Inspection on 21/07/09 for Cowley Cottage

This is the latest available inspection report for this service, carried out on 21st July 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cowley Cottage 19/05/06

Cowley Cottage 15/11/05

Cowley Cottage 05/07/05

Cowley Cottage 15/10/04

Cowley Cottage 11/07/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Cowley Cottage Ray Park Road Maidenhead Berkshire SL6 8PZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Dickens     Date: 2 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Cowley Cottage Ray Park Road Maidenhead Berkshire SL6 8PZ 01628776542 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.caremanagementgroup.com Care Management Group Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The house is situated in a residential area of an attractive town on the River Thames. There are shops in the town though it is a distance to walk. The garden is shared with a second larger home on the same site. The staff and residents of both homes mix on a daily basis. Residents have access to a patio area and lawn. The home is based in a large detached house and has two distinct areas. The larger house provides accommodation for seven residents with communal space plus a two-bedroom apartment over two floors. All of the residents accommodation is single rooms. The residents in the larger house have moderate to mild learning disabilities and are all older men. Two females can live in the flat and can be supported to do more for themselves by the staff, although at this time only one place is occupied. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 9 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection was unannounced and took place over 7 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector. Ms. Geraldine Dummer, the Registered Manager, represented the establishment. A partial tour of the premises took place, and a number of files and documents, including three residents care plans, two staff recruitment files, staff training records, quality assurance information, and the Annual Quality Assurance Assessment (AQAA), were examined as part of the inspection process. Questionnaires returned to the Commission regarding this service, were also used in writing this report. The Inspector saw and spoke with most residents during the day, and had more in depth interviews with two of them. She also spoke with staff members on duty, and the service manager who visited Cowley Cottage during the inspection. Care Homes for Adults (18-65 years) Page 5 of 31 The inspector would like to thank the residents, staff and the manager of the home, for their time, assistance and hospitality. Fees at this service range from £750-£1200 per person per week according to their assessed needs. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? The service has met the Requirements and Recommendations made at the last inspection including ensuring staff have safeguarding adults training, and other training that was needed to ensure they were trained to carry out the work they were asked to perform. The service now has service user agreements in place for each resident, together with the charges for the service. Residents who are able, have signed these agreements. A great deal of work has been carried out on creating care plans that are more accessible to service users. Those sampled were in an easy read format, with pictures and personal photographs. One member of staff had training in person centred plans, and this has been cascaded to other staff who now all follow the same care planning format. Notes are kept of residents meetings which enables the service to keep a record of the issues discussed and decisions that have been made. Care Homes for Adults (18-65 years) Page 7 of 31 Risk assessments have been improved and now contain any changes made at the previous review. The service now makes a brief note about safeguarding adults referrals in their complaints book, and directs the reader to where more detailed information can be found. The service has now introduced the Skills for Care Common Induction Standards for new staff, and some longer term staff have also completed the induction to up-date their knowledge. The manager was able to demonstrate year on year improvements in the personal development of each resident, and those residents who spoke with the inspector were very positive about the support they had received from the staff and manager in this respect. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are fully assessed and assured their needs can be met before they are offered a place at Cowley Cottage. Evidence: Three residents files were sampled, one of whom had been admitted to the home since the last inspection. Records and an interview with this resident showed that they had had the opportunity to make two visits to the home prior to moving in, including an overnight stay. The manager said this resident chose the decor in their bedroom and this was arranged before the person moved in. This persons room was very personalised and during interview, the resident confirmed they liked the room and had everything they needed. The resident also confirmed that they liked living at the home and had settled in well. An assessment is carried out on prospective residents by a CMG assessor, together with the home manager. This assessment was used to draw up the residents person centred plan.The new residents assessment was sampled and contained a thorough overview of their needs including any support needed with activities of daily living, and Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: covering health needs and leisure interests in some detail. There was evidence of the residents involvement as they had signed a number of assessments and documents in their own file. An assessment was obtained from the placing authority though this this had been completed some time before admission. The manager said this was all that was forthcoming from the local authority, and as the home had carried out their own detailed assessment, they accepted the older one from the placing authority in London. Other assessments from specialists were on file for example a clinical psychologists assessment. A survey was returned to the Commission from a care manager following the inspection. They ticked that the services assessment arrangements Always ensured accurate information was gathered, and that peoples social and health care needs are Always monitored. The previous inspection report recommended that fees be added to contracts. The manager said residents are given this information on an annual basis from head office when fees are up-dated. She said the terms and conditions are given to residents and staff go through this with them. Two residents who were interviewed in some depth were very complimentary about their initial experiences of moving in and living at the home. One described living at Cowley Cottage as Absolutely fabulous. Another more recent resident said they liked it very much and thought it was Excellent. The AQAA completed by the manager prior to this inspection was discussed, especially in relation to the information provided about this Key Standard. She agreed that more detailed information needed to be included to properly reflect the good practice at Cowley Cottage. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Cowley Cottage benefit by each having a person centred plan of their care to ensure their support needs will be met. They are encouraged to make their own decisions, and to participate in the day to day life of the home. They are also supported to take reasonable risks as part of an independent lifestyle. Evidence: Three residents care plans were sampled during this inspection. Since the previous inspection, one staff member has undergone person centred planning training and cascaded this to other staff. All care plans have now been changed to a person centred format as set out in their AQAA, and therefore the Recommendation on this subject from the previous inspection has now been met. The new format includes slightly larger print, easier words, and lots of images, including many photographs of residents enjoying their everyday activities. Each plan has details and images of the residents family and social connections, an overview of what support they need, and it records their goals and achievements. Two plans were Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: due for their 6 monthly review, and the third had been reviewed recently. The manager was reminded that care plans for residents aged over 65 would need to be reviewed monthly as per the National Minimum Standards. It is also recommended that more detail be included in person centred plans about how residents like their support to be delivered, especially in relation to personal care. Following a discussion on this subject relating to one resident, it was clear that both the manager and the key worker were very knowledgeable about this persons needs. The key worker then added much more detail to the care plan and the manager said the others would be reviewed in the same way. Residents are encouraged to make their own decisions and routines at the home are very flexible. Throughout the day examples were seen of residents deciding how they spent their time, where they went and who they saw. They are encouraged to be independent, and to make a contribution, both in the home and in the wider community. One resident was making drinks for visitors, another was seen doing their own laundry, and two people choose to do voluntary work at the local hospice shop. Another resident who was at home in the morning was heard to be given choices about going out. Residents are given choices about meals, activities and holidays. Another said they did their own laundry, kept their room clean and did the vacuuming, and they also cleared the tables and filled the dishwasher after meals. The resident who lives in the lodge does all their own housework, with support as needed from staff. Staff were heard to give positive encouragement to residents throughout the day. Residents are also given the opportunity to make choices through residents meetings which are held every 2 months and, as per the Recommendation at the previous inspection, notes are now kept and there are records of the actions to be followed up. Risk assessments are in place, and the manager demonstrated how these are reviewed regularly depending on the level of risk. The manager said she goes through the risk assessments with residents as needed, and residents are involved in drawing up and signing their own guidelines. Some remarkable behavioural improvements have been recorded with some of the residents at Cowley Cottage. The manager said risk assessments are now up-dated when there is a change, in addition to the actual change being noted on a separate review sheet. A recent safeguarding incident at the home has now been dealt with by reviewing risk assessments and putting new guidelines in place. A care manager who returned a survey to the Commission following this inspection Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: made some very positive comments about the support their client had received since moving in to this home. The survey noted that the client previously had very challenging behaviour which had resulted in various placement breakdowns. They added that With a lot of hard work from Geraldine and her team, this person was able to turn their life around. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at this home benefit by the excellent arrangements in place for personal development. They have opportunities for cultural and leisure activities, and for involvement in the local community. They are supported to maintain family and friendship links, and to develop new relationships. Mealtimes offer a pleasant social experience as well as a healthy diet. Evidence: From the three residents files sampled, and speaking in some depth with two of these residents, it is clear that there is ample opportunity for personal development for people who live at this home. The AQAA noted some of the achievements made by residents. During the inspection one resident described how much they had improved both physically and in terms of their health and independence since they moved in. They Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: were now living very independently and enjoying life including having their own accommodation, a part time job, and being in a relationship. This person made some very complimentary remarks about the manager and said: I have got all my confidence back. If it wasnt for Geraldine, I would still be as I was then. The other resident who was interviewed also demonstrated that they had become more independent and said they were enjoying life at Cowley Cottage. Residents are supported to be part of the local community and most residents attend day services which gives them opportunities for further education and learning including drama, cookery and sewing. They use the local swimming