Care Home: Caldicott House

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What the care home does well The home has a motivated and caring staff team who understand the needs of the service users well and are committed to the ethos of the home of choice and supporting independence. The care planning is person centred and individualised and fully involves the service users in decision-making. The home have developed its health monitoring to a high standard with Health Action Plans and other processes in place. The Manager and Deputy, who also ensure that the home is efficiently and effectively administered, provide the home with good leadership and direction. What has improved since the last inspection? Extensive renovations and alterations to the home have resulted in the provision of a spacious and homely environment. The home have further developed their care planning and staff understanding of this process. The arrangements for monitoring health and planning for future needs have been improved to a high standard. There has been an improvement in the quality assurance processes in place with regular visits from the Area Manager and the development of a continuousimprovement plan that is regularly reviewed by the staff team and management. What the care home could do better: No specific areas requiring improvement were identified at this inspection. CARE HOME ADULTS 18-65 Caldicott House 27 Old Bath Road Leckhampton Cheltenham Glos GL53 7QE Lead Inspector Mr Simon Massey Key Unannounced Inspection 10 & 16th January 2008 09:30 th Caldicott House DS0000016394.V348438.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 Caldicott House DS0000016394.V348438.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. Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Caldicott House Address 27 Old Bath Road Leckhampton Cheltenham Glos GL53 7QE 01242 221343 01242 257422 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) H46013@mencap.org.uk Royal Mencap Society Elizabeth Anne Wright Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2006 Brief Description of the Service: Caldicott House is a semi-detached house in Cheltenham. It is a residential home for six adults with learning disabilities. It is very close to the town centre and is within walking distance for the residents. There is a short front lawn and pathway leading to the front door. At the rear of the property there is a large lawned area and patio. The home has three stories. On the ground floor there is a larger entrance hall, lounge and kitchen. There is also one bedroom on this level. On the first floor there are five bedrooms, a staff room and two bathrooms. The second floor is used for office space. The home is staffed and run by the Royal Mencap Society. The house is owned by the local Mencap group and the property is maintained by the New Era Housing Association. The current fees are set at £643 per week. Caldicott House DS0000016394.V348438.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on the 10th and 16th January 2007. The Inspector met and interviewed the Manager, Deputy Manager and various members of the care staff team. Staff were observed supporting and working with the service users. The Inspector also met with all the service users. Feedback was also received from some of the relatives of the service users. Records relating to care planning, medication, staff recruitment, health and safety and staff training were examined. An inspection of the environment was also carried out. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Extensive renovations and alterations to the home have resulted in the provision of a spacious and homely environment. The home have further developed their care planning and staff understanding of this process. The arrangements for monitoring health and planning for future needs have been improved to a high standard. There has been an improvement in the quality assurance processes in place with regular visits from the Area Manager and the development of a continuous Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 6 improvement plan that is regularly reviewed by the staff team and management. 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. Caldicott House DS0000016394.V348438.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 Caldicott House DS0000016394.V348438.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide provide accurate and accessible information to service users and prospective admissions to the home. EVIDENCE: The home has had no admissions since the previous inspection, or indeed for a number of years. The home have reviewed and updated the Statement of Purpose, which is available in an easy read format, and contains all the required information. A new Service User Guide has also been produced, which contains pictures and symbols. Both are excellent documents that provided a clear picture of the service provided and what prospective and existing service users can expect form the home and the staff working there. Caldicott House DS0000016394.V348438.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): 6, 7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans ensure that the service user’s needs are documented and guidance is available to staff. The home takes action to encourage service users to make choices and supports them to take appropriate risks. Increased independence is an objective for all service users that the home supports them to work towards. EVIDENCE: All service users have person centred Care Plans in place and all have been reviewed at regular intervals. This has been done in conjunction with the service users, some of whom were able to explain their role in reviewing plans and drawing up goals and objectives. The plans are detailed and easy to follow and give a clear picture of needs and aspirations and the actions required within the given timescales. Some sample of care plans were seen and these contained good detail and current information. Records were made of visits from the Community Learning Disabilities Team and any advice and guidance was correctly recorded. Some Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 10 of the care plans contain pictures and symbols to increases understanding and ownership for the service users. All care plans also contain “action plans”, which are