CARE HOME ADULTS 18-65
Stratheden 8 Portland Square Carlisle Cumbria CA1 1PY Lead Inspector
Liz Kelley Unannounced 25 May 2005 10.00am 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. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Stratheden Address 8 Portland Square Carlisle Cumbria CA1 1PY 01228 818376 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) The Croftlands Trust Mrs Angela Caroline Whitehead Care Home 9 Category(ies) of MD - Mental Disorder registration, with number of places Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29 November 2004 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 services in the County. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 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. Three residents were at home across the day and spoken to, and two came back for lunch. Two staff members and the manager were interviewed. Feedback cards had been received from visiting professionals earlier in the year. 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 records and residents files were examined. What the service does well: What has improved since the last inspection? What they could do better:
The manager should obtain a copy of the Mental Health Act Code of Practice so that staff have the most up-to-date advice.
Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 6 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 F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 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 Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 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 provides good clear information to residents assisting them to make informed choice on choosing a home. The use of thorough and comprehensive assessments of residents leads to successful placements where residents needs are identified and met. EVIDENCE: The registered manager had produced both an updated statement of purpose for the home and a Brochure. These are user-friendly and included photographs. They explained both rights and restrictions of living in the Home. Residents said this information had helped them decide to come to the Home. All referrals to the home were agreed by the Carlisle Adult Community Mental Health Team on an enhanced care programme approach, including a risk assessment. This gave staff detailed information prior to a resident entering the Home and allowed the Home to assess whether they could met each individuals needs. One resident’s file detailed a series of evening and overnight visits as part of the Homes assessment which was in line with the homes written admission procedure. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 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) 6,9 Residents are confident that their mental well-being is being promoted and monitored by knowledgeable and well trained staff who have their best interests at heart. Staff work hard to encourage the resident to take control and make informed choices. EVIDENCE: The Home had a comprehensive system for recording daily notes and these were collated into monthly up-dates, which in turn informed regular review meetings. Individualised contingency plans detailed indicators in changes in behaviour 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 which leads to residents being fully aware their own mental health needs. A community psychiatric nurse(CPN) interviewed stated that he was impressed with the skills of the staff team, and that they were successfully maintaining in the community service users with complex and potentially difficult behaviours. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 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, Opportunities for personal development and leisure interests have increased recently and now provide residents with an individually tailored lifestyle. EVIDENCE: Care plans detailed individual leisure and personal developments. Residents spoken to described their own hobbies and interests and how staff had supported them to pursue these. For example one resident had an allotment and greenhouse and maintained the Homes gardens to high standards with assistance and interest from staff. Another resident was being supported to live more independently in a self-contained flat within the Home. This person was hoping that this would lead to living on his own and appreciated the chance for this personal development. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 11 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 Good systems are in place to monitor the health and personal care which ensures that residents are healthy and have access to appropriate healthcare when required. EVIDENCE: Files were well ordered and organised and contained separate sections on health care. Staff were well informed on the individual needs of each resident and were keen to promote the involvement of residents in taking control of their healthcare. For example one resident was diabetic and was encouraged to eat the right foods and others were encouraged to self-medicate. These aspects demonstrated the homes ethos of promoting independence and encouraging residents to take responsibility for their own personal care and health. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 12 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) 0 These will be examined at the next inspection. EVIDENCE: Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 13 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) 24,30 Recent investment has improved the appearance of the home creating a comfortable and safe environment for those living there and visiting. EVIDENCE: Recent improvements have included a new kitchen which both residents and staff say is much nicer to work in and to keep clean, and it improves the look of the dining area, which has also been redecorated. The hall and lounge carpet has been replaced creating a much more cared for appearance as the other was heavily worn and unhygienic. The manager stated that these improvements were to shortly be extended to new sofas, which are also badly worn as they get a lot of use. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 14 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, 35 Staff morale is high resulting in an enthusiastic workforce that work positively with residents to improve their whole quality of life. Staff are supported by good organisational structures: training, supervision, and strong senior team leadership. EVIDENCE: Croftlands offers new staff a thorough induction programme and this leads to further training in NVQ’s at level 3 Promoting Independence. Although this is a higher level NVQ than is normally expected in a care home it is more appropriate to the group of residents and their needs. A number of more experienced staff have already completed or are enrolled on the Mental Health Certificate, which again is specific to the service being offered and this ensures that staff are equipped with training to high levels. Croftlands has a training officer who, along with the manager, monitors the training requirements of the home to ensure each staff is up-to-date with both specialist and mandatory training. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 15 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) 37,40,42 The manager provides clear and strong leadership throughout the home and has put in place a good programme of self-reviews and consultations, which ensures that residents live in a safe, comfortable, well run home with their views listened to and acted upon. EVIDENCE: Staff and residents spoken to confirmed that they felt that the atmosphere in the home was relaxed and supportive. A newly introduced Quality Assurance system ensures that residents views are listened to and acted upon. From information gained from residents, staff and visiting Community Psychiatric nurses and from documentary evidence the manager was judged to be competent and effective in managing the Home. The administrative systems within the home were found to be up-to-date and in good order, ensuring the home was run in an efficient and effective manner. Risk assessments and Health & Safety policies and procedures had been reviewed ensuring that staff had the latest guidance. The Home did not have a copy of the Mental Health Act Code of Practice that is recommended for this area of work. Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 16 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 3 2 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 x x x x x Standard No 31 32 33 34 35 36 Score x 3 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Stratheden Score 3 x x x Standard No 37 38 39 40 41 42 43 Score 3 x x 2 x 3 x F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 17 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 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. Refer to Standard 40 Good Practice Recommendations The Home should obtain the Mental Health Act Code of Practice Stratheden F58 F10 s22571 stratheden v208731 250505 ui stage 4.doc Version 1.30 Page 18 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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