pool and health and leisure facilities, and the local shops. One resident described how they liked going into town with another resident for a walk. Two residents work at a charity shop in the town. One resident said they had taken part in a sponsored swim for charity and had helped to raise over £5,000. Residents had just returned from their annual holiday to the Isle of Wight which was enjoyed by all. Staff had taken photographs which were going to be displayed within the home, and clearly showed that residents had enjoyed themselves. The manager said that some residents had been on other holidays but they all still wanted to go on their annual holiday to the same hotel. The manager was heard to encourage one resident to try a European holiday next year, but the resident said they wanted to go back to the Isle of Wight. Residents are encouraged to maintain and develop relationships. One described their improving relationship with their family, and their new relationship with another resident. Both residents interviewed confirmed that staff supported them in their relationships with others. Care plans for all residents clearly set out the family and friendship links which each resident wishes to maintain, and those staff spoken with were found to be very knowledgeable on each residents family connections. Daily routines at the home are noted to be flexible and residents who are more independent were seen to come and go as they pleased. They were seen making drinks and snacks for themselves and each other, and going out when they pleased. Residents have unrestricted access to the home and garden. Staff interacted very positively with residents, offering discreet support as needed. The service manager visited the home and had lunch with residents, and the atmosphere throughout the day was relaxed and friendly. Residents get involved in domestic activities including cooking, cleaning and laundry. Residents are consulted on the weekly menus and assist with shopping for food. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Records of what each person has eaten is in their daily diary, and care plans contain information on the likes, dislikes and preferences of each person. Menus were sampled and the manager said four or more of the main evening meals each week would be completely homemade, and the others would would always include fresh vegetables. One resident told the inspector they had been very successful on a weight reducing diet and they outlined how they had done this with support from staff and by seeing the dietitian on a regular basis. They were given opportunities for healthy options at mealtimes, and positive encouragement was given by staff when healthy options were chosen by residents. A local authority care manager who returned a survey to the Commission following this inspection noted many positive developments in regard to the client she had placed at Cowley Cottage. She noted her client ...now has a job which they enjoy, and their independent living skills have come along in leaps and bounds. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Cowley Cottage benefit by receiving personal and health care support in the way they prefer and require, and by the arrangements in place for the safe administration of medication. Evidence: The AQAA states that personal care is given according to residents care plans. Care plans have been revised since the last inspection into a person centred planning (PCP) format and one staff member has been on training and is cascading this down to other staff. Excellent progress has been made on this project and all residents now have a PCP in a very user friendly format which is much more accessible to them. Peoples preferences about how they receive their support are followed by staff and the manager and team leader knew about the detail of residents preferences, for example in relation to personal care. They accepted that more detail should be documented and a Recommendation has been made in this regard. The two residents who were interviewed confirmed they got the support they needed. Most of the residents have been at the home for many years and are supported by staff they have known for a long time. They are fairly independent in relation to Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: personal care and activities of daily living. Routines are established and their preferences well known, with appropriate risk assessments in place, for example in relation to cross gender care. Each person has a health action booklet which contains information on health appointments, specialists assessments, and future appointments. The booklet covers regular appointments and treatments for example with the optician, dentist and chiropodist. Diet, sleeping and exercise are also covered. The manager said all these booklets had been reviewed in July this year though this had yet to be recorded. Residents files sampled also contained specialists reports for example from the clinical psychologist and the dietitian. Residents weights are recorded and monitored, and they are encouraged to take regular exercise and this includes for current residents, walking, swimming and line dancing. The person centred plans sampled showed that residents had goals set in relation to maintaining and improving their health, and progress towards these goals was noted. None of the residents currently living at Cowley Cottage are administering their own medication, though the manager outlined plans to work towards this goal with one person. This goal was also identified on that persons care plan. A high street pharmacy carries out checks on the medication arrangements at the home twice per year. The last report in January 2009 stated that all staff have received training and no shortfalls were noted. The manager confirmed that staff had had the in-house competence assessment and training on the Boots MDS system. There is also a separate medication training at head office and 3 of the 4 staff have done this. The fourth staff member is going on the next course but will do an e-learning course in the interim. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Any complaints from residents at Cowley Cottage are taken seriously, and the safeguarding adults policy and procedures should protect residents from abuse. Evidence: The AQAA states that there is a user friendly complaints policy in place, and during the inspection this was seen to be displayed in the home. Both the residents interviewed were asked if they knew what to do if they were not happy about something, and both said they would speak to the manager. Throughout the day residents were seen to approach staff for assistance and guidance. Residents are listened to and their concerns are acted upon before they become formal complaints. A complaints record is kept at the service and two have been recorded in last 12 months. Both have now been satisfactorily dealt with. No complaints have been received by the Commission in relation to this service in the last 12 months. There is a safeguarding adults policy in place and written information, in a user friendly format, is displayed in the home. Staff receive training on this subject, and the home ensures that residents are made aware of this issue, for example during residents meetings. The manager demonstrated this from the notes taken at the last residents meeting. One safeguarding adults referral has been made to the local authority since the last inspection. This is now reaching a conclusion and the home manager said social Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: services were satisfied with the actions the home has taken. The inspector spoke with the care manager from the local authority who had led the investigation, and she confirmed this was the case. A previous Recommendation to record any Safeguarding matters in the complaints book has now been met, though for confidentiality purposes, the entry contains minimal detail and refers the reader to where the full information can be found. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cowley Cottage offers a homely and safe environment, which is clean and fresh throughout. Evidence: The AQAA completed by the home states that bedrooms are personalised, and health and safety checks are carried out. On the day of the inspection a tour of the premises took place and the home was found to be well kept, clean, fresh and comfortable throughout. Communal areas are nicely decorated with domestic style furnishings and fittings. The lounge has three large leather sofas and a number of domestic style pieces of furniture and ornaments, and offers a very comfortable area for residents to relax. Residents had worked on a canvas which gave each person the opportunity to contribute artistically, and the finished artwork is now mounted and displayed in the lounge. Bathrooms and toilets were also clean and tidy, as were the three residents rooms visited. All were found to be very personalised with family photos, certificates of achievement, and various items of artwork. The manager said the decor and fittings were chosen by residents, who were supported to keep their own rooms clean and tidy Two residents who were interviewed confirmed they liked their accommodation and had everything they needed. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Residents hobbies and interests are encouraged and these could be seen throughout the home including football memorabilia, jigsaws, computers and music players, and, as the home has a number of TV Soap and chat show followers, a very large flat screen TV. Cowley Cottage has a homely feel, and a very friendly and welcoming atmosphere. The AQAA states that staff and service users are jointly involved in the monitoring of a clean environment. The home was indeed found to be clean and fresh with no unpleasant odours in any part of the building. Residents spoken with described how they contributed to keeping the home clean and tidy, including vacuuming, dusting, and helping in the kitchen. The resident who lives in the annex was congratulated on the standard of cleanliness in their accommodation including a very tidy kitchen. There are user friendly reminders about the importance of hand washing near hand basins throughout the home, and each hand washing facility had paper towels and individually dispensed soap to minimise the spread of infection. The company provides guidance for staff on maintaining good hygiene and minimising the spread of infection and some of these guidelines were displayed discreetly as a reminder to staff. The service manager stated that a new audit was being introduced the following week which included looking at infection control procedures. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by being supported by an effective staff team, but more work needs to be done on the homes recruitment records to fully protect service users. Residents individual and joint needs are met by the staff at Cowley Cottage. Evidence: Cowley Cottage has a small staff team who have worked with these service users for years. The manager and team leader were on duty during the inspection and both demonstrated excellent knowledge of residents needs, and were seen to communicate well with them. They were seen to be committed and motivated and showed a respectful attitude to service users. The people who live at the home were seen to turn to them for advice and guidance, and it was nice to see that residents who had been out for the day all came to the office to chat with the manager about their day when they got home. The two staff files checked showed staff had NVQ Level 2 qualifications in care, and the manager has just completed her Leadership and Management Qualification. The recent safeguarding incident at the home highlighted that the needs of residents are constantly changing and this was discussed with the manager during this inspection. She said she will need to keep staffing numbers under review, and a Recommendation is being made in this regard. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The recruitment files are well maintained at this service, and individual documents were easy to find. Two staff files were sampled and each found to have an application form, evidence of a CRB and a POVA check to confirm they had not been deemed unsuitable to work with vulnerable adults, and appropriate references. There were also copies of photographic identification, training certificates and evidence of having done the Skills for Care induction. There were copies of each staff members job specification, their contract, and a record of supervision sessions. Those who drive service users also have their drivers licence checked. Both files also had copies of the General Social Care Council Code of Practice. One file for a new member of staff did not have a full employment history and this was discussed with the manager. She said she had not been clear about that particular requirement in the Regulations and undertook to ensure that a fully documented employment history was sought from this