Inspection on 03/02/06 for Summerson House

This inspection was carried out on 3rd February 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Summerson House 08/11/06

Summerson House 03/08/05

Summerson House 24/02/05

Summerson House 13/08/04

Summerson House 23/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Blenheim House

Prince Bishop Court

Park View (15)

Craigmore House

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

CARE HOME ADULTS 18-65 Summerson House 29-31 Stone Street Windy Nook Gateshead Tyne & Wear NE10 9RY Lead Inspector Mr Lee Bennett Unannounced Inspection 3 and 10 February 2006 10:10 rd th Summerson House DS0000007424.V268172.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 Summerson House DS0000007424.V268172.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. Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Summerson House Address 29-31 Stone Street Windy Nook Gateshead Tyne & Wear NE10 9RY 0191 469 9611 0191 469 9611 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) www.c-i-c.co.uk. Community Integrated Care Care Home 6 Category(ies) of Learning disability (6), Physical disability (5) registration, with number of places Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2005 Brief Description of the Service: Summerson House is care home, providing personal care for up to six people with a learning disability related need. Nursing care is not provided, but District, Learning Disability and Psychiatric Nursing services can be arranged where necessary. It is a purpose built bungalow style care home, with level access throughout. There is a large enclosed garden to the side and rear of the home, which includes a smaller paved area. The home is situated in a quiet residential area near to local public transport links and a range of local facilities, including a doctors surgery, shops, pubs and places of worship. The shopping centre and community facilities at Felling are a short drive away. Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in February 2006, with a follow up inspection conducted the following week. This was a scheduled unannounced inspection. A tour of the building took place, and a sample of service users’ records was inspected. The inspector was able to chat with the service users and staff present (including the registered manager), and observed life in the home. A meal was taken with some of the service users and staff. The judgements made are based on the evidence available to the inspector on the day of the inspection. The Commission for Social Care Inspection considers that a number of ‘core’ standards must be inspected at least once during the inspection year (April 2005 to March 2006). Therefore, to gain a full picture of how this care home is performing, this report should be read in conjunction with the report of the inspection conducted in August 2005. What the service does well: What has improved since the last inspection? The recently registered manager has worked hard to address those requirements and recommendations made following previous inspections that are within her power to act. These have included the development of guidance for staff in respect of supporting service users when they display ‘behaviour that challenges the service’. The guidance represents a significant improvement on that previously in place. Fire safety issues (relating to a door Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 6 lock) have been addressed, and risk assessments reviewed for service users who have bed rails fitted to their beds. Staff continue to positively engage with service users and the service is effectively managed. 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. Summerson House DS0000007424.V268172.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 Summerson House DS0000007424.V268172.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): Standard 3. Service users’ personal and social needs are met at the home. EVIDENCE: The information outlined within service users’ care plans and their progress notes, along with observed practice, demonstrates how the service is able to meet their needs. Staff have, in the past, received training relevant to learning disabilities and general care topics (however, see the comments below regarding training). Additional advice and guidance can also be sought from visiting professionals, such as the District Nurse, for health care needs, as well as other health care professionals from the Community Learning Disability team. Summerson House DS0000007424.V268172.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): Standards 7 and 9. Decision making arrangements and safeguards regarding service users’ personal expenditure (specifically in relation to their personal allowance and benefits to assist with their mobility) are not transparent. This may lead to service users’ financial interest not being best served. Service users are supported to take risks within a risk management framework. This helps to ensure they remain safe whilst their independence is promoted. EVIDENCE: As reported following the last inspection, an adapted ‘mini-bus’ type vehicle is available for service users living at the home. This is funded through their personal benefits income, and allows for them to access a range of community services and facilities. There are individual agreements drawn up between the service user and Community Integrated Care (C.I.C.) in the form of a contract. However, a representative of C.I.C. has signed this agreement on behalf of the service users as well as on behalf of C.I.C. This appears to present a conflict of interest. In addition, all six service users contribute to the cost of the Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 10 vehicle and it’s associated running costs. The arrangements that would