CARE HOME ADULTS 18-65
St Bede`s Cottage Auton Style Bearpark Durham DH7 7AA Lead Inspector
Ms Vicky Hargreaves Unannounced Inspection 7th December 2005 10:00 St Bede`s Cottage DS0000007503.V266310.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 St Bede`s Cottage DS0000007503.V266310.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. St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Bede`s Cottage Address Auton Style Bearpark Durham DH7 7AA 0191 3731124 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) Durham Careline Limited Mrs Anita Ennis Care Home 28 Category(ies) of Learning disability (10), Physical disability (19) registration, with number of places St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Room number 22 can be used to accommodate a person in either the DL or the PD category dependent on need. 28th June 2005 Date of last inspection Brief Description of the Service: St Bedes Cottage is a large old building that has been an adapted and extended. There is car-parking to the front and side but little in the way of a garden area, although the site is large enough to provide one. The home is on a bus route and is close to the local shops. St Bedes has been divided to provide two units for adults between 18 and 65 years. The units are linked but have their own entrances. The St Bedes Unit is for 19 people with physical disabilities, and the Vicarage Unit is for 10 people with learning difficulties. The two units are each staffed separately. At the time of this inspection major building work was being done which should improve facilities. The Home provides care and support for people with a wide range of needs. It has good links with care professionals in the community and is active in getting residents any special aids they might need. All the bedrooms are single and have ensuite toilets. The bedrooms are all very individual in size and shape, and are decorated according to the residents choice. There is flat access to both entrances of the home and a lift to all floors. St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and was the second one of the two inspections that the Commission for Social Care Inspection does on every registered home each year. This inspection was six hours long. The time was spent talking to the manager, the activity organiser, two staff and nine residents. Some residents’ files and staff training records were looked at. In line with current CSCI policy of ‘Proportionality’, the inspector looked at a number of key standard outcomes for residents. The key standards not looked at in this time had been looked at in the first of the year’s inspections. What the service does well: What has improved since the last inspection?
There are more opportunities for residents to go out and the activity organiser keeps a current record of residents’ individual interests so they can be followed up. Staff have done more training and they are up-to-date with all the statutory courses. Building work is being done to split the home into smaller units and provide kitchen and laundry facilities that the residents will be able to use. St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 6 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. St Bede`s Cottage DS0000007503.V266310.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 St Bede`s Cottage DS0000007503.V266310.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): 2. The needs of prospective residents are assessed before admission and they are asked about their interests and hobbies after they are admitted. EVIDENCE: Before they came in, the home had a full assessment of needs for each resident, done by social work or health professionals. These assessments were done with the person, if they were able. The activity organiser made a record of the interests and hobbies of the residents after they were admitted. St Bede`s Cottage DS0000007503.V266310.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 and 9.. Residents are involved in their assessments and are kept up-to date with any changes made to their Action Plan because their needs have changed. Residents are supported to take risks as part of an independent life-style. EVIDENCE: Residents had individual Action Plans and they had signed them to show that they had been involved. The Action Plans included their health needs, social and religious interests, how any finances are looked after, and, if necessary, how to manage any challenging behaviour. The residents also had Daily Care Plans that gave details about how their needs should be met on a daily basis. There were regular evaluations of the Action Plans in each resident’s file that the residents also signed. Residents had individual risk assessments in their care plans which they had agreed. The manager gave examples of occasions when risks had been discussed with residents so that they could make an informed decision about taking the risk. There were strategies in the care plans to minimise any risks, as far as possible. In the case of a resident who didn’t seem to understand the risks s/he was taking, the manager has asked for an independent professional to assess the person.
St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13. While some residents are able to take part in education and training appropriate to their age and peer group, many of them don’t have the opportunity to take part in valued, or fulfilling, activities. Residents have some opportunities to get out into the community but this is limited. EVIDENCE: Most of the residents with learning difficulties attended a day centre. Some of the physically disabled residents went to a social centre, but others didn’t qualify because they had come from another area. One resident had been given support to attend a college course, but no one else was following any education, training, volunteer, or work related activities. The staff and activity organiser supported residents to go out into the community and the records showed that some residents were usually taken out once or twice a week, for shopping and visits to pubs, clubs, church and cinemas. None of the residents had a regular timetable for going out, or joining in community activities. The manager said that activities would be the first to suffer if there were problems in the home, or staffing difficulties, but the home
St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 11 was advertising for an activity organiser to do more hours. One resident said he would ‘like to get taken out, anywhere’, while another said, she ‘would like to go to South Shields’, but both said they hadn’t been asked’. One resident said his hobby was swimming but he hadn’t had the opportunity yet. All activities and transport have to be paid for by the residents and this has also restricted some of them. St Bede`s Cottage DS0000007503.V266310.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. The home meets the physical and emotional needs of the residents. EVIDENCE: The residents’ files showed that they had regular visits from health professionals (dentist, optician, chiropodist etc). These all came to the home, although, when residents are able, they should be given support to use the services in the local community. Annual, (general) health checks had been started for residents on the Vicarage side. A resident said that staff were good about getting in touch with health professionals when necessary: ‘The staff understand my needs’. An occupational and physio-therapist were visiting the home at the time of the inspection, because a resident’s needs had changed. In another case the manager had asked for support from psychiatric nursing services when this seemed necessary. St Bede`s Cottage DS0000007503.V266310.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): In the previous inspection. EVIDENCE: St Bede`s Cottage DS0000007503.V266310.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): In the previous inspection. EVIDENCE: St Bede`s Cottage DS0000007503.V266310.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): 35 The staff have been trained and understand the needs of the residents. EVIDENCE: The training records for the staff showed that they had had done all the statutory courses and that staff had done, or were going to do, the special induction and foundation training to work with people with learning difficulties. The training records didn’t show if the staff had had any training in the different conditions of the residents, although residents were satisfied that staff understood their needs. Ten of the staff had NVQ’s in care. The manager said that there was a programme of training available next year that will cover some of the different conditions. St Bede`s Cottage DS0000007503.V266310.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): 39. Residents views are sought but they aren’t given feedback on this, or the homes development plan. EVIDENCE: The home sends out annual questionnaires. The new one for residents, that was seen, covers the food, care, building, management and daily living in the home. The manager said that relatives, and others involved with the home, will also get questionnaires. The proprietors were given the results so they could decide on any action to be taken. There was no system to give people any feedback on the surveys, or the plans that are developed, as a result of them. St Bede`s Cottage DS0000007503.V266310.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 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Bede`s Cottage Score X 3 X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X X X DS0000007503.V266310.R01.S.doc Version 5.0 Page 18 Yes 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 YA17 Regulation 16 Requirement Timescale for action 30/12/05 2. YA39 24 3. YA13YA12 16 Adequate and safe and accessible facilities must be provided for service users on each unit to prepare their own food, and the use of suitable laundry facilities should be made available. The involvement of an occupational therapist is recommended. The registered person must 28/02/06 make a copy of any review of the service available to the residents. The registered person must 30/03/06 ensure that residents are supported to get involved in local social, and community activities, and that the home has a programme of activities in relation to recreation, fitness, and training. St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 19 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. 5. Refer to Standard YA24 YA14 YA24 YA35 YA19 Good Practice Recommendations Separate units for ten or fewer service users should be created by April 2007. Service users should have the option of a weeks holiday each year financed through the fees The corridors that are scuffed and marked should be redecorated. There should be evidence that staff have a knowledge of the disabilities and specific conditions of the residents. To promote community integration, only residents who are not able to use healthcare facilities in the community, should receive these services in-house. St Bede`s Cottage DS0000007503.V266310.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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