CARE HOME ADULTS 18-65
The Nak Centre Sundial House Coosebean Truro Cornwall TR4 9EA Lead Inspector
Lowenna Harty Unannounced Inspection 26th January 2006 09:30 The Nak Centre DS0000009157.V280068.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 The Nak Centre DS0000009157.V280068.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. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Nak Centre Address Sundial House Coosebean Truro Cornwall TR4 9EA 01872 241878 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) Mrs Anne Elizabeth Barrows Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th July 2005 Brief Description of the Service: The Nak is a home providing accommodation and personal care for up to six adults with learning disabilities. It is owned and managed by the registered provider, who is in active daily charge of the home. A small team of care staff and a cook assist her. Residents live in a large, detached property with extensive grounds, in a semirural situation. The house is located on the outskirts of Truro, the centre of which is a few minutes drive away. The house has two floors, the upper floor being reached via stairs. There is one bedroom on the ground floor with en suite facilities and four on the upper floor. One of the bedrooms is currently a shared room. There is an additional bedroom for staff to sleep in at night. There are two bathrooms on the first floor. There are two lounges on the ground floor, with a very large entrance hall with additional seating. The home has a spacious kitchen, separate laundry facilities and an office on the ground floor. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 26 January 2006 and lasted for approximately five hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. The principle method of inspection was case tracking, whereby a small number of service users are selected and their care notes are reviewed. This is followed through with interviews and/or observation of them and staff working with them. At this inspection, two service users were case tracked and one was interviewed, in private. In addition to this the inspection focused on an inspection of the premises, examination of care, safety and employment records and discussion with the registered provider. A staff member was interviewed and there were opportunities to observe the daily life of the home and staff interaction with the service users. The home is quite unique and special. It provides a very good standard of care to the service users placed there, which the service user who was interviewed confirmed and there is evidence of ongoing work to improve it further for them. What the service does well:
Service users have good information about the home and are very familiar with the services provided to them there as they have all lived there for many years. The most recent admission was in 1997 and three of the service users have lived there since 1977. Service users take part in a wide range of activities in and out of the home, including horse riding, cycling and swimming. They are encouraged to take risks in a safe way to develop their skills and independence. Service users are treated with respect and are encouraged to take part in the day-to-day life of the home, including household tasks such as shopping and cooking, depending on their individual abilities. They have detailed written care plans, which set out goals for them to achieve, so that they can develop their skills and independence over time. The home employs a cook and meals are home prepared, using fresh, locally sourced ingredients. Service users are encouraged to take part in shopping and cooking and are able to access the kitchen to prepare snacks and drinks for
The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 6 themselves. A service user interviewed at the inspection was very complementary of the food and services provided to them at the home. Service users’ healthcare needs are well met and they regularly access a range of local NHS healthcare providers and there are safe and sound systems to manage their medicines. A service user interviewed at the time of the inspection said that they are well cared for and are able to make their views known. Overall they were very satisfied with the services provided to them at the home. They also stated that they feel safe there. There are good informal systems in place to protect service users from neglect, self-harm and abuse. Probably most importantly, they are part of their local community and regularly interact with a range of people from outside of the home, with the support of the registered provider and staff. The home is exceptionally attractive and well maintained. It was decorated and furnished to a high standard and appeared clean and safe inside and out at the time of the inspection. It provides service users with a comfortable, domesticstyle family home setting, in which they can be cared for safely. The registered provider is closely involved in the day-to-day management of the home and care for the service users and ensures that their needs are paramount. In this respect, the home is very special and her dedication is very obvious. The home is kept safe for service users and staff working there. What has improved since the last inspection?