take effect should one or more service users leave the home are not clear, and could result in increased payments not specified in the contract, or payments being required in excess of the collective benefits income of the remaining group of service users. Clear evidence of the decision making arrangements and the individual liabilities being entered into still need to be clarified and provided to CSCI. Service users’ personal allowances are also managed on their behalf by C.I.C. These allowances, along with a small proportion of their other benefits are paid into their personal accounts via a business account. This practice must cease and arrangements made in liaison with the relevant Social Services Department for benefits to be paid direct to the service user. Any additional charges need then to be paid by the service user to C.I.C. This is a requirement of this report. Areas of risk are also documented within each service users’ care file, including assessments relating to activities out of the home and the use of equipment. This can contribute to staff having guidance to enable service users to access community facilities without being placed at undue risk of harm. A model is used, whereby each risk area is identified, who or what may be harmed is noted, current and additional control measures are documented, and this is then reviewed. Summerson House DS0000007424.V268172.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): Standards 12, 13 and 15. Service users are assisted to lead active and fulfilling lifestyles by having a regular community presence and by accessing a range of community facilities. This can assist in them leading a full and enjoyable life. Service users are supported to maintain their personal relationships and friendships, which helps them to keep in touch, and where possible to be involved in family life. EVIDENCE: On the day of the inspection, the majority of service users were supported, by staff, in several different activities, both within and outside of the home. A minibus is available to assist in this area. Activities undertaken are documented within each service users’ care file, and a plan of forthcoming activities is also compiled and periodically reviewed. Although contact with relatives varies, due to individual circumstances, staff in the home will assist service users to ‘keep in touch’ by sending cards and making phone calls, as well as assisting with transport and visits. Service Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 12 users also attend a range of activities, such as the Allerdene Club, local leisure centres, cafes, pubs, and so on. This allows contact with people outside of the immediate home environment. Summerson House DS0000007424.V268172.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): Standards 18 and 19. Service users receive personal support appropriate to their needs and in a discreet manner, which can help to ensure their privacy and dignity is respected. Staff help to ensure that the service user’s physical and emotional health needs are met. This can contribute to ensuring fair access to health services and the promotion of general health and welfare. EVIDENCE: The service users living at Summerson House have their personal care needs outlined within their case files. Their needs are supported and met, where appropriate, in private, and they are encouraged to be independent where possible. Specialist support and adaptations (such as manual handling and pressure relieving aids) have been sought and maintained where necessary, and care staff are able to demonstrate, through discussion and observed practice, a good understanding of service users’ needs. Staff are sometimes required to help service users manage behaviours that can challenge the service. Guidelines have been developed and recently updated to help staff in this area, and training has been sought to provide Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 14 further guidance to staff. The registered manager was advised that this must include an element of training relevant to the specific requirements of the individual service users living in the home. An approach to behavioural support is now adopted that: • • • • • • Details each ‘behaviour’ on an individual basis. If understood, describes the reason for, or motivation behind the behaviour (such as sensory stimulation, means of communication, response to specific staff, and so on). Describes how the need described above can be met in an alternative manner (such as through sensory activities, avoiding over stimulation, and so on). What diversionary tactics are to be deployed or are currently successful. The actions to be taken if a situation escalates or becomes dangerous. The reporting, monitoring, evaluation and review arrangements. If breakaway techniques, or other physical interventions are deployed, then staff guidance indicates that these are only to be used as part of a broader behaviour management strategy. This aspect of care will continue to be subject to monitoring through inspections. Regular access to primary and secondary health care services, such as GP and psychiatric services, occupational therapy and the dentist, is supported, and medical support is currently available for a service user with specific dietary needs. See comments regarding training. Contact with health care professionals is documented within the service users care records. Summerson House DS0000007424.V268172.