CARE HOME ADULTS 18-65
The Nak Centre Sundial House Coosebean Truro Cornwall TR4 9EA Lead Inspector
Lowenna Harty Announced 28 July 2005 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 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 Stationary 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 D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 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 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 D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration to those stated above. Date of last inspection 24 Feburary 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 manged by the registered provider, who is in active daily charge of the home. She is assisted by a small team of care staff and a cook. 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 facilties and an office on the ground floor. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the home’s annual inspection programme, which took place on 28 July 2005. The inspection lasted for approximately 6 and a half hours and consisted of the following activities: 1. Inspection of records, including assessment information and care plans 2. Discussion with the registered provider on how it operates on a day-to-day basis 3. Inspection of the premises 4. Pre-inspection information supplied by the registered manager of the home 5. Observation of the daily life of the home with particular regard for the interaction between staff and service users. Overall the home provides service users with a very good standard of care in beautiful surroundings. The inspector would like to thank the registered provider and residents for their kind assistance in the conduct of this inspection. Comments made by residents’ relatives and representatives as part of the home’s annual quality assurance programme are all very positive, including: “Sundial House provides a loving and caring “family” environments, producing results beyond expectation”; “staff were friendly and the home was clean and comfortable”; “highly professional, supportive, dedicated care”. These and other comments are displayed in the home’s recently updated service users’ guide. What the service does well:
This home is quite unique in that the residents have, in the main, grown up together, in a family type environment. A small and dedicated team of staff assists the registered provider. She is very actively involved in providing residents with direct care and attributes the progress they have made in developing their skills and independence over time to the continuity of the service. Most of the residents have been with it since the 1970s and the most recent admission was in 1997, so residents are very familiar with the services that the home provides. There is sufficient background information held on
The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 6 their individual files to provide evidence of their progress as they continue to live in the home. Residents are helped to make decisions about day-to-day aspects of their lives that affect them. Staff help them depending on their individual skills and abilities. The registered provider has built up knowledge of their individual preferences over time and this is recorded in their care plans. Residents enjoy a wide range of activities in the home and in the local community. There is evidence of their art and craftwork throughout the home and residents are planning to exhibit their work publicly, shortly. One is involved in training for the Special Olympics. Residents attend different placements and activities in the Community during the week, depending on their individual needs and interests. Residents are encouraged to maintain contact with their families, where they have them and one was on an extended break with their family at the time of the inspection. They are appropriately supported to make choices about relationships with each other and other people. Staff help residents with their personal care, including washing, dressing and grooming depending on their individual skills and needs. They are encouraged to be as independent as possible. There are sufficient bathrooms in the home to provide residents with privacy and dignity when they are receiving assistance. They all looked smart and fashionably dressed at the inspection. The home is well situated, within easy reach of the local city of Truro but in a quiet, rural location. It is beautifully decorated and tastefully furnished throughout to provide residents with a comfortable and homely environment. The home was clean and tidy throughout at the time of the inspection. It is homely and generally safe for the residents. There is a very small staff team, who assist the registered provider to care for the residents and a low staff turnover. Staff are either very experienced in caring for the residents or currently in the process of completing training to obtain formal qualifications to NVQ level 2. What has improved since the last inspection?
The registered provider has undertaken a review of the information the home publishes to describe the service and improved it so that people from outside of the home are more aware of what happens there. She has sought the
The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 7 opinions of residents’ relatives and professional visitors to the home on the quality of the service. The results are published in the home’s public information, to inform visitors on how others view the home. Residents’ care plans are now reviewed every six months and their daily records are clearly separated in individual record books, so that they can be kept confidential to each person. The registered provider has reviewed the homes written policies and procedures to ensure that staff are provided with clear guidance to assist them in their day-to-day work. The registered provider has enrolled in training towards achieving NVQ level 4 in management, to enhance her considerable experience in providing care for the residents. She is also seeking independent advocates for the service users. She is in the process of recruiting an additional member of staff to provide additional support to the residents and free up more time for her to undertake necessary management tasks and individual training. What they could do better:
Although information about the home has been updated, there is still a lack of information to residents and their representatives about the terms and conditions of their placements in the home. This includes information on the fees they are charged and what they cover. Residents have a legal right to know about their tenancy rights and terms and what they are expected to buy for themselves from their personal allowances and they need to be given this information. Residents are not currently personally involved in their care planning reviews and more should be done to assist them with this in ways that are suitable for them. This was discussed with the registered provider at the inspection. Options include providing residents with information in picture book formats simple language and reading information to those that can access it in this way, for example. They should also be provided with information on how to complain, if they wish, in ways that they can understand, wherever this is possible. This includes informing them and/or their representatives of their right to complaint directly to the Commission, if they wish. Residents, particularly those with communication difficulties and those who do not have relatives who are actively involved in their care, should be provided with independent advocates. There should also be a consideration of employing advocates who have learning disabilities themselves, as they can often provide useful insights on how staff can assist service users. The registered provider is currently exploring options for this.