Some service users have improved information on the amount and method of payment of their fees on their personal files, which are available to them and their representatives, so that they are better informed of their rights and responsibilities. Service users, who are able to participate, are to be invited to their forthcoming reviews, which have been arranged with them and their representatives. This will mean that they are more formally consulted and involved in making decisions about important aspects of their lives. The registered provider has developed links with a local advocacy service and two of the service users now have an independent advocate, who can oversee their rights and best interests. The registered provider has introduced improved, more detailed healthcare plans for service users to complement their existing care plan. The registered provider has improved formal systems for service users to make their views and opinions known, from including them in their care plan reviews to updating the home’s complaints procedure so that service users are informed of their rights to make comments directly to the Commission if they wish to. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 7 The home’s written environmental risk assessments now include an assessment of specific risks attached to service users not being provided with window locks on the upper floor bedrooms, which include satisfactory risk management plans, to demonstrate that they are safe. 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 Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 8 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 Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 9 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): 1 Service users have most of the information they need about the home, with the exception of information on fees and what they cover. EVIDENCE: All of the service users have been resident in the home for many years. They and their representatives are very familiar with the services provided to them. Three of them have lived in the home since 1977 and the most recent admission was in 1997. There are no current vacancies and none are expected. There is a statement of purpose and separate service users’ guide, which provide service users and their representatives with most of the information they need to inform them about the home. There is clear information for one service user, whose case was tracked during the inspection, on the amount and method of payment of their fees but this was not clear for all of them and the home’s service users’ guide should provide more information on the terms and conditions of service users’ placements in the home. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Service users have clear written care plans although they should be slightly more comprehensive and more regularly reviewed so that they can be confident that all their care needs are considered and regularly updated. Service users are enabled to take safe risks to develop their skills and abilities. EVIDENCE: Service users’ written care plans address most of their personal, social and healthcare needs, including needs relating to their individual backgrounds, culture and religion, based on those that were case tracked at this inspection. Review dates have been set, with a view to including those service users who would be able to participate in the care planning process. The registered provider has developed links with a local advocacy service and has independently obtained the services of a voluntary advocate for two service users. Care plans reviews should be set so that they are held at least every six months, so that they can be regularly updated. Service users are enabled to take part in a broad range of activities in and out of the home, according to their individual abilities and interest. Specific risks are addressed as part of the home’s environmental risk assessment for each service user, but should also be included in their individual care plans,
The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 11 particularly where restrictions may be needed for their own protection and welfare. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 Service users are treated with respect and are encouraged to exercise their rights and responsibilities as adults to develop their skills and independence. They are provided with healthy, home cooked meals, in accordance with their needs and preferences. EVIDENCE: Service users’ individual care plans clearly set out goals that they are encouraged to work towards, to maintain and develop their skills and independence. They are encouraged to help out with household tasks, depending on their individual abilities. The home has links with a local advocacy service and two of the service users now have an independent advocate. Service users’ individual care plans consider their dietary needs, which are reflected in the menu. Meals are home prepared with fresh, locally sourced ingredients. Serviced users are encouraged to assist with shopping and are able to assist the cook in the kitchen, if they wish. They are able to access the kitchen to prepare themselves drinks and snacks at any time, if they wish. The Nak Centre DS0000009157.V280068.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): 19 & 20 Service users’ healthcare needs are met well and there are safe and sound systems for the management of their medicines. EVIDENCE: Service users’ individual healthcare needs are considered as part of their written care plans and the registered provider is in the process of introducing improved, more detailed healthcare plans for all of them. There are records of regular medical appointments with a variety of NHS healthcare professionals for all of the service users. There is a written procedure for medicines, which is suitable for the home’s setting, and which provides for service users to manage their own medication, if they are able. The home’s pharmacist recently completed an inspection, which was satisfactory. There are clear records of medicines administered to service users. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 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): 22 & 23 Service users have opportunities to make their views known and these are respected. There are good informal systems to protect service users from abuse but the formal systems should be strengthened. EVIDENCE: The registered provider has made arrangements to include those service users who are able to directly participate, in their care planning reviews so that they can formally contribute to decisions that affect their lives. The home’s written complaints procedure has been updated and now fully informs service users of their rights to complain directly to the Commission if they are unhappy with any aspect of the services they receive. The registered provider has good links with service users’ families and representatives and the service user interviewed at the time of the inspection said that they are satisfied with the care and services provided at the home. A service user and staff member interviewed in the course of the inspection confirmed that they are well protected from harm and abuse. The registered provider is dedicated to caring for them and very closely involved in the dayto-day running of the home. Service users regularly access a range of services in the local community, where they interact with other people from outside of the home. Staff have undertaken training in the protection of vulnerable adults from abuse and the registered provider has applied to attend local multiagency training on this. The home’s written procedures have been updated, but were not readily to hand at the time of the inspection. They should be available for staff to reference at all times. Copies of the up-to—date local multi-agency procedures should also be held in the home to guide and inform staff on what to do if they suspect abuse of a service user.