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): Standard 22. Where possible, service users’ views are listened to and acted upon. This can help contribute to a service user centred service. EVIDENCE: A clear complaints procedure exists within the home, however, there have been no complaints reported within the past twelve months. As noted above, service users have varying communication needs, which make it difficult for them to directly express their views and opinions on the service they receive. It would therefore be difficult for a service user to directly and independently use the complaints system, which would need to be done on their behalf by a relative, advocate, or other person involved with their care. Staff therefore have to be mindful of service users’ mood and behaviour as a means to gauge their feelings. Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 16 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): These standards were not assessed on this occasion. EVIDENCE: Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 17 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): Standard 35. Staff continue to receive inconsistent levels of training, although improved monitoring records have now been introduced by the registered manager. A comprehensive range of training can contribute to staffs understanding of service users needs and help ensure that staff are able to effectively meet such needs. EVIDENCE: Staff receive a range of training relevant to health and safety issues. Training records are now more fully developed than at the time of the last inspection, and can assist in the planning of future training for the staff team. Specifically, training for new staff in relation to the ‘PEG’ feed used by a service user must be provided by the responsible nurse practitioner and not undertaken by staff in the home. This is a requirement of this report. Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 18 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): Standard 39, 41 and 42. External oversight of the home is inconsistently implemented and does not meet regulatory requirements. The home is generally safe and on the whole free from hazards to service users. EVIDENCE: The implementation of the providers quality assurance system is still to take place in the home and this has been noted in several previous inspection reports. Regulation 26 inspections (undertaken on a monthly basis by a representative of C.I.C.) have not been undertaken each month and must be. Some internal procedures are used to check the quality of some aspects of the service, such as building and health and safety checks, and the progress and development for service users is outlined within individual care planning processes. The home’s policies and procedures are developed on a corporate basis and reflect good practice guidance in a number of areas. Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 19 At the time of the inspection, there were no observed hazards or risks to safety, with the exception of: • • A loose and inadequate dining chair. An inadequately robust dining table. A meal was taken with a service user, who used a dining table to assist himself to a seated position. The table was of a drop leaf design, and inadequate in construction to take the weight of the person concerned. An immediate requirement was issued at the time of the inspection to replace this. It may also be appropriate for a professional, such as an Occupational Therapist to assess this person’s needs. Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 20 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 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 1 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X X X 2 X 2 2 X Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 21 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 YA7 Regulation 13(6) and 20(1) Requirement The registered person must arrange for a full audit of service users personal allowances, that they have been entitled to and have received, to be undertaken, and for this to be documented and forwarded to the lead inspector for the home. (This is an outstanding requirement. The previous action plan dates for completion were 22/11/04, 5/8/05 and 12/11/05). The registered peron must ensure that the decision making and liability arrangements entered into on behalf of service users, in respect of the minibus, are subject to external scrutiny and agreement, and best serve service users financial interests. The previous action plan date for completion was 12/12/05. The registered person must, in consultation with the local Social Services Department, DS0000007424.V268172.R01.S.doc Timescale for action 21/05/06 2 YA7 12(3) and 13(6) 21/05/06 3 YA7 20(1 and 2) 21/05/06 Summerson House Version 5.1 Page 22 4 YA16YA23YA35 13(6) 5 YA35 18(1)(c) 6 YA39YA41 26 arrange for service users’ personal allowances and benefits to be paid direct to them and not via any bank account operated by C.I.C. This is a new requirement. The registered person must integrate training and guidance regarding control and restraint into the staff induction programme. It is acknowledged that training in this area is now planned, but delivery is still awaited. The previous action plan date for completion of this requirement was 12/12/05. The registered manager must liaise with the responsible nurse practitioner for staff to receive training in relation to the management of a specific service user’s P.E.G. feed. This is a new requirement. The registered person must ensure that the regulation 26 inspections are undertaken on a monthly basis and reports of the inspection supplied to the local office of CSCI. This is a new requirement. 21/05/06 21/04/06 21/05/06 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 YA35 Good Practice Recommendations The registered person ensure all care staff receive a minimum of five days paid training per year (pro rata for part time staff). Summerson House DS0000007424.V268172.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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. 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