Inspection on 29/10/07 for Stratheden

This inspection was carried out on 29th October 2007.

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

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

Other inspections for this house

Stratheden 02/05/06

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 29th October 2007 11:00 Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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.V351511.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V351511.R01.S.doc Version 5.2 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.V351511.R01.S.doc Version 5.2 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) 2nd May 2006 Date of last inspection Brief Description of the Service: Stratheden is a nine bedded home for people experiencing 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 handbasin. 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. A Handbook is available for prospective residents, which includes a summary of the latest Commission for Social Care Inspection report. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection where all the key areas of the National Minimum Standards were assessed. Residents, and their families, and members of staff had given feedback regarding the service and care to us. These comments, and the observations and assessments we made, have informed the judgements made in this report. We also: • Received questionnaires from professionals and other people working with the home • Interviewed the manager and spoke with staff • Visited the home, which included examining files and paperwork • Received a self-assessment report from the manager. On the day of this visit four people where at home and the house had a lively and friendly atmosphere with people busy making lunch, chatting with staff and popping into town and back. The overall picture was that people living at the home are pleased to be offered an individually tailored service that promotes their well-being and offers opportunities to become more independent. What the service does well: A Care co-ordinator stated that staff “provide a stable, supportive environment for its residents.” And “ individuals are respected in terms of privacy and dignity”. Another said that “assessments are always carried out appropriately and peoples health care needs are properly monitored and any problems are picked up and dealt with appropriately.” All people living at the home said that they were being well supported and had been pleased with their decision to move into the home. The staff team have recently become more proactive at helping people to consider their options and for some people this has led to moving onto a less supported environment or a home of their own. The health and safety monitoring in the home is carried out to particularly high standards and they were recently awarded 5 Stars by the Environmental Health Department. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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.V351511.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, and 4 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 appropriate referrals and that they accept only people whose needs they can meet. EVIDENCE: A new resident’s introduction to the home was examined in detail which demonstrated that an initial referral and assessment is made via the Integrated Care Team, and this included up-to-date risk assessments relevant to the mental health field. 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. He said “Its been great so far at Stratheden” and staff had “gone out of their way” to help him to settle. 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 on the support from staff and the care he would receive. Staff carry out a set induction for each new resident and this helps Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 9 them settle and ensures they know such things as fire drills, rules on drug and alcohol use, and any other house rules. It also covers useful information on the local area such as shops, bus services and health care with contact numbers. 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.V351511.R01.S.doc Version 5.2 Page 10 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. 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. EVIDENCE: Recently a more person centred approach has led to care plans that have real meaning for individuals and which gives them more control in setting their own targets. To support this work risk assessments have also been greatly improved and demonstrate clear steps to support people to achieve success. One resident described how they had been encouraged to work through a difficult family issue and to make plans for the future through staff support and that this had really helped him and to “get a load off his mind”. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 11 Individualised contingency plans detail indicators that would trigger staff to seek further advice or putting agreed strategies in place. Staff have a comprehensive system for recording daily notes and these are collated into monthly up-dates, which in turn inform regular review meetings held between individuals and their keyworkers. This leads to residents being fully aware of their own mental health needs. A high degree of resident participation and engagement was evident throughout these processes. A residents stated in feedback “ I find it very reassuring here, good communication with staff.” A social worker stated “ I have found the daily records and care planning to be informative and helpful and of a good qualitative standard”. And another said that staff always respond to the different needs of individual people in a sensitive and respectful manner. Risk taking is well-managed and a good balance is achieved between promoting independence and ensuring well-being and safety of residents. Risk assessments examined demonstrate that they under pin these activities and had clear instructions to inform staff. Part of this process was to make residents aware of any potential risks to their mental well-being and to discuss these so the individuals could make an informed choice. Examples of this were seen in degree of family contact, peer group pressure and drug and alcohol use. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): All the above Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are assisted to have a good quality of life and access a variety of life experiences through a skilled and committed staff team. EVIDENCE: Individuals’ files contain many well-recorded examples of how rights and choice are recognised and promoted, and it is clear that this is one of the underpinning values of the staff team. In particular staff receive regular training on positive approaches to support a persons mental well-being and this sets the value base from which staff work. Residents were observed interacting in a positive manner with staff and other residents. There was lively conversation and an interest in the welfare of Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 13 others in the home. People have individual hobbies and interests and they plan and choose their own holidays with the support of the staff team. A good quality and healthy diet is identified as a key feature in promoting a persons well-being whilst staying at the Home. A significant shift has been noted from the last inspection and now residents are being encouraged to do more individual shopping and preparing of meals. This is to promote a more positive model of working whereby staff enable and support people to become more independent and this better equips them to move onto the next stage in their lives. 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, and aids self-esteem. This was clearly demonstrated by one person who expressed that they had felt so grateful of the care given to him by the staff that he felt he wanted to give “something back”. Staff had helped him to explore what he would like to do and he had decided to set up a regular contribution to a charity. Family contact is indicated in each person’s individual plan and staff are knowlegble about the extent of this contact, and are 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. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each individual’s health and medication is carefully monitored ensuring that they have access to services that help to maintain good health. EVIDENCE: Records seen by the inspector confirmed that people have access to a full range of general health care services and more specialised services, such as psychiatrists, community psychiatric nurses (CPN) and behaviour specialists. People spoken to felt staff are approachable and are helping them to achieve greater stability and promote their mental well-being, and felt this support was offered at the right levels. One resident had been assisted to carry out a minor health procedure that had initially been done by a district nurse and then by staff. This person’s keyworker had spent a lot of time breaking the task down into manageable steps and building these up over a matter of months to allow the person to gain confidence and they are now totally in control and have gained a better understanding of others issues surrounding maintaining their well-being. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 15 A significant shift in ethos was noted from previous inspections, people are now being supported and enabled to develop skills and increase their confidence to assist them in leading much more independent lives. For some people this was leading onto them moving into their own homes. Another similar improvement has been encouraging people to take more control of their own medications, and from re-ordering and collection through to taking them at the correct times and levels. This has been a significant piece of work carried out by staff to ensure that this is done at the individual own pace and is done safely. All staff have completed a formal training programme on the safe handling of medications, and after examination of the medication cabinet and records staff were judged to be competent in this area. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have good knowledge and understanding of how to safe guard and protect residents from abuse and promote their well-being. EVIDENCE: The service has a complaints procedure that is up to date, very clearly written, and is easy to understand. It can be made available on request in a number of formats (including other languages, large print, etc) to enable anyone associated with the service to complain or make suggestions for improvement. The policies and procedures relating to protection of individuals are of a high quality and are regularly reviewed and updated. The service is clear when incidents need external input and who to refer the incident to for further investigation. Staff receive training in their induction period about how to safeguard residents from abuse and harm, and this is followed up by a rolling programme of further training to ensure that staff are up-to-date on these issues. The manager is also currently receiving additional training on safeguarding to ensure that she is fully briefed on the local protocols. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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. 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. Stratheden provides a safe and comfortable place to live. EVIDENCE: Stratheden is located in the city centre of Carlisle and is on the edge of a Victorian park. Residents said they appreciated the location and were seen coming and going across the day to visits shops and local community facilities. They also commented upon recent improvements to the home such as the lounge being redecorated and having new furniture, and some people had redecorated their bedrooms. The home was clean and tidy and residents were helping staff to keep it this way. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a competent, well-qualified and vetted staff team who offer a high quality service to the people living at Stratheden. EVIDENCE: Stratheden has a core group of staff with a good mix of skills, experience, and gender, which reflects the profile of the residents. The age range is biased towards younger people and the manager feels this is appropriate to meet the support needs of an active resident group. There are staff in sufficient numbers to be flexible to meet residents needs and to support individual activities. When interviewed staff are clear regarding their role and what is expected of them. The manager said they had adopted a much more thorough approach at selection and interview of the type of person they were looking for and the nature of the job. New employees are also expected to undergo induction training and sign an undertaking to attend core skills training essential for the role of supporting people with mental health issues. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 19 This leads to good levels of confidence and satisfaction from residents, relatives and professionals with the care that is delivered. Relative comment cards stated that staff know what they are meant to do, and that they are able to meet their needs. Another said “There is a feeling of “home” at Stratheden.” A consultant clinical Psychologist states of the staff: “The staff team are skilled in managing peoples mental health positively and they offer quality of life to residents”. The Home follows the recruitment procedures of The Croftlands Trust. Staff recruitment files are held at the organisations head office, and a copy is also held in the home with access only by the manager to maintain confidentiality. All staff have CRB disclosure checks and a checklist ensures that all safeguards are put in place prior to an appointment. Upon appointment staff are issued with a handbook, which includes job descriptions and terms and conditions. Appointments are subject to a sixmonth probationary period. Croftlands Trust has a code of conduct and all members of staff have a statement of terms and conditions. A member of staff who was interviewed confirmed these practices. The home is looking at ways to further improve its recruitment procedure by including residents as part of the selection procedure for new staff. These are all good practices to ensure that people are supported by a carefully selected and vetted staff team. The home has a framework for supervisions and appraisals, and these have been carried out to good standards; staff reported that these are helpful and they feel well supported by the supervisor, manager and the organisation. Staff training continues to have a high profile in the home and staff are keen to gain new knowledge and skills that will assist them in supporting residents. For example all staff have recently completed a Safe Handling of Medication training course, and all except two staff have a recognised care qualificationNVQ2/3. The remaining two staff are over half way through completing this qualification. Staff also receive varied training to equip them with skills and knowledge to support residents. A rolling programme of training includes first aid, safeguarding vulnerable adults, fire wardens, moving and handling, health and safety and courses relating to mental health. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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. 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. The home is well managed by an experienced and competent manager, who in turn is supported by a committed staff team, who together run the home in the best interests of residents. EVIDENCE: The manager promotes an open, positive and inclusive atmosphere in the home through a variety of ways, for example: regular staff meetings and supervision; regular residents meetings and frequent reviews and meeting with people to give them the opportunity to speak up. The manager communicates a clear sense of direction, and is able to evidence a sound understanding and application of ‘best practice’ in care and in operational systems. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 21 Staff have received training to ensure the health and safety of residents and themselves. This responsibility is delegate to the senior, and both she and the manager attended an environmental training course to implement “Safer Food, Better Business”. The home was recently assessed as delivering a five star service by environmental health, which is the top rating. The Home has a well-developed system for tracking care and staff practices which forms part of the homes Quality Assurance system, that includes physical aspects of running the Home as well as monitoring the delivery of service. The provider, Croftlands Trust, carries out regulation 26 monitoring visits and sends a copy of these into the Commission for Social Care Inspection. Record keeping is of a consistently high standard. Records are kept securely and staff are aware of the requirements of the Data Protection Act. The administration systems within the home were found to be up-to-date and in good order, ensuring the home was run in an efficient and safe manner. Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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 x 2 4 3 x 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 3 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 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 3 x 3 x x 3 x Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stratheden DS0000022571.V351511.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!