The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 8 Residents themselves should be more actively involved in providing information on the quality of the service, where this is possible. Those with communication difficulties should be helped to make their views known using alternative formats such as pictures and/or symbols, for example. Finally, The home is generally safe and very well maintained but the written risk assessment needs to fully account for the fact that the upstairs bedroom windows are not fitted with restrictors and clearly state how residents are protected from falls. 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 D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 1 & 2 Information to service users about the home needs improvement. There are satisfactory assessments in place for all the residents. EVIDENCE: This home is quite unique in that the residents have grown up together and lived with each other since childhood. They are all very familiar with the services provided there. There are no current vacancies and none are expected. The home’s statement of purpose is kept in a folder in one of the lounges, alongside the service users’ guide. The registered provider has updated and improved the information about the home, which now contains all the information required by regulation with the exception of a statement of the terms and conditions, range of fees and what these cover. This needs to be included in the service users’ guide. Three of the residents have been with the service since 1977. The most recent admission was in 1997. There is initial assessment information and/or background information for all of them on their personal files, which is sufficient to demonstrate how they have progressed and developed their skills and abilities over time. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 6 & 7 Residents need to be more involved in the care planning process. They are assisted to make decisions about their lives. EVIDENCE: All of the residents have detailed written care plans, which are reviewed and updated every six months. These cover all aspects of residents’ health, personal and social care needs, including attention to their religious and cultural backgrounds. These are not currently provided in alternative formats and there is a lack of evidence of participation in the care planning process by residents and/or independent advocates. The registered provider is currently trying to set up independent advocacy for the residents, and they may benefit from peer advocacy, which should be explored. This is particularly important for those who do not have relatives who are involved in their care or who have communication difficulties. Residents should be provided with copies of their care plans in ways or formats that are meaningful to them, such as picture
The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 12 books. Where they are able, residents should be encouraged to take charge of their care planning and lead the process. Residents have individual daily record books, which back up their care plans. The registered provider described how they are given choices and assisted to make decisions about their daily lives and this was observed in practice during the inspection. Staff provide more support to residents who need it and those who are able to make more decisions independently are given opportunities to do so. They can make use of the kitchen independently to make snacks for themselves, for example. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 12, 13 &15 Residents undertake a range of age, peer and culturally appropriate activities in and out of the home to develop their skills and for their enjoyment. They are able to have personal relationships and maintain contact with their families. EVIDENCE: Residents’ daily care records provide evidence that they are engaged in a range of activities in the Community, in accordance with their individual care plans. Activities are planned according to their individual abilities and interests. There is evidence of their art and craftwork throughout the home and they are shortly to hold a public exhibition of their work at a local art gallery. They have a wide range of videos and music to listen to and were watching a favourite film in the main lounge at the start of the inspection. They are encouraged to go out for walks with staff so that they keep fit and healthy. During the week they attend different day placements in the local community. One is involved in training for the Special Olympics.
