Inspection on 05/02/08 for The Eyrie

This inspection was carried out on 5th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Eyrie 01/12/06

The Eyrie 24/02/06

The Eyrie 10/08/05

The Eyrie 19/01/05

The Eyrie 20/09/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Eyrie Moresby Park Whitehaven Cumbria CA28 8XG Lead Inspector Liz Kelley Unannounced Inspection 5th February 2008 10:00 The Eyrie DS0000022678.V356072.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 The Eyrie DS0000022678.V356072.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. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Eyrie Address Moresby Park Whitehaven Cumbria CA28 8XG 01946 599772 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) moresbyparks@walsingham.com www.walsingham.com Walsingham Mrs Susan Palmer Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 1st December 2006 Date of last inspection Brief Description of the Service: The services and care at The Eyrie are provided by Walsingham who have a number of homes for people with learning difficulties in Cumbria and throughout the Country. The Eyrie can accommodate six people who have a learning disability. The Eyrie is a detached dormer style bungalow with car parking facilities to the side of the premises. There is an enclosed garden area and patio to the rear of the home. The home is situated in Moresby Parks, a village off the West Coast of Cumbria. Built on two floors the home has six single occupancy bedrooms, two of which are on the ground floor. The office is situated on the first floor. There are two toilets available on each floor, as well as a bathroom with specialist bathing facilities. The lounge, dining room, kitchen and utility room are on the ground floor. The current scale for charging is £746.75 per week. A Handbook is available for prospective residents, and the latest Commission for Social Care Inspection report is made available on request. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 their opinions regarding the home to Commission for Social Care Inspection (CSCI). These comments, and the observations, 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/questionnaire from the manager. The residents and staff team are going through a difficult and stressful time over the last few months. Staff have been struggling to settle new people and to meet the wide range of needs of those now living in the home. This has been made even more difficult by the home experiencing staffing shortages. What the service does well: What has improved since the last inspection? The manager is in the process of tidying up people’s files of old and out-dated material to make it easier for staff to find important information that they need on a day-to-day basis. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 6 Care planning is currently under review and being developed along more person-centred lines in an attempt to improve choices and promote more individualised care. 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. The Eyrie DS0000022678.V356072.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 The Eyrie DS0000022678.V356072.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): 1, 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment of new people needs to be strengthened in order that people’s needs can be met by the staff team and to ensure they are compatible with other people living in the home. EVIDENCE: The service consults the assessment information to see if they can meet the prospective resident’s needs before they make the decision to accept the application for admission and offer a place. For most of the residents the home has received copies of the summary and care plans from the assessments carried out through care management arrangements. However recently, evidence indicates that prospective residents would have benefited from a more in-depth needs assessment before they came to live in the home. The manager has been put under pressure to admit people who’s needs have proved difficult to meet, and at a time when the home was experiencing staffing shortages. This led to compatibility problems of people living in the home and difficulties in meeting the wide range of needs. After a review with Adult Social Care services arrangements are in place to find more The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 9 suitable accommodation for people. This should resolve the current situation in the house but may take some time. Since the new admissions the manager has consulted professionals for both advice and training for staff to help them better understand the needs and best approaches to use. To improve on the admission process a more in-depth assessment process and forms should be developed so that all the information and observations made prior to a person being accepted are properly analysised to determine if the home can meet the persons needs and if the home has the capacity to do so. The organisation has begun work on improving how they admit people and are offering additional training to managers. From this process the manager must in future assess whether the staff have the necessary specialist skills and that staffing levels are sufficient to care for individuals who are admitted. The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the specialist care the home offers. All relatives surveys returned stated that they were given sufficient information prior to moving-in, in order to make an informed decision. Two, however felt that they would like to have been consulted about new residents to the home and this should be included in any revised admission procedure. The Eyrie DS0000022678.V356072.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 adequate This judgement has been made using available evidence including a visit to this service. Care planning is currently under review and being developed along more person-centred lines to improve choices and promote more individualised care. EVIDENCE: Each person has a care plan to instruct staff on their needs and what they need to do to attempt to keep them safe. Staff are able to communicate with people, and understand what their needs are. Recent training in autism has highlighted for the staff that they could be using picture planning to good effect with people to improve communication, for example by letting them know who’s on duty, what day it is and what’s planned for that day. For people with autism this is good practice in giving them structure and routine and this can help to alleviate anxieties. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 11 Some staff have recently had training on person centred planning and have made a start on a couple of care plans. These plans were in good detail and were in formats suitable for use with service users. Work was being carried out on one service users plan to explore the best ways of communicating and understanding. This was impressive and should lead to a more meaningful care plan being developed. This should be continued with other peoples care plans as soon as possible, however staff shortages and managing the current situation is hampering this process, staff have limited time for paperwork. People’s ability to make individual choices is limited at the moment due to the recent incompatibly of residents and the low staffing levels. In light of the Mental Capacity Act the home needs to review the people living in the home with regard to their capacity to make decisions and provision should be set up for those requiring support, for example do they have an advocate, or if not identifying who would be involved in making important decisions on behalf of this person. This needs to be clearly detailed in each person’s care plan. The Eyrie DS0000022678.V356072.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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s lifestyle choices are being detrimentally affected by staffing shortages and lack of funding. EVIDENCE: Staff are working hard to cover shifts and to care for people living at the home as best they can but they are being hampered by long-term staffing shortages, and lack of appropriate funding for those with more complex needs. Some of whom require two staff to take them out, and often two or more staff are needed to stay in the home. This would necessitate the need for 4/5 staff for the home to offer the required level of support for people to have a reasonable quality of life. On the inspection visit the manager was on duty with one carer for five people, one person had gone on holiday with the support of a member of staff. Some people have not been able to go to activities they had previously taken part in. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 13 Staff are doing their best to be flexible and make the most of the few opportunities they have to take people out on their own, this is therefore leading to people spending long periods of time in the home. However, generally staff are aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. The manager and the organisation need to ensure they are receiving the correct levels of funding to be able to meet people’s needs. The food in the home is of satisfactory quality, well presented and meets the dietary and cultural needs of people who use the service. The Eyrie DS0000022678.V356072.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 good. 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: Based on information received from professionals, relatives, and observations of the staff, and also from the written records, people receive appropriate support to access the health services they require. Residents are registered with a GP of their choice and have access to other members of the Primary Health Care team. Other checks such as opticians and dental checks are also recorded on Healthcare files. Staff have a good understanding of residents healthcare needs. The staff team work positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain good health. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 15 Records on healthcare needs are well maintained and kept up-to-date, these are linked to care plans to alert staff on any changes. This could be further strengthened by keeping contact sheets to see at a glance who has last seen the GP, District Nurse etc with brief details of the outcome. The home is sensitively handling the ageing process and offers good support to minimise any impact on independence. The staff team are managing complex healthcare issues, as demonstrated, for example, by careful monitoring of seizures, in conjunction with input from the persons own GP and consultant. Staff have attended a course on specialist healthcare issues to assist them to take care of residents, these have included training in epilepsy, and a Safe Handling of Medicines course is planned with all the staff. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. Any personal care is delivered in resident’s own bedrooms and staff demonstrated that they are aware of issues of dignity and privacy. Interactions were observed between staff and residents and this was carried out in a sensitive and respectful manner. The Eyrie DS0000022678.V356072.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. The ways in which the staff safeguard people has recently improved to ensure that steps are taken to protect people. EVIDENCE: Staff in the home are recently having to deal with more challenging behaviours and have been put under stress in having to protect other more vulnerable people in the home. Consequently it is recommended that the current training in physical intervention is reviewed to assess what level of training staff now require in order to protect people in the home. Currently staff are trained only to level 1 which is “hands-off” approach which involves diversion, recognising triggers and de-escalation. This assessment needs to be specific to the home situation and carried out by a qualified person in these techniques accredited through the British Institute of Learning Disabilities, in order to comply with good practice. The home is however receiving input from specialist healthcare professionals on strategies for managing behaviours. The organisation recently carried out a review of how it handles allegations of abuse, and consequently has updated its policies and procedures and staff have been given training to ensure that they meet the latest guidance. The Eyrie DS0000022678.V356072.