CARE HOME ADULTS 18-65
The Close Short Break Service Rock Lodge Road Roker Sunderland SR6 9NX Lead Inspector
Mrs Elsie Allnutt Unannounced Inspection 13th December 2005 10:00 The Close Short Break Service DS0000032753.V263201.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 The Close Short Break Service DS0000032753.V263201.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. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Close Short Break Service Address Rock Lodge Road Roker Sunderland SR6 9NX 0191 553 5425 0191 553 5430 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) Council of City of Sunderland Mrs Christine Norman Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (3) of places The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th May 2004 Brief Description of the Service: This short break service is delivered in a large detached building, which stands in enclosed grounds. The service provides personal care for younger adults with a learning disability. and is situated close to the sea front at Roker in Sunderland. The house has its own grounds with mature trees; lawns and well cared for gardens and retains many attractive original features such as wood panelling and fire- places. The décor and furnishings reflect the style and period of the building. There is a large reception area that leads onto a large staircase leading to the bedrooms on the first floor. It has eight single bedrooms, two of which are on the ground floor and which provide accommodation for people with disabilities. There are also two twin bedrooms offering accommodation to friends or family members who request to share. A music centre and TV is provided in each bedroom. The dining room and two lounges also lead off from the reception area and overlook the gardens. There is a main lounge that is very large, and a smaller one that offers a more quiet area. The building provides four bathrooms and eight toilets. Three of the bathrooms also have showers and there is also one separate shower room. The top floor of the building accommodates a full sized snooker table, dartboard, music centre, and a wide screened TV and coffee corner. The majority of people who use the service are quite independent and are able to access all areas of the building. However, people with a physical disability are restricted to using the ground floor. There are no restrictions however to the service provided. The aim of the service is to provide a holiday type break for people attending the service while providing a break for the carers at home. A team of staff provide a programme of organised activities, as well as personal support, during each person’s stay. The Close Short Break Service DS0000032753.V263201.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 5 hours over one day in December 2005. No surveys were sent out to service users and their carers prior to the inspection, however the views of six service users and four members of staff were sought on the day. As some service users have difficulty with verbal communication their satisfaction of the service was interpreted not only through speech but also through the observation of body language, interaction with staff and the examination of records. This process demonstrated that all were satisfied with the service and the care and support given by staff. As part of the inspection process the service users’ care files and a sample of the homes records were examined and a tour of the building took place. What the service does well:
This service provides accommodation to a very good standard. The standard of the furnishings and the way the daily routines are organised compares with that of a good quality hotel. The building is well maintained, and as a result of effective cleaning routines, offers a clean and hygienic environment. The grounds offer attractive well established and well cared for garden areas, where service users can relax and enjoy the attractive surroundings. One service user using the service at the time of the inspection described with pride how he was one of the team of gardeners who kept the gardens at The Close tidy. As found on the day of the inspection, the friendly interaction of service users and staff create a warm and welcoming atmosphere in the home. So that service users are able to form and maintain relationships between each other, careful planning is carried out by the home so that friends receive breaks together. This is often at the request of service users, or as a result of an assessment carried out by staff, who try hard to create groups that get on well together. Service users’ wellbeing is generally supported well by staff. At the time of the inspection it was observed that one service user, who had arrived the night previous, was in need of medical attention. Records confirmed that staff had observed this, recorded it in the care plan, and plans were in place to support them to a local GP. Observations showed that service users are supported to live a full and active lifestyle. Staff were observed working with respect and skill and involved service users in making their own choices about what they preferred to do. Service users confirmed that they are offered choices at the beginning of their stay and are asked at the end of the stay what it was that they had enjoyed and if there was anything that they did not like about the service.
The Close Short Break Service DS0000032753.V263201.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. The Close Short Break Service DS0000032753.V263201.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 The Close Short Break Service DS0000032753.V263201.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): 5 So that the service users are aware of the homes Terms and Conditions of their stay and the costs incurred they are provided with detailed contracts. EVIDENCE: New contracts have been developed to include the cost of the stay at The Close and the manager stated that individual copies have been issued to all guests for them to read, agree to and sign. The understanding of the contract was limited for some guests but others were aware of what agreements they had made in relation to staying at The Close, one person was also aware of the costs incurred. The manager demonstrated the new document and records proved that they were in use. The Close Short Break Service DS0000032753.V263201.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 needs are assessed prior to being offered a service at The Close and from this a care plan is developed. This system provides staff with up to date information they need to satisfactorily meet the service user’s needs. However not all areas of risk have been identified and this could have a detrimental effect on the care of service users. EVIDENCE: The manager stated that everyone using the service has a care plan developed. Although some of the care plans in the sample examined include various pieces of important information some of the information is repetitive. By condensing some of the repetitive information could improve the lay out of the care plan. Service users would benefit from a more accessible and effective care plan. At the last inspection it was commented that there was limited information accessible to equip staff to support service users to make decisions and informed choices, for example there was little information in relation to service users likes and dislikes. Although the files sampled demonstrate an improvement in relation to this it is felt that this information could be further improved.
The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 10 In relation to the risk imposed for one service user regarding seizures experienced, there were clear guidelines for staff to follow that reduces the risk in relation to different activities. The service user, who was equipped with the appropriate equipment to support their needs and protect them, confirmed that they took part in and enjoyed the activities recorded. However in relation to another service user where a particular behaviour had been identified in the preadmission assessment this was not addressed in the care plan and in particular in relation to the risks involved. This could provide inconsistency in the delivery of care and put the service user and others in a vulnerable position and should be addressed. Another service user’s manual handling assessment is not fully complete and some of the risk assessments also need to be reviewed. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 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): 17 Service users are provided with wholesome food that is both nutritious and varied and supports them to live a balanced and healthy lifestyle. EVIDENCE: Service users confirmed that they enjoy the food at The Close and confirmed that at the beginning of their stay it is determined what they like to eat. One service user stated that, “If I don’t like the food I just tell the manager.” Some of the care plans include examples of individual food preferences and these and the records available in relation to discussions with service users’ that take place at the beginning of their stay, confirmed that service users needs in relation to food are addressed. Staff also confirmed that the weekly menu often was dependent on the needs and the dislikes and likes of the service users using the service at the time. For the past 6 years this service has been awarded The Heart Beat Award that is presented by the local authority and includes being assessed on the nutritional value of the food presented in the home, as well as the menu planning and food hygiene.
