CARE HOME ADULTS 18-65
Sycamore Drive (9) Carley Lodge Fulwell Sunderland SR5 1PP Lead Inspector
Mr Clifford Renwick Unannounced Inspection 18th October 2005 10:00 Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 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 Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 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. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sycamore Drive (9) Address Carley Lodge Fulwell Sunderland SR5 1PP 0191 549 6083 0191 549 6083 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) Community Integrated Care Mr Robert Trueman Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (2), Physical disability (1) of places Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th April 2005 Brief Description of the Service: The home provides personal care to four men both over and under the age of 65 years all of who have a profound learning disability. One person also has a physical disability. The current age range is from 47 – 73 years. It provides residential care only and any health needs are dealt with by the Community Nursing Services. The home has been open since 1995 and was especially adapted for the current service. The house is a bungalow and sits in what could be described as a small exclusive housing estate. It would be difficult to determine from the outside of the home that it provides a residential service, blending in well with other houses in the cul de sac in which it is located. There is a local bus service, which offers access into the City Centre where there is a range of services and shops. The home has its own transport due to the level of disability that service users have. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4.5 hours and was carried out as part of the statutory twice-yearly inspection process. All areas of the premises were viewed and care records were examined as well as records that related to health and safety. Discussion took place with the three staff on duty on the morning shift and also with the three staff on the changeover of shift in the afternoon. This discussion focused on the key worker roles and also individual service user plans and the changes that had been made since the last inspection. Observations also took place of staff practices, as none of the service users are able to communicate using speech. So the focus was on observing body language and gestures that service users use to communicate their needs to the staff. The judgement statements made are based on the evidence available at the time of the inspection. What the service does well:
The staff team continue to build up a considerable knowledge of each individual service user all of whom are unable to communicate verbally. Observations confirmed that staff continue to provide good support to the service users and staff have a good understanding of each individual service users needs. Staff could demonstrate what it means when a service users mood or behaviour changes and consequently are able to respond appropriately and quickly. Staff continue to work well with maintaining good links with health professionals and this ensures that any individual health needs are met. Good care records are maintained and staff are fully involved in maintaining records to demonstrate the actions/interventions that are carried out as part of the plan of care. The home is well managed and the manager and staff team is committed to ensuring that service users receive a good standard of care at all times. The atmosphere throughout the inspection was relaxed and pleasant and the inspection visit was an enjoyable experience. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 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. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 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 Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 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): 2, 5 Service users needs are always assessed on a regular basis in order to determine that their needs are being met in the home. Each person is also issued with a copy of his terms and conditions of residence, which clearly states what is to be provided in the home. EVIDENCE: Examination of service users case files confirmed that each service users needs are continually assessed and staff responds quickly to any change in needs. Monthly key worker reviews are in place, which ensure that if there are any change in health needs these can be addressed quickly by the involvement of the appropriate professional. Each service user has been issued with a contract which confirms the fees, what they cover and who is responsible for the payment. In addition to this a pictorial licence agreement is in place, which accompanies the contract and makes the document more easily understood. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 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, 9 Service users assessed needs are reflected within their individual plans of care. These provide guidance for staffs’ care practice. Service users are supported to take risks within a risk management framework. This helps to ensure they remain safe and that their independence is promoted. EVIDENCE: Two service users files were sampled and these confirmed that a plan of care is in place, which demonstrates the specific actions that are being carried out by staff to meet service users assessed needs. Each service user has an updated written profile, which has been compiled by staff, and this offers a good pen picture of each individual service user. Care plans are evaluated monthly by staff that work as a key worker and a record of this is available in the files as well as appropriate documentation to confirm whether planned goals are being achieved and whether any changes are needed to the care plan. Appropriate risk assessments are in place and have been updated in order to reflect how service users are supported to take risks as part of the lifestyle. This includes examples such as using the kitchen and eating and drinking independently. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 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 the following standard(s): 12, 14 A range of opportunities and activities are available to service users and these have been developed by staff so that service users can take part in events which are appropriate to their ability and therefore promote a stimulating and inclusive lifestyle. EVIDENCE: Observations made confirmed that two service users like to spend part of their day in their bedrooms listening to their classical music c.d’s. Another service user likes to spend time in their bedroom that is equipped with a range of sensory equipment and which offers the person the opportunity to receive a range of stimulating experiences in an environment that they are comfortable with. Service users have been making use of the sensory facilities in Gateshead Leisure Centre and also go out for meals with the staff. One service user is going on a coach trip to Blackpool and another is going to Amsterdam for 5 days. A new digital camera has been purchased and this will be used on the holiday so that the service user has a photographic record of the trip, which will be his first holiday overseas. Staff spoke about the tropical fish tank that they are about to purchase as they feel this will also offer service
Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 11 users an interest, which will also provide additional stimulation. The DVD collection in the house has been increased and the use of a free box television receiver ensures that service users have an extended range of television channels to view. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users receive good support from staff to ensure that their personal, physical and emotional health needs are met. EVIDENCE: Each service users care plan contains written information as well as coloured pictures, which are termed, “support with personal hygiene and appearance”. These are well set out and give a clear description and instruction to staff about service users personal preferences and how they are to be supported. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Both of these standards were assessed during the last inspection and evidence available confirmed that both standards were met. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26, 30 Overall improvements to the décor ensure that service users have a comfortable and safe environment to live in and all bedrooms have the necessary fittings to promote independence. Service users have access to a range of bathrooms and toilets. The home is clean, hygienic and was free of any noticeable hazards at the time of the inspection. EVIDENCE: One service user has additional electrical sockets in their bedroom so that they can make full use of the sensory equipment, which includes a projector, lights and water bubble features. Each room is furnished differently and reflects individual service users choice and personal taste. At the time of the inspection the maintenance person was carrying out remedial works in the home and also testing hot waters as part of the regular checks carried out in the home. In addition to this the home were being fitted with a new computer and internet access. Plans were available to show what works are to be carried out in the garden area in order to make it more accessible to service users. The plans have been available since June of this year but to date no work has been carried out in the garden consequently this restricts the service users from making full use of the garden area.
Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 15 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): 33 Staff work well together, are well organised and share information and views so that service users care is consistent and well thought out. EVIDENCE: All staff are receiving ongoing training and have covered NVQ training at varying levels. Two staff are about to start NVQ Level2 and one member of staff has received specialist training on record keeping. The training plan was on display and confirmed the planned training courses for the next 12 months, which include aging/dementia in learning disabilities, and infection control. Discussions held with staff confirmed that they enjoyed the training courses and found them helpful with the work that they do as they offered them a better understanding of the needs of service users. The home are still using two bank staff members to cover 61.5 hours within the home while vacant positions are advertised. The manager confirmed that they use the same bank staff at all times to ensure consistency of care and one of the bank staff also acts as an additional driver so that service users can make good use of the homes mini bus. Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 16 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 The manager is appropriately qualified and experienced to ensure that service users benefit from a well run home which guarantees that the health, safety and welfare of service users is always promoted and protected. EVIDENCE: The manager has completed the registered managers award and is about to commence NVQ Level 4 care training. The manager is currently giving two days per week management oversight to another of the organisations homes and a member of staff acts as a senior care worker in his absence in order to ensure that there is management cover. Continuous improvements are evident within the home and the manager and staff team continue ton be enthusiastic about the work that they are doing. A number of polices and procedures that are in place and which are kept under constant review by the manager ensure that good working practices are adhered to at all times. The manager was able to produce documentation that demonstrated how improvements have been made.
Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 17 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 X 3 X X 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Sycamore Drive (9) Score 3 X X X Standard No 37 38 39 40 41 42 43 Score 3 X X X X X X DS0000015759.V251745.R01.S.doc Version 5.0 Page 18 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 YA24 Regulation 23 Requirement Steps must be taken to address the works required to the rear patio in order that all areas are safe and accessible to service users. Active steps must be taken to recruit permanent staff for the vacant posts. The registered provider must ensure that the manager’s time giving oversight to another service is kept under review. Timescale for action 31/05/06 2 3 YA33 YA37 18, (1), (a) 9 31/01/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sycamore Drive (9) DS0000015759.V251745.R01.S.doc Version 5.0 Page 19 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
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