Care Home: Baldock Core & Cluster

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What the care home does well The residents appeared content and well cared for. The residents spoken to gave positive feedback about the care and service provided. A resident commented, "I am happy here." Another said: I like most of the staff." Staff were observed to interact well with the residents in each of the houses visited. They have knowledge of the needs and preferences of the residents in their care. In a recent CSCI survey, the 3 respondents gave positive feedback about the care and service provided. A relative commented that the resident "enjoys coming to see us but he also enjoys going back to the care home" and that the resident "is happy the way life is going." Another relative said, "We are aware of all the daily planned programme." What has improved since the last inspection? All the Statutory requirements from the last key inspections were met. What the care home could do better: The staffing level in one of the houses, New Farm, was inadequate. The registered manager who was present on the day of the inspection has agreed to increase the number from two to three staff within a week. In some of the houses, such as North Road, Icknield Way and 15 Clothall Road, there is only one care worker on duty at any one time. The management is reminded to assess the staffing level to ensure that both staff and residents are not exposed to any risk. Wedges were used to prop doors open in some of the houses visited and this is a fire hazard. The manager stated that they have placed an order for the doors to be fitted with automatic hold-open door devices. It was further noted that all the radiators felt quite hot to the touch and there were no radiator covers on them. This may expose residents to accidental scalding. One of the residents has a tendency to alter the radiator temperature in their bedroom. The management said that risk assessments had been carried out in previous years. CARE HOME ADULTS 18-65 Baldock Core & Cluster 17/18 Coach House Cloisters 10 Hitchin Street Baldock Hertfordshire SG7 6AL Lead Inspector Yoke-Lan Jackson Key Unannounced Inspection 6th December 2007 10:00 Baldock Core & Cluster DS0000019278.V356396.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 Baldock Core & Cluster DS0000019278.V356396.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. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Baldock Core & Cluster Address 17/18 Coach House Cloisters 10 Hitchin Street Baldock Hertfordshire SG7 6AL 01462 491141 01223 576 750 baldock@grantahousing.org.uk www.grantahousing.org.uk Granta Housing Society Limited 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) Karen Lawrence Care Home 30 Category(ies) of Learning disability (30), Learning disability over registration, with number 65 years of age (30), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1), Physical disability (30), Physical disability over 65 years of age (30) Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This cluster may also accommodate people with physical disability (when associated with a learning disability) aged 18-65 years or over 65 years. The registration category of MD(E) applies only to the resident currently living in the scheme and will cease once the service user is no longer resident in the home. All care staff must receive certified training in Mental Health care. Current emergency strategies that are in place are reviewed on a regular basis to ensure the health, safety and wellbeing of all residents, staff and visitors to the home. 15th November 2006 3. 4. Date of last inspection Brief Description of the Service: Baldock Core and Cluster provides residential care to people with learning disabilities and some may have physical disabilities or dementia as secondary conditions. It is provided by Granta Housing Society Limited, which is a charitable organisation. The service consists of six houses situated in and around the town of Baldock. Each of the six houses is managed by a senior care worker and they are supported by the registered manager and two assistant managers. The managers are based in the administrative office, which is situated in the town centre of Baldock. Five of these houses are detached properties and one is a semi-detached property. All are within easy walking distance of local amenities. All offer single rooms and some have assisted bathrooms. Each house has a full range of domestic facilities. New Farm has seven bedrooms, 2b Icknield Way has three bedrooms, 12 North Road has five bedrooms, 7 Clothall Road has six bedrooms, 15 Clothall Road has four bedrooms and The Rowans has five bedrooms. The people cared for are encouraged into independent living and they are assisted to integrate into the local community. Currently the fees range from £711.84p to £790.28p per week. Information about the home and the service it offers is contained in the Statement of Purpose and Service User Guide. A copy of these and the most recent CSCI inspection report are available on request in the home. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 06/12/2007. The registered manager was present. New Farm has 7 residents, North Road has 4 residents, No.7, Clothal Road has 5 residents and 1 vacancy, No.15 Clothal Road has 4 residents and The Rowans has 4 residents and 1 vacancy. The inspection began with a detailed discussion with the registered manager in the administrative office. This was followed by a site visit to all the six houses. Both staff and residents were spoken with. Documents were examined. Information received by the Commission since the last inspection was reviewed. This included the written survey questionnaires and the Annual Quality Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how well outcomes are being met for people using the service. What the service does well: What has improved since the last inspection? All the Statutory requirements from the last key inspections were met. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 6 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. Baldock Core & Cluster DS0000019278.V356396.