also reviewed on a regular basis. Where required plans contain eating and drinking guidelines, guidelines for supporting such things as teeth cleaning, bedtimes and laundry. All plans are written in a person centred format and style and all fully involve the service users as much as their abilities and interest allow. Service users gave various examples of how they are making choices about their daily lives, particularly in relation to their day time activities and leisure interests. There are many pictures and symbols around the home designed to help understanding and service users spoken to could also explain the importance to them of making their own decisions about such things as food, bedtimes, clothes, holidays and outings. Guidance is provided to staff in the care plans of how some people will make decisions. For example one plan says, “I will shake my head, NO, if I do not want a shower.” The plan also contains information about how a service user will complain if they are unhappy with something, with a section called “This is how I show how I feel”. Service users also have regular house meetings, which are recorded, and these showed evidence of service users expressing their opinions. It was also seen that the staff team regularly discuss individual service user objectives at the staff meetings. Caldicott House DS0000016394.V348438.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): 12,13,15,16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using the service have opportunities to take part in a variety of activities in the community and in the home. Service users benefit from a person centred approach towards their care that ensures they are treated with respect and involved in all aspects of decision making about their lives. EVIDENCE: Interviews with service users and care staff and recording, showed that a variety of leisure and vocational activities are supported and encouraged. People gave various examples of daily and weekly activities they enjoyed and how they were able to suggest outings and other events. All service users have individualised routines that they will have helped to choose as far as their abilities allow and those able to expressed satisfaction with the variety and quality of their lifestyle. People use the resources of the local community and are supported to maintain as much independence as possible. Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 12 Feedback from relatives was positive about contact with the home and the support provided to maintain links and organise visits. Service users spoke about their ability to make choices and decisions and the person centred approach to care planning ensures they are fully involved in all aspects of decision making about their lives and the running of the home. People were very positive about the food and the opportunities for shopping, cooking and menu planning. All service users have opportunities to be involved in the kitchen, which during this inspection appeared to be a lively and relaxed large communal area. The kitchen was well stocked with fresh and packaged produce and information is available on personal likes and dislikes as well as dietary advice. Caldicott House DS0000016394.V348438.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): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear guidance and recording supports service users to receive their personal care in a way that promotes their privacy and dignity. Monitoring of health needs and access to the healthcare professional they require ensures that physical and emotional health needs are met. EVIDENCE: The care plans detail the support that individuals require and also provide guidance to staff on how they would prefer this to be delivered. Individual files contain details of medical appointments and also information and correspondence from outside professionals. Staff record information following appointments into the individual files. Medication administration and storage was examined and found to be satisfactory. All staff are required by the home to complete the appropriate training before they are permitted to administer medication. All the service users have completed Health Action Plans, which provide detailed documentation around all aspects of their health care and potential future needs. People have medication pen pictures and also written guidance, Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 14 which can be used in an emergency in the event of being admitted to hospital. This is an example of excellent practice. There was evidence of regular health checks being completed and staff supporting appointments and recording outcomes. Several people have had a Dementia Pathways assessment completed. The staff have also undertaken training in dementia awareness to help them meet current needs, and also in anticipation of future developments. Caldicott House DS0000016394.V348438.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): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory arrangements and procedures in place for the protection of service users and provides a safe environment in which people are respected and treated with dignity. EVIDENCE: The home has a complaints policy in place and service users are aware of how to use this. This is a national Mencap procedure and service users are occasionally remained of the procedure to follow at their house meetings. Service users said they knew how to complain and were happy to talk to the Manager if anything concerned them. People were observed as confident and relaxed in their home and able to make their feelings and opinions known. Some care plans also contain advice to staff on how a service user may express their preferences or wishes. Training around communication and the imaginative use of various visual aids and pictures help the staff to seek the views of the service users and encourage people to make decisions about their daily lives and express their wishes. All but the recently appointed staff have undertaken training in Adult Protection. Caldicott House DS0000016394.V348438.