The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 14 There is transport to take residents out for trips into the local community and their personal records show that they are out in the community on most days. The home’s location is ideal for residents to access the nearby city of Truro but still benefit from a quiet, rural environment. Residents are able to have relationships with each other and are supported in this appropriately. Their families are encouraged to maintain contact with them, where they have them and this is recorded in their individual care plans. One resident was away from the home at the time of the inspection, on an extended visit with their family. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 18 Residents’ personal care needs are met in accordance with their individual needs. EVIDENCE: Residents’ individual care plans provide guidance for staff to help them appropriately with their personal care needs, according to their individual skills and abilities. They are encouraged to maximise their abilities to make choices about their personal appearance through having a range of different clothes that they can select each day, for example. Where they are able, they are encouraged to maintain their own personal hygiene and grooming, with less support from staff so that they can develop their independence. There are sufficient bathrooms for them to receive personal care in private. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The ways in which residents’ views are heard need to be improved. EVIDENCE: There is a clear, written complaints procedure, which is in the service users’ guide in one of the lounges so that it is available to residents and their representatives. It should be provided in alternative formats, which service users with communication difficulties can access directly and needs to state clearly that residents can contact the Commission at any time, so that they are clear about their rights to do this. There have not been any formal complaints made to the registered provider or the Commission and comments supplied by residents’ relatives and representatives are all very positive. These are published in the home’s service users’ guide. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Residents live in a homely and comfortable environment, which is mainly safe, although this would benefit from slight improvement. The home is clean and hygienic throughout so that residents are protected from infection. EVIDENCE: The home is beautifully decorated and furnished throughout. It provides residents with a homely, non-institutional environment, which is like a family home but also mainly safe for them. Formal systems to ensure their safety are discrete and do not intrude on their daily lives. There are records of appropriate safety checks and tests. The fire safety officer visited the home shortly prior to the inspection and provided a satisfactory report. There are written policies and procedures to guide staff on health and safety, hygiene and infection control and food safety. There are records of staff training. There are individual risk assessments in place for each of the residents in respect of the environment but these do not include a formal written assessment of the upstairs bedrooms, which are not fitted with window restrictors. There should be a written risk assessment to address the prevention of injury from falls from upper floor windows.
The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 18 There are suitable facilities for laundering clothes and preparing food in the home to protect residents from the risk of infection. Staff have written guidance and access to appropriate training. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Staff are appropriately trained to meet residents’ needs. EVIDENCE: There is a small staff team, of three care workers and a cook employed to assist the registered manager in caring for residents. One of the care assistants has worked in the home since 1980 and is very experienced in caring for the residents, alongside the registered provider, who has known them all since they commenced their placements with her. The two most recently employed members of staff have been in post for over twelve months. They have been provided with essential training and are both in the process of completing training to achieve qualifications to NVQ level 2 in care. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40 & 42 There is a quality assurance programme in place but residents should be more fully involved in this. There are policies and procedures in place to protect residents. Residents are mainly safe in the home although this would benefit from specific improvement. EVIDENCE: Residents’ relatives and professional visitors have been asked to complete questionnaires stating their opinions on the quality of the care provided in the home and copies of these are held in the home’s service users’ guide. All the comments are very positive. Where possible, however, residents themselves should be asked to contribute their views, in ways that are appropriate to them. The home has formal written policies and procedures, which are specific to the home’s environment. These provide clear and useful guidance to staff on how
The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 21 to meet residents’ needs appropriately. They are reviewed and revised as necessary. The home is mainly safe, as previously stated in this report, although risk assessments in respect of the upper floor windows should be completed in writing to provide full evidence that all risks to residents have been properly identified and eliminated. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 22 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 2 3 x x x Standard No 22 23
ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Nak Centre Score 3 x x x Standard No 37 38 39 40 41 42 43 Score x x 2 3 x 2 x D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 23 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 1 Regulation 5(1)(b) Requirement The homes service users guide must include a statement of the terms and conditions in respect of accommodation to be provided for service users, including information on the amount and method of payment of fees. The homes complaints procedure must state that complainants may approach the Commission at any stage. Timescale for action 31/12/05 2. 2 22(7)(b) 31/12/05 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 6 Good Practice Recommendations Service users should be more involved in the care planning process. They should be provided with copies of their care plans in formats which are appropriate to them, wherever practicable. Where this is not possible, they should be agreed with service users representatives. Service users should be more involved in the care planning process. They should be provided with copies of their care plans in formats which are appropriate to them, wherever practicable. Where this is not possible, they should be
D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 24 2. 6 The Nak Centre 3. 4. 5. 22 24, 24 39 agreed with service users representatives. The homes complaints procedure should be provided to service users in alternative formats, which they can access directly and/ or formats that are appropriate to them. Environmental risk assessments should address the risk of falls in respect of upstairs windows, which are not fitted with safety restrictors. Environmental risk assessments should address the risk of falls in respect of upstairs windows, which are not fitted with safety restrictors. The Nak Centre D52-D04 S9157 The Nak Centre V229567 280705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 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
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