Inspection on 02/05/06 for Stratheden

This inspection was carried out on 2nd May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stratheden 29/10/07

Stratheden 19/12/05

Stratheden 25/05/05

Stratheden 29/11/04

Stratheden 27/05/04

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

CARE HOME ADULTS 18-65 Stratheden 8 Portland Square Carlisle Cumbria CA1 1PY Lead Inspector Liz Kelley Unannounced Inspection 2nd May 2006 10:00 Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 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 Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 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. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Stratheden Address 8 Portland Square Carlisle Cumbria CA1 1PY 01228 818376 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) The Croftlands Trust Mrs Angela Caroline Whitehead Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 9 service users to include: up to 9 service users in the category of MD (Mental disorder under 65 years of age) 19th December 2005 Date of last inspection Brief Description of the Service: Stratheden is a nine bedded home for people experiencing severe and enduring mental health problems. The property is set in an attractive town square very close to the centre of Carlisle. The premises are a large terraced, four-storey older property, which has been modernised and converted for its present use. On the ground floor there is a lounge, conservatory, kitchen, dining room and office. On the first and second floors there are 8 bedrooms. In the basement there is a self-contained flat for one service user, and a games room with snooker table. All service users have individual bedrooms, each with a wash hand-basin. The Croftlands Trust operates Stratheden. This is a non-profit making organisation, which runs a number of residential and community based mental health services in the County. All referrals are made, and funded via the Integrated Health and Social Services Team. The current scale for charging is £381. A Handbook is available for prospective residents, which includes a summary of the latest Commission for Social Care Inspection report. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 4 hours. Four residents were at home across the day and spoken to. The manager and two members of staff were on duty and assisted with the inspection. Feedback cards had been received from residents, relatives and professionals. A partial tour of the premises took place, as some bedrooms were locked and the occupants were not at home to seek permission to enter. Staff, resident’s records and administration files were examined. What the service does well: What has improved since the last inspection? The Home has further developed ways of ensuring that it meets the needs of people who live there. Most recently the manager has carried out a satisfaction survey of residents and professionals. And a new checking system has been introduced at each staff shift change which ensures that residents monies, petty cash and medications are all up-to-date. This had been brought about due to theft of residents money by a member of staff, who is no longer working at the Home. The recruitment of staff has also been tightened up as a result of this incident, and if there are any doubts about appointing a person a senior management group, including the registered manager make this decision. Training continues to have a high profile in the home and recently all staff have had medications training and have ether completed or are enrolled on nationally recognised care and mental health qualifications. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 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. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 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 Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 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): 1,2,3,4 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has good procedures and paperwork in place to ensure approriate refferals and that they accept only people who’s needs they can met. EVIDENCE: A new resident was case tracked which demonstrated that an initial referral was made via the Integrated Care Team, an OB3 assessment was in place along with an up-to-date risk assessment. Evidence via daily notes and speaking to the new resident established that he had been given choice and plenty of opportunities to visit and this allowed him to make an informed decision. The new resident had been given a Residents Guide and a contract on terms and conditions of his placement. He was therefore clear on his reason for placement and expectations and any rules. Staff carry out an induction for each new resident and this helps them settle and ensures they know such things as fire drills and rules on drug and alcohol use. The majority of service users feedback forms stated that they had good information and all had visited prior to making a decision to move in. A couple of people were placed in the home as a result of an order under the Mental Health Act, and therefore choice had been more limited. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff work hard to encourage residents to take control and make informed choices which is carefully monitored through a well-developed system of care planning. Risk taking is well-managed and a good balance is achieved between promoting independence and ensuring well-being and safety of residents. EVIDENCE: The Home has comprehensive systems for recording daily notes and these are collated into monthly up-dates, which in turn inform regular review meetings. Individualised contingency plans detailed indicators that would trigger staff to seek further advice or putting agreed strategies in place. The Home’s recording, communications systems and the on-going development of care plans was identified as good practice . This leads to residents being fully aware their own mental health needs. A high degree of resident participation was evident throughout these processes. A social worker stated “ I have found the daily records and care planning to be informative and helpful and of a good quaulative standard”. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 10 Risk assessments examined demonstrate that they under pin these activities and they are of a good quality and had clear instructions to inform staff. Part of this process was to make residents aware of any potential risks and to discuss these so the individuals could make an informed choice. Examples of this were seen in degree of family contact and drug and alcohol use. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16, and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s rights are promoted and each person has a good degree of control and choice. The meals in the home are of a good quality offering both choice and variety, and cater for special dietary needs. Staff have training in the importance of diet in promoting good mental health. EVIDENCE: Residents are supported to maintain and develop relationships with the community and are in contact with relevant professionals, such as community psychiatric nurses. This promotes and assists in developing their social and relationship skills. Residents were observed interacting in a positive manner with staff and other residents. There was lively conversation and an interest in the welfare of others in the home. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 12 Family contact is indicated in each persons individual plan and staff are knowlegble about the extent of this contact. Staff are also supportive of the family and relationship dynamics for each person. Where appropriate, relatives are encouraged to visit and arrangements are made to allow privacy on visits. Residents said that their rights and responsibilities are promoted by the positive attitude of staff. These are based on any orders or sections under the Mental Health Act, as detailed in each persons care plan. Good quality foods and the importance of a balanced diet has a high profile in promoting good mental health within the Home. Residents are encouraged to prepare their own food or to agree to share these responsibilities with others. This allows for those who may move onto more independent living to develop the necessary skills. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health care issues are well managed and service users are supported to make informed decisions. The handling of medication has improved in the home, with the manager reviewing many of the practices to ensure that resident’s medications are handled safely and competently by staff. EVIDENCE: Staff have a good understanding of residents healthcare needs. The staff team work positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain their mental and general health. A recent new resident required a more in-depth healthcare plan and this was supported by accessing external training and developing risk assessments to ensure this person remains in good health. Other evidence of supporting healthcare needs was the request for an Occupational Therapist assessment for a resdeint with mobility problems and as a result an extra hand rail was added to the extensive stairway. Another resident with diabetes is supported by staff to manage this through appropriate diet and monitoring of blood sugar levels. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 14 The staff team are skilled in supporting people with mental health problems. The home has very good tools to assist in carefully monitoring each persons progress and in maintaining good mental health. In particular the care planning system, which includes healthcare, promotes good and positive outcomes for people living at the home. Policies and procedures for medicines handling were inspected and are appropriate for the setting. Emphasis was placed on maintaining independence through self-medication and this was supported by staff. Four residents currently control their own medication, and risk assessments had been undertaken to support this safely. Service users had access to locked facilities for the safe storage of medicines, and residents agreed to staff periodically checking compliance. All staff are currently undertaking a Managing and Safe Handling of Medications through a local College, to Level 2 as reccommeded by CSCI guidance, and Level 1 for new staff as part of Induction. Medication is part of a new staff hand over checking routine to minimise errors. This has led to an improvement in record keeping to previous inspections. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has since improved its systems to protect service users from abuse and to protect their rights. The home has a satisfactory complaints system with residents being able to express their views on the home, and these are acted upon. EVIDENCE: Procedures have improved recently as a result of a seroius incident of theft to ensure that residents finances and monies are safeguard and are better protected against theft or fraud. Large sums of money had been stolen from two service users by a member of staff, who has since been dismissed, and now procedures have been tightened up. These service users held their own bank accounts and statements were sent directly to each person and staff respected their privacy. The missing money only came to light when one service user took up the managers suggestion to store any important letters in the office for safe keeping. Money was taken by using cards and knowledge of pin numbers. Now only the manager and deputy have access to this information and cards are kept in a locked drawer in the office. All monies, service users and pettty cash, require two staff to signatures, and these are checked at each staff hand-over. Service users confidence in this area has been damaged and the staff team are also feeling emotional after this betrayal of trust. The manager is working to gain this trust back and restore a more postive atmoshpere. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 16 This incident highlighted that the manager and staff were not familiar with the latest Multi-disciplinary guidance for referrals and investigations and a requirement was made to attend an up-to-date course on Adult Protection. The Home has induction training that covers basic adult protection issues and the various forms of adult abuse. Staff have a good knowledge of mental health and the various strategies to support residents. None of these strategies include physical interventions, and this was deemed appropriate. Residents were observed freely expressing opinions on the home to staff. Residents said that they would feel able to speak to any of the staff and approach the manager with any issues they had. Those residents spoken to said they would approach the manager with any issues and felt confident that any concerns would be resolved. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a well kept and safely maintained home that is centrally located for local amenities. EVIDENCE: Recent improvements to the building have been: new stair carpets, non-slip flooring for bathrooms and re-decoration of bedrooms. The home has complied with a requirement of the last inspection and now has a fire year electrical wiring certificate. Satisfactory reports had been received from both the Fire Officer and the Environmental Health officer. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well-trained and supported to have the skills to support people with mental health problems. Recruitment procedures have recently been improved to ensure they are safer and more robust in protecting residents. EVIDENCE: The home continues to demonstrate a commitment to providing staff with a thorough training programme. All staff have either completed or are errolled on NVQ 3 and one person is doing a Mental Health certificate. The manager and deputy are training to be NVQ assessors. There is a good rolling programme of training including- Medication training, Fire warden training, and Food hygenine up-dates. The Home followed the recruitment procedure of The Croftlands Trust. Staff files are now held in the home contained all the relevant documentation and were clearly sectioned and well-organised. The selection procedure includes obtaining two written references, and a formal interview. All staff have enhanced level CRB disclosure checks. Upon appointment staff are issued with a handbook, which includes job descriptions and terms and conditions. Appointments are subject to a six-month Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 19 probationary period. The Croftlands Trust have a code of conduct and all members of staff have a statement of terms and conditions. A new member of staff interviewed confirmed these practices. As a result of the recent staff dismissal the policy for employing ex-offenders has been revised. In particular instead of the decision being made by one person a group of senior managers including the registered manager make a decision on offences recorded on a CRB. These improvements are good practices to ensure that service users in future are supported by a carefully selected and vetted staff team. The home could improve its recruitment procedure by including residents as part of the selection procedure for new staff. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a service that is well-run by the manager, and by the systems of the organisation, which ensure that service users are central, and their views are valued and acted upon. EVIDENCE: The Home operated to The Croftland Trust’s Quality Assurance standards that included physical aspects of running the Home as well as monitoring the delivery of service. A professional commented that Stratheden was “a very well run home”. The provider, The Croftland Trust, appoints an operations manager to carry out Quality Assurance checks (regulation 26). These are sent into the Commission for Social Care Inspection on a monthly basis. From these reports areas for improvement are highlighted and the actions were checked at inspection. These were judged to work well in monitoring and improving the service for those living at the Home. The manager has sent in the findings of a recent satisfaction survey and again Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 21 these were positive. The records examined on the day of the inspection were well-ordered, relevant, appropriate and up-to-date to assist in the smooth running of the Home and in meeting the needs of the residents. Health and safety measures are particularly thorough for example the home has just had an electrical wiring test. Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 X 3 3 X 3 X X 3 X Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 23 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 YA23 Regulation 13 Requirement The manager and staff must have training on Adult Protection procedures Timescale for action 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA34 Good Practice Recommendations Residents should be actively encourage to take part in staff selection Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 24 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 © 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 Stratheden DS0000022571.V291950.R01.S.doc Version 5.1 Page 25 - 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. 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