Care Home: Clayton House

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What the care home does well The care home offers a comfortable environment. The home is well maintained. Staffing levels ensure that the needs of residents are met. Staff, feel supported by the homes managers. Residents feel staff are well-trained and are confident that their individual needs are being met. The home`s social skill training programme enables residents to develop computer skills literatures skills and work towards independence training where appropriate. What has improved since the last inspection? There were no requirements identified at the last key inspection. The home has improved the quality and detail and care records. All residents are seen as individuals with their own special needs. The training provided by the home to enable residents to be as independent as possible and to develop computer skills has been further developed. Improvements have been made to the environment of the care home. Teamwork has been improved, consistent supportive management is provided. What the care home could do better: The "skill for care" sector training an online resource and evidence book could be used more effectively. A second government system is used by the home "Train to Gain" this can again be used more effectively. CARE HOME ADULTS 18-65 Clayton House 11 Lea Road Gainsborough Lincs DN21 1LW Lead Inspector Ken Hague Key Unannounced Inspection 8th March 2009 09:00 Clayton House DS0000002308.V374486.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 Clayton House DS0000002308.V374486.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. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clayton House Address 11 Lea Road Gainsborough Lincs DN21 1LW 01427 613730 01427 617942 dawn@rmccoull.wanadoo.co.uk 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) Kingsway Mrs Kathleen Mccoull Mrs S Aunger Care Home 16 Category(ies) of Learning disability (15), Learning disability over registration, with number 65 years of age (1) of places Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Clayton House is registered to provide personal care and accommodation for both males and female service users under the following categories: Learning disability (LD) 15 Learning disability over 65 years of age (LD(E)) 1 One named person identified in the application to vary the conditions of registration dated 06/10/06 may be admitted to Clayton House before he is 18 years of age on 26/11/06 The maximum number of service users that may be accommodated in Clayton House is 16 12th June 2006 2. 3. Date of last inspection Brief Description of the Service: The home is an adapted property, achieved through converting two semidetached properties into a detached unit. It is situated in the town of Gainsborough, close to all the main facilities and services. There is a small front garden and a combined back garden, which offers privacy to residents in the summer. The home provides accommodation for sixteen residents who have a learning disability. They are accommodated in three double bedrooms and ten single bedrooms. Accommodation is provided on the ground and 2 further floors with communal facilities located on the ground floor. There are no shaft lifts or chair lifts in this home and all those residents who live in this home are ambulant. The homes philosophy of care is to enable residents to live as independent a life as possible in a homely environment. The current scale of charges at this home starts at £392.00 to £406.00 per week. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall rating given for this service is three star – excellent service. This key inspection was announced any previous information held by the Commission for Social Care Inspection about the home was taken into account. The Commission for Social Care Inspection was replaced from 1st of April 2009 by the Care Quality Commission who have published this report and are now responsible for the inspection of this home. Throughout this report the terms we and us therefore refer to the Care Quality Commission. Before the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next 12 months. We sent out surveys to residents of which 15 were returned. These surveys had been completed sometime before the inspection date. A further 15 surveys completed by residents for the home as part of their quality assurance checks were studied. These quality assurance surveys covered the same areas as the have your say surveys sent out by the Commission for Social Care Inspection. The information from these quality assurance surveys is summarised within this inspection report. Six Staff surveys were returned to the Commission. The main method inspection used was called case tracking. This involves selecting a proportion of the residents and tracking the care they received through the checking of records, discussions with them and the staff who care for them, and observations of care practice. What the service does well: What has improved since the last inspection? There were no requirements identified at the last key inspection. The home has improved the quality and detail and care records. All residents are seen as individuals with their own special needs. The training provided by the home to enable residents to be as independent as possible and to develop computer skills has been further developed. Improvements have been made to the environment of the care home. Teamwork has been improved, consistent Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 6 supportive management is provided. 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. Clayton House DS0000002308.V374486.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 Clayton House DS0000002308.V374486.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): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. New residents receive a full comprehensive assessment before being admitted to the care home. The home confirms in writing to new residents that their needs can be met. EVIDENCE: We studied the files of three residents. They all contained a detailed initial assessment, which was structured and identified the needs of each resident. An assessment had been completed prior to the resident being admitted to the home. The assessor had used the same internal document for each assessment. The assessments were written in plain English and were easy to follow. An index was seen at the front of each file and this tells the reader where information can be found within the care records. Assessments identified social needs and care needs. Detailed risk assessments had been completed for each resident. A management strategy for any identity risk was seen to be in place on each residents file. All assessments were personalised. Identified needs were recorded in detail. We found information from family and other professionals supporting the resident within their assessment. Assessments described the residents wishes in respect of the manner in which they wished help to be provided. Assessments were signed Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 9 and dated by the assessor and the individual resident or a member of their family. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent, this judgement has been made using available evidence including a visit to this service. Residents have updated comprehensive care plans to ensure staff know how to meet their needs. Medication is being administered and stored safely to ensure resident’s good health. EVIDENCE: The care plans for three residents were sampled. Each individual residents file contained a current care plan which had been reviewed every four weeks. Staff stated that they use this plan as a working document. The initial care plan included information obtained at the initial assessment. Care plans contained the social need, personal care needs, and included the wishes of each resident in respect of social activities. The manner in which residents preferred personal care to be provided was recorded. Care plans instruct staff how to meet safely the personal needs of each resident. They give guidance how each task should be carried out and included instructions how staff could ensure that the safety dignity and privacy of the residents is maintained. All records were written in clear English and were Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 11 easy to follow and understand. The equipment and the number of staff required to complete each task safely were found detailed within care plans. Care records were filed in a consistent manner with a common index inserted at the front of each residents file. The resident or a family member and the assessing officer signed care plans. The information stored within care files enables you to understand very quickly the needs of each individual resident. Care plans described residents wishes and goals for the future. The registered manager stated personal care plans are discussed with residents and family members and with multi -discipline teams which support the home. They contained the medical history and the current medication being taken by each resident. No residents self medicate, but risk assessments are completed if anyone chooses to do so. Each residents care plan contained a description of the choice of activities for each resident. Any allergies or special dietary needs were recorded on the current care plan. The home has an updated medication procedure. Staff confirmed that they had been trained in the administration and storage of medication. The last pharmacy report was a positive one and contained no recommendations. Staff, were observed to make sure that the privacy and dignity of residents was maintained. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy a diet, and a range of activities that suit their needs and wishes. They benefit from being able to maintain links with the local community EVIDENCE: Care plans are detailed and guide staff how they can ensure that social stimulation is provided to all residents. Work training and social activities take place within the care home and in the community. All residents are taken into the community for organised social outings. Residents obtain skill training within the home and at local training centres in Gainsborough and Lincoln. A resident stated in his quality assurance questionnaire I enjoy the workshop activities at Lincoln. The home has a computer room, which is used to increase the IT skills of residents. Staff stated that ensure that every individual resident is provided with social stimulation. Staff, were able to explain the choices and wishes of the residents Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 13 being case tracked and how these are being met by the resources of the care home. Residents use the community facilities on a daily basis. They go out to local shops, restaurants, churches, and leisure centres. The registered manager stated all residents have been assisted to obtain an activity pass to the local leisure centre and bus passes. Four residents commented that we feel very contented and secure the other residents are our friends we are like one family. The menu offers choices to residents while meeting their individual dietary needs and runs over a four week rolling programme. The likes and dislikes of residents are recorded on care plans. Staff were able to discuss the dietary needs of the residents been case tracked. The quality assurance surveys completed in February 2009 contained only positive comments about the homes menu. A resident stated the menu is very good, the food is very good. A second resident stated I have no problem with the food and I do like the menu. The registered manager and staff stated that visitors are free to visit at any reasonable time. Staff stated that residents are encouraged to maintain links with their own family and the community. Residents have been enabled to purchase sky TV packages. Nine residents practise their chosen faith. A visiting priest holds Bible classes in the home. Three residents are actively involved in church activities in addition to attending services Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have comprehensive care plans, which identify their health care, and social needs and instruct staff how these are to be met. Staff, preserve residents dignity and privacy. Medication is administered and stored safely. EVIDENCE: The registered manager stated the goals of a number of individual residents are to maximise their own ability and skills towards possible independence. In the majority of cases personal care needs are therefore being met by providing advice and support rather than physical care. Residents are encouraged to self -medicate where the personal goal is to work towards independence and a risk assessment confirms that this will be safe practice. The individual care needs and social needs of each resident are recorded on their care plans. This includes the time when residents choose to go to bed and their sleep patterns. Residents who see a consultant on the regular basis have these appointments recorded in their care records. Staff stated that they support residents to ensure they can keep appointments with Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 15 consultants and GPs. Community nurses visit the care home and these visits were recorded. Residents visit the local opticians, dentists and where appropriate receive chiropody. Residents stated that their health care needs are being met. A resident stated staff, do make sure that I can keep hospital appointments. A second resident stated I am happy with the way that staff support me and help me. They do protect my privacy. Any allergies or special dietary needs were recorded. Staff stated only qualified competent members of staff are allowed to give out medication. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are systems in place to protect residents. Staff, are trained to protect residents from potential abuse. EVIDENCE: The complaints procedure was displayed in the home. No complaints have been received since the last key inspection. The manager stated that she checks the complaint book monthly. Even if there are no complaints recorded she signs and dates the book to demonstrate that she is monitoring complaints. There have been no notifications in the last year, which have raised any concerns about the care practice. Staff stated that adult protection training has been provided. Training records seen supported this statement. Staff stated that they would have no difficulty in using the whistle-blowing procedure. Staff stated that they felt the home was a safe place in which to work and could not identify any health and safety issues which would affect the safety of residents. Residents confirmed that they were able to raise any concerns with the homes managers and staff. A resident stated I know who to speak to if I am unhappy. Staff will put it right. Training records seen at the site visit provided evidence that all staff have being trained in protecting residents from potential abuse. Staff stated they were confident in being able to protect residents from any potential abuse. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a clean well maintain care home, which provides safe comfortable accommodation. The up-to-date infection control procedure is followed and a safe environment is maintained. EVIDENCE: Residents stated in the have your say documents that the home is always clean and smells fresh. Observations made during the site visit support this statement. Staff stated that the home is safe and free of hazards. Two bedrooms were looked at as a sample of the facilities offered by the home. All the rooms were clean and personalised. Residents stated their satisfaction with their own individual bedroom. A resident stated I am very happy with my bedroom. A second resident stated my room is great staff helped me change the colour of my curtains. The registered manager stated that there is an ongoing maintenance program in place. The home was found to be clean tidy and smelt fresh. Bedrooms had Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 18 been personalised and were decorated to a good standard. All social areas were well maintained furniture has been provided to meet the needs of individual residents. There were no infection control or health and safety issues identified at this inspection. Off-road parking is provided for visitors. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff, are recruited safely using the updated recruitment procedure of the care home. They are trained to meet the needs of residents. EVIDENCE: The staff-training plan showed that core and specialised training is provided to staff. The registered manager produced evidence that 75 of staff hold an NVQ level 2 in care or an equivalent qualification. The registered manager stated that supervision and appraisals do take place. Staff confirmed this statement to be correct. Recruitment records for staff were seen. There is a procedure in place, which ensures the manager obtains a criminal record bureau check (CRB), two written references and Proof of identity before offering new staff employment. The registered manager stated that all new staff are given an induction. Staff confirmed this statement to be correct. Staff were able to discuss in detail the needs of the individual residents been case tracked. They described how they helped each individual resident while maintaining their dignity and privacy. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 20 There were six surveys returned by staff. All contained only positive comments. One carer stated there are regular courses with outside agencies as well as in-house training. The same carer stated that the Church in the local area helps me to support residents and allow them to follow their own religion. A member of staff describes the home has a lovely homely atmosphere which encourage service users to develop and grow. Another member of staff stated any training needed has always been provided. We are a friendly home the home which offers choice to residents and encourages them to me remain part of the community. I work in a happy home with caring staff. A third member of staff stated communications in this home are very good. Staff stated that the staffing rota is given to them in plenty of time to allow them to maintain their own personal lifestyle. There is no pressure to work additional hours except by choice. Staff stated that they feel well supported by the registered manager and work well as a team. The registered manger stated that staff turnover is very low. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was well run, with good leadership. The Health and Safety and the well-fare of residents is promoted. EVIDENCE: The registered manager produced any evidence which the inspector requested. She was able to describe the needs and care plans for any resident in detail. Recruitment Records produced evidence that the staff turnover is very low. Supervision and appraisals were seen staff confirmed that they had taken place. They were reviewed monthly and formal reviews held twice a year. Staff training is being provided which includes specialised training in addition to essential core training. The AQAA states that Staff training has been organised to inform staff of the new Mental Capacity Act. Policy and procedures are being reviewed to update them in line with current legislation. Staff meetings are held every two months. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 22 The registered manager has kept the Commission for Social Care Inspection informed of all events, which had a potential impact on the safety of residents. No complaints have been received by the home since the last key inspection or by the Commission for Social Care Inspection. No health and safety issues or infection control issues were identified during this inspection. The staff surveys were seen to contain the evidence that in the opinion of staff communications is good. Staff find the manager is supportive and approachable. A member of staff stated the management are very supportive and patient and explain things very clearly to me. The communications I find are very good. Residents consistently stated their satisfaction with the care home. There were no recommendations or requirements identified at this inspection or the last key inspection. Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 n/a 2 4 3 n/a 4 n/a 5 n/a 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 n/a 26 n/a 27 n/a 28 n/a 29 n/a 30 3 STAFFING Standard No Score 31 n/a 32 3 33 n/a 34 3 35 3 36 n/a CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 n/a 3 n/a LIFESTYLES Standard No Score 11 n/a 12 3 13 3 14 n/a 15 3 16 n/a 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 n/a 4 n/a 4 n/a n/a 3 n/a Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 n/a Clayton House DS0000002308.V374486.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East Midlands Region Citygate Gallowgate Tyne and Wear NE2 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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