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 Baldock Core & Cluster DS0000019278.V356396.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): Standards 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be assured that they will have the opportunity to visit and assess the facilities and suitability of the home and a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. EVIDENCE: The care plans examined confirmed that a full pre-admission assessment is carried out and the home will only admit a prospective resident whose care needs can be fully met. The Manager will carry out the pre-admission assessments. Currently there are vacancies at The Rowans and No.7 Clothal Road. A resident was recently transferred to more suitable accommodation elsewhere since the home was not able to meet all their needs. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident can be assured that they will have a written care plan which details for staff the care required and how to meet any individual needs in a person centred way. EVIDENCE: Since the last inspection, the residents have had their written care plans reviewed. Recently a new person-centred format was introduced and members of staff are updating all the relevant records. Risk assessments were carried out and documented. Each care plan now reflects the specific and changing needs of the resident, including the monthly review of care needs and a six monthly review that involved relatives and healthcare professionals. Residents are given choices and staff respect their wishes and decisions and assist them accordingly. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 10 Residents who are able to do so are encouraged into independent living. They have their own bank accounts and staff will accompany them to the bank to withdraw their own money when required. Staff handle confidential information in accordance with the home’s policy and procedures and the Data Protection Act 1998. For those residents who require an independent advocate, the home will arrange with a local advocacy organisation to assist them. Recently an advocate was arranged for a resident before the resident was transferred to another residential home. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect that their rights will be respected and they will be encouraged to lead independent lifestyle and engage in communal activities. EVIDENCE: Residents are encouraged to attend the day care centres organised by Social Services. The majority of the residents attend either the Nightingale Day Centre or Grayslates Day Centre. The latter is adjacent to one of the houses (New Farm). Some older residents who wish to remain in the home rather then attend the day care centre are given the choice to do so. Alternative recreational activities are arranged for them. Some residents attend the local educational colleges. One of the residents is employed locally and they travel to work independently. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 12 Members of staff assist residents to organise their annual holidays and staff accompany them. Residents are supported to write or telephone their family members. Most residents have close contact with their families and some residents return to their family home at weekends. The meals provided are nutritious and balanced and there is a choice of menu. Members of staff take turns to cook the meals. Those residents who are able to help out are encouraged to do so. They are encouraged into healthy eating. Bowls of fruit were seen on the dining room table and some residents were helping themselves to fruit while waiting for their evening meals to be served. There was a ‘family atmosphere’ in the houses visited. The residents appeared happy and content and the members of staff interacted well with the residents. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. People who use the service can expect to be treated with dignity and receive personal care and support in the way they prefer and require. EVIDENCE: All the residents in each of the six houses appeared content and they all appeared well cared for. The home has the support of health care professionals such as the General Practitioner and the Community Psychiatric Team. Health and behavioural concerns are referred to them for immediate assessment. Currently there are two residents with high needs. They have been referred to the relevant medical team for assessment of their conditions. The Monitored Dosage System is used for drug administration. Each home is monitoring the room temperature where medication is stored. The controlled drugs that are in use were appropriately recorded. The Medication Administration Charts were examined and no gaps were found. It was noted however, that the handwritten notes on the Medication Administration Record Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 14 charts were not signed or dated and there were some inconsistencies among the houses in the way written instructions were highlighted, some in pen and others with stickers. The manager has taken note of these inconsistencies and will reissue new instructions on recording of MAR charts to ensure consistency in practice. There were no medication errors reported. All staff who administer medication have been trained. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 15 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): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that they will be listened to and their legal rights will be protected. EVIDENCE: An ‘easy to read’ complaints procedure is included in the Service User Guide. The manager has arranged for all residents to attend Residents’ Meetings, which are held monthly. Minutes were taken at the last meeting and a copy was readily available for inspection. The management ensures that issues raised at each meeting are taken seriously and changes are made accordingly. All staff are aware of the home’s policy and procedure on safeguarding issues and the whistle-blowing policy. They all have training on issues concerning safeguarding of the vulnerable. The home follows the multi-agency Safeguarding Procedure of Hertfordshire County Council. Since the last inspection there have been no safeguarding issues or complaints raised. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26, 27, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the people who use the service can expect to live in a homely and comfortable environment, with access to all the communal facilities and the specialist equipment they require to maximise their independence. However, the practice of holding doors open manually may put people at risk. EVIDENCE: The home appeared tidy and comfortable. There is a rolling maintenance programme. At No.7, 3 bedrooms were recently redecorated and one of the bedrooms has had new carpet fitted. The washing machine in 15 Clothal Road has been replaced. One new resident was assisted to decorate their bedroom and choose the bedroom curtains. The bedrooms in North Road have been redecorated. New carpets were fitted in The Rowans and a new suite and ornaments were purchased for the lounge. The residents were supported to purchase new furniture and bedding for their bedrooms. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 17 The bedrooms examined appeared clean with personal items on display. Some bedrooms have en suite toilet facilities. The wheelchairs were in good working order. It was noted that the radiators felt quite hot to the touch and there were no radiator covers on them. One of the residents has a tendency to alter the radiator temperature in his bedroom. The manager said that risk assessments had been carried out a while ago. It was further noted that not all the doors were kept open with automatic holdopen door devices. Manual wedges were used to prop doors open in some of the houses visited and this is a fire hazard. The Manager said that they have placed an order for the doors to be fitted but she is not sure when it will be done. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 18 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): Standards 31, 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be assured that every house has adequate staffing levels to support them, which may put them at risk. However, they can be confident that they are safeguarded by the robust recruitment policy and procedures in place. EVIDENCE: Staff have defined roles and responsibilities. They are appropriately trained to ensure that they can meet the service users’ individual and joint needs. Proper staff records are kept and these are available for inspection. They have had specific training on Dementia Care and Epilepsy. The management encourages staff to undertake professional development in addition to mandatory training. At least 72 of their staff have NVQ qualifications. Regular team meetings are held. On the day of the inspection, it was noted that the staffing level of two care workers for the current group of 7 residents in New Farm was inadequate. One of the residents was very restless and needed one-to-one supervision and the Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 19 other member of staff had to attend to the personal care needs of another resident who has swallowing problems and has a tendency to regurgitate food after each meal. In addition, New Farm has no senior care worker. The home however has advertised for more staff. The Registered Manager has assured the inspector that an additional member of staff will be deployed to New Farm within the week and that one of the assistant managers will be managing New Farm until a senior care worker is appointed. It was further noted that North Road, Icknield Way and 15 Clothall Road are each manned by one care worker per shift. The manager assured the inspector that one of the assistant managers is readily available and that additional staff will be deployed if required. On the day of the inspection, the members of staff were coping well and the residents were well cared for. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standards of administration and management of the home are well maintained for the benefit of the people who use the service. EVIDENCE: The services are well maintained. Although the administrative office is separated from the six houses, the management team make frequent random visits to each of the houses to ensure the care and services are maintained. Staff are well supported by the management team. The Registered Manager is well supported by the provider through the Area Support Manager. Residents are supported to complete a yearly questionnaire as part of a yearly quality assurance and monitoring system. The annual report is readily available for inspection. All servicing records are updated. Records about the residents Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 21 and staff are securely kept. The Liability Insurance certificate and the CSCI Registration certificate are on display in the entrance hall. The yearly CSCI Annual Quality Assurance Self-Assessment (AQAA) form was completed and sent to CSCI on time for this inspection. Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 2 X Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 13(4)(c) 23(4) ( c )( i ) 2. YA33 YA42 18 (1)(a) Requirement To ensure the safety of residents and staff all doors that are kept open must be fitted with automatic hold-open door device approved by the Fire Authority. To ensure the safety of residents adequate staffing levels must be maintained at all times. Timescale for action 28/02/08 28/02/08 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 YA20 Good Practice Recommendations It is recommended that all hand-written instructions on the Medication Administration Record chart be signed and dated by the author. It is recommended that the use of stickers be discontinued. It is recommended that a risk assessment is undertaken on all radiators and if necessary a radiator cover be provided to ensure safety for residents. 2. YA24 Baldock Core & Cluster DS0000019278.V356396.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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