The Close Short Break Service DS0000032753.V263201.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): 19,20 Service users receive support from staff to ensure that their personal, physical and emotional health needs are met, however on this occasion the support given to one service user in relation to their emotional needs could have been improved. Medication arrangements are appropriate for the needs of service users, and are managed in a safe manner. EVIDENCE: Many of the people using this service are independent of personal tasks, however records demonstrate that, when needed, tasks are supported in a way preferred by the service user. One service user said, “I look after myself,” but added that if assistance is needed, for example when I get a bath, a member of staff helps me.” Another service user who relies on the use of a wheelchair said “I like coming here because I like to go bowling and staff help me to do that.” Another service user commented, “I’m happy coming to The Close because staff book me in the same time as my friend.” However one service user was emotionally upset during the inspection and could have been given more appropriate support. The nature of the service does not generally include supporting service users with their healthcare needs, however staff stated that if a GP is needed during
The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 13 anyone’s stay then a local GP is accessed. This was evident on the day of the inspection when one service user was supported to attend the GP. A new policy in relation to the Administration of Medication has been developed by the home and records confirmed that all staff have now received training in relation to this. A brief inspection of the storage and records of the medication was made and no anomalies were found. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 14 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): 23 The service has robust procedures in place that protect the service users from abuse. EVIDENCE: Staff confirmed that they have received awareness training regarding abuse and adult protection, as well as training in relation to handling challenging behaviour. In discussion staff were able to appropriately describe what action to take in a situation where they witnessed abuse. The local authority’s adult protection procedure is available within the home to guide staff on what to do and the people to contact in the event of witnessing abuse, or having an alleged abusive situation reported to them. On the day of the inspection such guidelines were followed in relation to an alleged incident, reported by a service user, that took place outside of this service. The manager alerted the incident to Social Services and a Strategy Meeting was organised for the same week. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 15 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): 30 Service users benefit from well-maintained, homely, safe and clean accommodation. This ensures that service users remain comfortable and safe. EVIDENCE: The environment continues to be kept to its established high standard. All rooms examined were clean and free from any offensive odours. Furnishings are well presented and maintained offering the guests a comfortable and fresh environment in which to stay. The cleanliness of the environment reflects good and effective cleaning routines as well as effective procedures relating to infection control. Staff confirmed that they had received training in relation to this. The manager stated that the Environmental Health Department had recently inspected the home in relation to assessing the quality of air within and around the outside of the building and as a result awarded the home the Silver Award for Clean Air. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 16 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): 35 Regular training opportunities ensure that service users are appropriately supported and protected by a competent and qualified staff team, however not all staff present themselves to service users in a consistent professional way. EVIDENCE: Records and staff confirmed that the home has a comprehensive induction programme that new staff follow. The manager confirmed that new staff also work through the Learning Disabilities Framework Award (LDAF) as part of their induction process. This improves their knowledge in relation to issues surrounding learning disabilities. Records demonstrated that, a service-training plan and individual staff training plans are in place. Staff confirmed that all staff either have NVQ or are working towards it and enthusiastically discussed their progress. Concerns were raised in relation to the attitude and behaviour of one member of staff who did not present them self to service users in a consistent professional way, this was discussed with the manager. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The manager, who is well supported by senior and administrative staff, provides a service that is well managed and monitored. Service users views are addressed and used in the development of the service, however service user could be further protected with further development and consistent use of the risk assessment process. EVIDENCE: There is a clear administrative system that supports a well run home, this includes satisfactory monitoring of the quality of the service. Records are accessible, clear and stored securely. The manager is now fully qualified, after achieving the Registered Managers Award, NVQ 4 in Care and the A1 Assessors Award. Observations and discussions with service users and staff confirmed that effective relationships have developed between service users, staff and the manager. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 18 Staff were observed to work appropriately regarding health and safety procedures however there are risks evident in relation to some risk assessments. The records relating to health and safety monitoring were satisfactory. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 19 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 X X X 3 Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 4 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Close Short Break Service Score X 2 X X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 X DS0000032753.V263201.R01.S.doc Version 5.0 Page 20 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 YA6 Regulation 14(2) Requirement The preferences and changing needs of service users must be kept under review and recorded in their care plan. 1 As identified in preadmission assessments the risks to the health and safety of service users must be addressed and guidelines, to eliminate or reduce the risk, must be put in place for staff to follow. 2 The manual handling assessment docments must be fully complete. 3 All of the above must also be kept under review. 18(1)(c)(i) All staff must be trained to 31/01/06 support service users with their emotional needs. 18(4) The registered manager must 31/01/06 make sure that all staff understand and follow the standards and practice expected of social care workers as stated in the Codes of Practice set out by the GSCC(General Social Care Council). Timescale for action 31/01/06 2 YA42YA9 13(4)(c ) & (5) 31/01/06 3 4 YA19 The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 21 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 YA6 Good Practice Recommendations It is suggested that by eliminating some of the repetitive information in the care plans they could be more accessible and effective. The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI The Close Short Break Service DS0000032753.V263201.R01.S.doc Version 5.0 Page 23 - 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!