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): 24 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well maintained and decorated throughout and provides a comfortable and homely environment. Service users are supported and encouraged to personalise their living space and are involved in all decisions relating to redecoration of the home. EVIDENCE: The home has been extensively renovated and extended with the addition of a new conservatory and the conversion of the kitchen into a new large kitchen/dining area. There are now two living room areas adjacent to the conservatory. Alterations have also been made which provide for additional office space and an en-suite bathroom for one person. All work appears to have been completed to a good standard and the home provides spacious homely and comfortable accommodation. All service users expressed satisfaction with the changes. A sample of bedrooms were seen and these were personalised and people are encouraged to take as much responsibility as they can for their personal areas. Service users confirmed that they afforded Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 17 privacy in their rooms and that staff and other people do not enter without permission. The home was clean, tidy and hygienic at the time of this visit. Caldicott House DS0000016394.V348438.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): 32,34, & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user needs are met by a motivated and effective staff team who are provided with regular training, which helps ensure they have the necessary skills and knowledge to meet the needs of the service users. Service users are protected by the home’s recruitment process, which ensures that all required checks are completed. EVIDENCE: The home is currently fully staffed, having recruited two new staff in recent months. The rest of the team are well-established staff who have worked at the home for several years. Records showed that correct recruitment procedures have been followed and that new staff complete a thorough induction. New staff sated they felt well supported by the Manager and the rest of the team during their initial employment. The home has regular staff meetings, with minutes being recorded, and these show a discussion of range of issues and staff inputting ideas and suggestions for consideration. They also provide evidence of the commitment to providing choice and independence skills for the service users living at the home. Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 19 Service users spoken to were very positive about the staff team and their individual key-workers. People stated that the staff were, “really nice, you could n’t ask for better”, and that “they help me with things, they are my friends”. One person said “ the staff are always helping us, I like them and do not want them to leave”. People gave examples of activities they had undertaken with staff support and also tasks they undertook in the house with staff help and encouragement. Staff and service users were observed interacting in a relaxed and positive manner. There was evidence that staff have a good understanding of needs and are able to communicate effectively and positively with the service users. Two relatives spoken to also commented upon the staff team, saying they were an excellent team and that the service users were very happy at the home. All staff are up to date with the required statutory training and all but the new staff have completed NVQ training. People have also undertaken additional training such as Adult Protection, Dementia Awareness Person Centred Planning and Epilepsy Awareness. All staff have been receiving regular supervision and also have had annual appraisals completed. Caldicott House DS0000016394.V348438.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): 37,39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well managed and organised and committed to providing high quality care and support. Systems are in place that help to monitor and improve the quality of the service. EVIDENCE: The home is well managed and organised, with information easy to access and all recording and paperwork seen up to date and where appropriate signed and dated. Part of the homes ethos is to encourage choice and support independence, and the Manager provides clear leadership to the staff team in this area. Staff spoken to demonstrated a good understanding of this aspect of their work. Staff were positive about the support and leadership they receive and said that the management was approachable and always listened to concerns or issues that were raised by staff. Service users were also very positive about the management and two people said they would go to the Manager if there was Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 21 anything that they were not happy about. Relatives also said that the home was well run. One person said that the Manager was “excellent” and that their son saw the house as his home and was always keen to return after visiting them. The home is visited regularly by the Mencap Area Manager who completes the Regulation 26 inspections, supervises the Manager and completes an ongoing Continuous Improvement Plan. This is an ongoing monthly record of objectives covering all aspects of the running of the home. This document is also discussed with the staff and the service users, who can make suggestions and comments if they wish. All fire safety testing has been completed and recorded and staff have completed fire safety training. One of the service users explained how they helped to complete the weekly fire testing. Portable appliance testing has been completed, the liability insurance was up to date and the gas central heating had had its safety test and certificate issued. All COSH assessments had been completed and were up to date and there was a list available to staff of what products to buy and what guidance needed to be followed. The home has had a recent inspection from the local authority Environmental Health Department and has taken action in respect of the recommendations that were made. Caldicott House DS0000016394.V348438.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 X 2 3 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 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 3 X X X X 3 x Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Caldicott House DS0000016394.V348438.R01.S.doc Version 5.2 Page 25 - 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. 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