which included, Huntingdon’s Disease, Mental Health, Equality & Diversity and Drug Awareness. The Commission for Social Care Inspection (CSCI) sent out surveys to a number of care staff when asked about the training they receive the following comments were made: • • There is sometimes a long wait due to places not being available before the budget runs out. Training at Skelton Court is an ongoing process and we don’t have to wait to be asked we also can put ourselves forward. Information supplied AQAA detailed that there are five care staff on duty in the morning and four in the afternoon, who are supported by the duty officer. The Registered Manager also acknowledges that there is a need for more in-depth training with regards to Huntingdon’s Disease and Acquired Brain Injury in order that staff have a greater understanding of service user needs. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36 and 38. (Older People) Standards 37, 38, 39 and 42. (Younger Adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 24 The service is not always managed in a way that always promotes the interests of service users or takes their views into account. EVIDENCE: The Registered Manager Lynn Dickinson has been the Registered Manager of Skelton Court since April 2005, and has attained a level 4 National Vocational Qualification. The Registered Manager and Assistant Manager were absent on the day of the site visit; the senior staff on duty and the Clerical Assistant supplied the written information. The Registered Manager detailed within the AQAA that in her view she finds little time to speak with service users due to the volume of paperwork and their deadlines, and therefore relies on her Management Team to keep her updated. This could potentially compromise her position as Manager. Service users raised concerns following the changes implemented at Skelton Court as a result of the legislation with regards to smoking. Care plans viewed all contained risk assessments whereby risks had been identified should service users maintain responsibility for their cigarette lighter and cigarettes. Service user meetings for Yellow Acre and Redwood are haphazard, however information supplied by the Registered Manager in the AQAA states that service user meetings are held monthly. The minutes of service users meetings identified that service users were informed as to the need for the practice of smoking at Skelton Court to change, given the implementation of new legislation. Service users confirmed when discussions were held with them that they were aware of the legislation. There are clearly issues as to the management of smoking it would appear through discussion with service users and reviewing of records that there is an overly rigid regime in place, with little supporting evidence of why these decisions were taken. This is having an adverse effect on service users wellbeing and is compromising their right to make informed choices and take managed risks. A majority of service users, as identified by risk assessments have to be supervised whilst smoking, information detailed in service users case records did not indicate why individuals were thought to be at risk from smoking unsupervised. Staff now go to the smoking lounge every hour on the hour, and are available for fifteen minutes, to light the cigarettes for service users. The minutes of one service user meeting had the following entry: Everyone is reminded that they should hand any lighters in to staff. If anyone is found inside smoking unsupervised, outside smoking will be stopped. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 25 We sent out surveys to a number of care staff when asked if they have the opportunity to meet with their manager and are offered support to discuss how they are working the following comments were made: • The Manager is sympathetic to personal problems, but doesn’t always follow complaints about staff up. You may come out of her office feeling better after making a complaint but nothing really changes. Three members of staff were spoken with who gave conflicting information as to the frequency of supervisions and the team meetings, and their views as to the day to day management of Skelton Court. A member of staff recently recruited confirmed that they commenced work only after they had an appropriate Criminal Record Bureau (CRB) clearance, and provided the appropriate references. The Clerical Assistant advised that there was a Quality Assurance process in the home, which included giving questionnaires to all service users seeking their views, which are then collated. The location of the Quality Assurance document was not known and therefore not viewed. Newsletters are produced, the most recent being for the period January – September 2007 which in some instances may not ensure that interested parties such as relatives and friends are kept up to date with events at Skelton Court. The Clerical Assistant advised that for some service users the day-to-day management of their finances is managed by representatives of Skelton Court, whilst in some instances their finances are managed by the individual service user or their relative. Leicestershire Housing Association audits financial transactions providing a report as to their findings. Information submitted prior to the site visit detailed the regular maintenance of health and safety systems within the home, including fire systems and equipment, environmental health visits, central heating systems and emergency call systems. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 3 21 X 22 2 23 X 24 3 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 2 33 3 34 X 35 3 36 3 37 X 38 3 Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 27 N/A 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. Standard Regulation 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. 2. Refer to Standard OP12 OP30 Good Practice Recommendations It is recommended that links with employment and voluntary agencies be explored, for the benefit of service users. Staff to access additional and detailed training in Acquired Brain Injury and Huntingdon’s Disease to ensure that the needs of service users are met. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Skelton Court DS0000006312.V350675.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!