The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 15 The Nak Centre DS0000009157.V280068.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): 24 The home is warm, comfortable, safe and homely for service users. EVIDENCE: The home was clean, tidy, well furnished, decorated and maintained inside and out at the time of the unannounced inspection. It is an exceptionally attractive property and provides service users with a comfortable, domestic-style family home setting in which they can be cared for safely. There are written risk assessments for specific environmental risks, including upper floor windows without restrictors and the fire safety officer conducted an inspection of the home in July 2005, which was satisfactory. The registered provider has engaged a specialist agency to undertake a fire safety risk assessment of the property and there are records of staff training in fire safety. The Nak Centre DS0000009157.V280068.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): 32 & 34 There are sufficient numbers of qualified and experienced staff to meet service users needs but there needs to be better evidence of fair, safe and effective recruitment and selection of staff. EVIDENCE: The home has a small care staff team, who assist the registered provider in caring for the service users. All of the staff are very experienced in working with vulnerable people in a care setting and half of them have achieved formal qualifications to a minimum of NVQ level 2 to demonstrate their competence. There was a lack of written information in relation to the most recently recruited member of staff, to confirm that they had been recruited fairly and safely and on the basis that they are suitable to work with vulnerable adults in a care setting. There was a completed application form, which listed a full employment history, but that was all. The registered provider must retain copies of their interview records, two written references and evidence of their application to the CRB for appropriate checks. The registered provider confirmed that they do not currently work alone or unsupervised in the home. The Nak Centre DS0000009157.V280068.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): 37, 39 & 42 The home is well run, for the benefit of the service users. Formal systems for including service users’ views in the ongoing development of the home need to be strengthened. The home is kept safe for the service users and staff working there. EVIDENCE: The registered provider is competent and experienced. She is registered with the Commission and actively involved in the day-to-day running of the home, with close involvement in the direct care of the service users. She is currently in the process of completing her NVQ 4 in management. The registered provider needs to develop a more formal quality assurance programme to enhance the less formal systems currently in place and include the results of this in the home’s annual development plan so that service users and their representatives can be fully confident that their views are central to the ongoing planning of the service. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 19 There are appropriate records in place to demonstrate that the home is kept safe for service users a selection of these was examined at the time of the inspection, including fire safety records and records of staff training; the home’s accident records and environmental risk assessments. The Nak Centre DS0000009157.V280068.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 2 2 X 3 X 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 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 X 2 X X 3 X The Nak Centre DS0000009157.V280068.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 YA1 Regulation 5(1)(b) Requirement The homes service users guide must include a clearer statement of the terms and conditions in respect of accommodation to be provided for service users, including information on the range of fees and method of payment. The registered provider must retain records required by regulation in respect of staff in the home at all times. Timescale for action 31/05/06 2. YA34 17 & 19 31/05/06 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. 2. Refer to Standard YA6 YA9 Good Practice Recommendations Service users’ care plans should be reviewed at least every six months. Service users’ individual care plan should include assessments and management of risk, with particular regard for restrictions on them, which may be necessary for their protection and welfare. The home’s written procedures for the protection of
DS0000009157.V280068.R01.S.doc Version 5.1 Page 22 3. YA23 The Nak Centre 4. YA39 vulnerable adults from abuse should be readily to hand at all times. Copies of the most recent multi-agency procedures from the local County Council should be obtained for the home. Service users’ and/ or their representatives’ views should be formally sought to contribute to the home’s annual development plan. The Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Nak Centre DS0000009157.V280068.R01.S.doc Version 5.1 Page 24 - 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!