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, 25 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, safely maintained home that meets their individual needs. EVIDENCE: The home has a good location in the heart of the community, which leads to ready access to local amenities. The home also has its own transport and is in easy reach of local towns and all their facilities. The home is a purpose built detached house and is well equipped for peoples needs, having specialist bathing aids and hoisting equipment. People’s individual rooms are well furnished and decorated to their own preferences. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 18 On the day of inspection the home was orderly and clean, and is well maintained to ensure the safety and well being of people in the home. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 19 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): 32,33,34, and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is short staffed which is putting a dedicated staff team under strain and this is affecting the care being delivered to people in the home. EVIDENCE: Staffing levels are not meeting the needs of the people using the service, with their quality of life being adversely affected. This has been reported upon in sections on Lifestyle and Individual Needs and Choices. Currently the home is down by 4 full time members of staff. Of the six staff surveys returned, two staff ticked the box to indicate that there were never enough staff to meet individuals needs, and four other ticked “sometimes”. Another said “ We are always short staffed” The home has a core group of experienced staff, and health care and social services staff report that they listen to advice and provide good care to residents. This staff team has provided care to all but one new resident, for over ten years and a strong bond and relationships has been formed. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 20 A number of barriers for recruiting new staff were identified and Walsingham has already responded with a series of measures to improve this situation and to ensure staff are recruited more efficiently. The manager said a new member of staff was due to start next week, after a much shorter recruitment procedure. Previously this had taken up to 6 months. Staff reported that they had been provided with a range of training courses to assist them in working with people with learning disabilities. However training in meeting more specialised care needs has only very recently been offered to some staff, for example in autism, picture planning. The manager should be given support and resources to provide this training to the staff team. Some of the staff team have received training in person-centred planning and are trying their best to put his into practice. The staff team reported that they felt a notable lack of support from the organisation through a very difficult time and they felt their views were not listened to. They used words such as “”traumas” “limited support” “we have had to put up with months of nervousness and pressure to look after the other service users” and “we need to do better in protecting ourselves and others whilst also meeting the needs of the new people in the home”. The organisation needs to consider how to support staff teams through stressful periods and how communication can be improved. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The manager requires additional hours to be able to effectively manage the home. EVIDENCE: The manager is qualified and has the necessary experience to run the home. She does not however have any supernumerary hours to carry out management tasks, and consequently areas that she would like to develop or improve are difficult to implement. This is made even more difficult by staff shortages. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 22 The manager and the organisation need to ensure they are receiving the correct levels of funding to be able to meet peoples needs, and that these resources are deployed in the best way to achieve this. Health and safety aspects of the home are satisfactorily managed and the home is well maintained. For example all fulltime staff have gained an appointed First aider certificate and the home has a qualified moving and handling assessor who attends regular up-dates. The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 23 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 3 2 2 3 2 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 24 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 YA2 Regulation 14 Requirement People must not be admitted to the home without full assessments, and due regard given to whether the home has the resources to meet their needs The registered person must ensure that at all times suitably qualified, competent and experienced staff are working in the home in sufficient numbers to meet the needs of residents Timescale for action 31/03/08 2 YA33 18 31/03/08 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 YA2 Good Practice Recommendations The manager should use a needs assessment tool to record and analyse if they can meet the needs of new service users, in addition to any other assessment received from other sources. Each person should be assessed by a multi-disciplinary team to determine capacity to make decisions under guidance from Mental Capacity Act 2005, and if DS0000022678.V356072.R01.S.doc Version 5.2 Page 25 2 YA7 The Eyrie 3 4 YA23 YA37 appropriate an advocate found to represent people. An assessment should be carried out by a qualified trainer to determine the level of physical intervention training required to keep people living at the home safe The manager should be given supernumerary hours to carry out her management tasks The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 26 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 The Eyrie DS0000022678.V356072.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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