CARE HOME ADULTS 18-65
Stanfield House Workington Cumbria CA14 4EA Lead Inspector
Nancy Saich Unannounced 20 September 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Stanfield House Address 4 Stainburn Road Workington Cumbria CA14 4EA 01900 65737 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Turning Point Limited Peter Ditchfield Care Home 12 Category(ies) of 12 A - Alcohol dependence past or present registration, with number 12 D - Drug dependence past or present of places Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 12 people over 18 years of age with past or present alcohol dependency to include people over 18 years of age with past or present drug dependency Date of last inspection 16 March 2005 Brief Description of the Service: Stanfield House is an older property located in a residential area of Workington. It is within walking distance of the town and has good local and national connections. The property has three floors and is unsuitable for people with disabilities. The home takes people between the ages of 18 and 65 who have had problems with substance abuse but who are no longer using drugs or alcohol. The home is only staffed during office hours so residents must be able to function fairly independantly. The home is registered to Turning Point, a national charity who run different types of home throughout the country and who have other services for people with problems of addiction. Peter Ditchburn manages the home on their behalf. Further information on Turning Point can be accessed through their website on www. turning-point.co.uk. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted by Nancy Saich. The visit started just before 9 a.m and lasted for approximately six hours. The inspector met briefly with the registered manager and spent time with the three other members of staff. She spent time with the eight residents in small groups and individually. She met with a visitor to the home. She also spoke to a number of residents by telephone after the visit. Residents allowed the inspector to check out all areas of the building and the inspector also looked at documents that backed up what was said by the people she met. What the service does well:
This service is good at admitting residents who can benefit from the therapeutic work of the home and who will fit into the existing group. This can be a difficult task for both the staff and the prospective resident but the visit and interview conducted prior to admission appears to be largely successful. Residents are very aware of the conditions of their stay and everyone was aware that drug or alcohol use could result in their stay being terminated. There was plenty of evidence to show that the individual and group work in the home, coupled with the approach of individual staff helps residents who are motivated to overcome their previous problems. Residents were very complimentary about the staff saying that they were “…just great…very supportive, don’t talk down to you and give you enough space to have privacy…its not a regime …it’s a community with support there when you are ready to ask for it…” Residents said that the home helped them to access health care. This might mean that they have physical problems dealt with and there was evidence to show that residents were referred to mental health professionals. The staff are very aware of how to protect the residents from potential abuse. Residents thought their rooms and the two lounges and the dining kitchen were comfortable and fairly well furnished and equipped. The small staff team are suitably qualified and trained and there is a good mix of skills amongst them to give residents good levels of support. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 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 standard(s) 1,2 The home is good at looking at what motivates people to come to the project and in looking at whether new residents will fit into the existing group. EVIDENCE: The inspector spoke to a number of residents who spoke about coming to visit and meeting existing residents and staff. Most people thought that this was a good way of finding out if the person was suitable for inclusion. Residents did speak about some recent admissions that had not been so successful but agreed that sometimes it was hard to predict how any person would fit in. The inspector saw evidence of this admission procedure in residents’ files. There were some documents showing that for some people the staff had asked for health or psychiatric assessments before agreeing the admission. Most files also had social work assessments in place. One resident commented on the need to update the service user guide on two points about activities. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 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 standard(s) 6,7,9 This home is very good at supporting people in recognising their needs and in supporting them making positive choices during their rehabilitation process. EVIDENCE: In this home residents have weekly one-to-one meetings with a member of staff who works as their key worker. During these sessions residents plan out their own aims for their stay. Residents said this was working well, despite recent staff shortages. Residents said they were supported and encouraged during these meetings and on a daily basis to make decisions for themselves. They appreciated the advice and help given by staff. The project has a weekly house meeting where residents can be consulted and where they can air their views. Some people felt that the company needed to have further discussions with them related to the food budget and the way activities were arranged. Residents felt they were supported in taking suitable risks and every person had a risk assessment that had been updated as they moved through the recovery process. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 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 standard(s) 11,12,13,16,17 The home is very good at promoting appropriate lifestyle choices for residents. EVIDENCE: The main focus of the work in the home is in helping people with their personal development. Residents said that they liked the fact that the project wasn’t just about helping people to stop using addictive substances but was also about replacing this behaviour and about strategies for rebuilding lives. This involves residents groups where they can talk about their previous behaviours and choices, individual support and work on things like self-esteem. Residents are encouraged to build on social and learning skills. There are wider opportunities for residents to gain qualifications and one person spoke about plans to get involved in local conservation work and another talked about completing a counselling course. Residents are encouraged to go out to shop and to sports and leisure pursuits. A number of people did say they wanted more of these activities and that the funding wasn’t adequate for them to do all the things they wanted to do. The inspectors felt that Turning Point needs to look at how activities are organised and funded and that there were opportunities for residents to be in control of this for themselves.
Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 11 Residents cook for themselves and do qualifications in food safety. Residents said they managed well but one or two people questioned the amount in the budget for food. One person said he felt the amount didn’t take into account large appetites and another thought that it was hard at this price to make the meals nutritious enough. The price per person hadn’t gone up in line with the increase in cost to residents and Turning Point need to look at this as a matter of good practice. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 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 standard(s) 18,19 The service is good at helping residents to access personal and health care support. EVIDENCE: Residents said they were registered with local surgeries and helped to access other more specialised health professionals. There was evidence to show that the home could help people use alternative therapists if they wished. The individual and group work is used to address the emotional needs of residents but where there are difficulties the home can help with psychiatric referrals or with contacts that have a more psychological approach. Several people had completed courses that helped them to look at emotional and psychological needs. Medication was not looked at in depth as a further inspection conducted by a pharmacist is planned for the service. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 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 standard(s) 22,23 Residents are protected from harm but there was evidence that some complaints were not dealt with properly and residents left feeling unhappy with the way things were managed. EVIDENCE: Residents discussed some concerns relating to the systems for calling staff out of office hours. Turning Point was aware of residents concerns but these had not been dealt with as complaints, nor had residents been supported in doing this. These matters were discussed with staff and they too thought that there might have been more follow through on these issues. Turning Point are required to look into these things so that residents don’t feel concerned and left feeling dissatisfied with arrangements in the home. Residents thought that staff were very aware of how to protect them from harm. Staff said they had received training and were aware of the particular problems the residents of the project might have. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 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 standard(s) 24,27,28,30 There are problems in the environment that detract from the comfort and safety of residents. EVIDENCE: The inspector toured all areas of the building and asked residents their opinions of the environment. The feeling was that the home was comfortable and well decorated. Residents only stay for a short period of time but many of them had personalised their rooms. The home appeared to be generally well maintained but there were a number of issues that had been overlooked. The matters relating to fire and general safety are detailed in the last section of this report. One of the bedrooms on the top floor was damp. Turning Point need to investigate where this is coming from and put matters right. The home has two bathrooms and one toilet. There are no ensuite facilities. At times there is a strong gender imbalance and it would be preferable if at least one room has an ensuite toilet. It is again recommended that Turning Point look into the feasibility of doing this. The inspector also recommended at the last inspection that the top floor bathroom be upgraded. This is repeated again in this report. There are two double rooms but staff try to have these as single occupancy where possible.
Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 15 The home was clean and tidy on the day of the inspection. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35 The staffing levels in this home are not adequate when staff are absent from work or when there are difficulties within the resident group. EVIDENCE: There had been staff absences over the last two months and this had left existing staff stretched. There had been no extra cover in place for absence, holidays or training. These problems have happened in the past with vacancies and were subject to enforcement action by the commission. Residents said that the staff had done “their very best” but they realised that they had been under pressure. One person said that this was fine when the home was stable but said that there had been some “tricky moments”. Staff thought that things had just been “ticking over”. Residents thought that the manager and the three support workers had “really excellent skills…” but were unsure about other people who had been used to cover any issues out of hours. They felt that people who weren’t used to the home and didn’t know them well had made some unsound decisions. The inspector judged that the system of people being ‘on call’ from home had proved inadequate on at least two occasions and had stretched the two staff who had done the bulk of these duties. The problems of covering vacancies and out of hours cover needs to be dealt with to allow the good care practices to continue without over stretching staff or allowing routine matters to slip.
Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41,42 There were a number of serious issues relating to record keeping and health and safety that detract from the good care practices. EVIDENCE: The inspector checked on a number of records relating to the support residents were given. She felt that there might be more details in some aspects of the care planning system and that a policy of daily records might be beneficial – especially when residents have some kind of crisis. She also though that the contents of what is known as the “on-call” book might be better contained in individual files. The staff are used to the systems and base much of it on individual casework. Some of this work was not as detailed as it might be because of the understaffing problems. The registered person needs to review how these very important records are maintained. There were some problems seen on the day that related to the health and safety of staff and service users. The windows had been painted and the window restrictors not replaced. The upstairs windows could be opened wide and might pose a risk of falls.
Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 18 The fire officer had visited the home and had noted two problems. There was an issue with the safety of the boiler house and the fire alarm system no longer met the needs of the residents or staff. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 19 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 2 3 x x x Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x 2 3 x 3 Standard No 11 12 13 14 15 16 17 3 2 3 x x 3 2 Standard No 31 32 33 34 35 36 Score x 3 1 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Stanfield House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x 2 1 x F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 22 Regulation 22 (2) and (3) 23 (2) 18 (1) Requirement Turning Point must look at why issues related to an alleged failure of the on call system were not treated as complaints. The dampness in room 8 must be investigated, treated and the wall made good and redecorated Turning Point must look into how the home is staffed and provide contingency plans for staff absences and for on call arrangements. The registered manager must look at the way daily events in residents lives are recorded Window restrictors must be replaced on all upstairs windows The fire alarm must be updated through repair or renewal Fire safety work to improve the fire block from the boiler room must be undertaken. Turning Point needs to review the way social and leisure activities are organised and funded Timescale for action 31st October 2005 15th November 2005 31st October 2005 15th November 2005 31st October 2005 31st October 2005 31st October 2005 15th November 2005 2. 3. 24 33 4. 5. 6. 7. 8. 41 42 42 42 12 17 (1) 23 (2) 23 (4) c 23 (4) a &c 16 (2) (m) & (n) Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 1 17 27 27 Good Practice Recommendations It is recommended that two errors are amended in the residents hand book. It is recommended that Turning Point review the budget allocation for purchasing food. It is recommended that Turning Point conduct a feasability study into creating an ensuite facility in at least one room. It is recommended that plans are made to upgrade the topfloor bathroom. Stanfield House F58 F10 s22602 stanfield house v236924 200905 ui stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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