staff member when they came on duty the following day. The manager was given a copy of the relevant Schedule from the Care Homes Regulations and she agreed to check all staff files to ensure they all complied with the Regulations. There are now well organised training arrangements in place and the home follows the company policy on training for staff. Training courses are provided on a rolling programme either externally, for example at their head office, or at the home through e-learning, a computer based training package. A training matrix is now set up so the manager can see which staff have done which training courses. The home previously used their own induction programme but following the Recommendation at the last inspection, now follow the Skills for Care recommended induction. One member of staff who has been at the home for many years said they had done an induction when they first started, but recently completed this new Skills for Care induction programme to improve their knowledge. Three of the four staff have an NVQ qualification and training linked to residents needs including person centred planning training, dementia training, and training in the care of older people, as some of the current residents were now over 65. Two staff files sampled showed that appropriate training courses had been completed for example in moving and handling, health and safety, safeguarding vulnerable adults, and first aid. Two surveys from staff, returned to the Commission following this inspection, confirmed that staff are Always given up to date information about the people they support, and that their induction covered everything they needed to know. Both ticked that they met Regularly with their manager for support, and that there were Usually enough staff to meet the individual needs of all the people who use the service. Asked Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: what they thought the service did well, one described it as Warm and friendly, and the other as a A warm, homely environment. They stated that service users were supported to keep in touch with their friends and family, and that the service promoted the independence of service users. In response to the question about what the home could do better, one noted Do more with service users in the community. and the other noted Increase staffing levels. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by the management arrangements in place at this home, and they know their views will be taken into account. The health and safety of residents are promoted at Cowley Cottage. Evidence: The current manager has been running the home for over a decade and since the last inspection she has completed the Leadership and Management Award which is the new equivalent of the Registered Managers Award. She is now about to start an NVQ4 in care. She demonstrated a positive attitude to the inspection process and arranged for a number of minor shortfalls that were identified during the inspection, to be rectified immediately, for example where a care plan needed more detail on the service users preferences. Positive comments were received about the manager from residents and staff. One resident, as mentioned earlier, said they wouldnt have made such good progress if it hadnt been for the manager. The manager was observed to communicate well with both staff and residents, and residents were seen to approach her for advice and Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: guidance during the day. Those who were at day services during the afternoon all came to greet her on their return to talk about their day. Quality assurance arrangements are set out by the Care Management Group and there is a folder with all the relevant documents kept at the service. The current quality assurance system includes monthly visits by a representative of the provider (known as Regulation 26 visits), residents meetings, staff meetings, and feedback from surveys. The service also has monthly audits for example on health and safety, and a more general audit where a selection of documents are sampled including a staff file, a service user file and any Regulation 37 incident reports. The AQAA completed by the service prior to the inspection asks the service to confirm what policies and procedures they have in place, and when these were last reviewed. The inspector noted that the majority of policies had not been reviewed since 2006 and the manager was asked to follow up on this. The inspector also forwarded this information to the National Provider Relationship Manager; a CQC employee who liaises with the head office of the Care Management Group. Cowley Cottage has a number of measures to ensure the health and safety of service users and staff. These include a fire safety book for recording all the fire safety monitoring. For example there are regular inspections and tests of the fire doors, emergency lighting, and fire alarms. The manager said fire drills are held monthly, and this includes some at night. A fire risk assessment is completed by the manager and reviewed annually. She said a Buddy file is kept at the home next door with details on essential information e.g. service users medication. This has been done in case there is a fire or other emergency where such important information cannot be accessed. Records are also kept of accidents, and a monthly health and safety checklist is completed. There are weekly checks on the first aid box, and monthly pest control checks. As the home has access to transport, regular checks are carried out on company vehicles. The manager said they are using the Safer Food folder, and they record fridge and freezer temperatures each day. The last Environmental Health Officers report in December 2006 said all matters were satisfactory. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 Staff files must be reviewed to ensure they contain all the information set down in the Care Homes Regulations 2001, and in Schedule 2. This is to ensure the safety and welfare of service users. 21/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 32 Person centred plans should contain more detail about how residents would like their support to be delivered. Staffing numbers should continue to be kept under review to ensure the changing needs of residents are met, and their safety and well being is maintained. It is recommended that policies and procedures are reviewed more frequently, as the majority had not been reviewed since 2006. 3 40 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!