Inspection on 19/12/08 for Cromwell House

This is the latest available inspection report for this service, carried out on 19th December 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Similar services:

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Credence House

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME ADULTS 18-65 Cromwell House Castle Street Torrington Devon EX38 8EZ Lead Inspector Susan Taylor Key Unannounced Inspection 19th December 2008 10:15 Cromwell House DS0000071360.V373584.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 Cromwell House DS0000071360.V373584.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. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cromwell House Address Castle Street Torrington Devon EX38 8EZ 01805 624847 01805 624952 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) C & K Homes Limited Mrs Cathryn Treanor Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 10. NEW following application to become a Limited Company 2. Date of last inspection Brief Description of the Service: Cromwell House is registered to provide 24-hour care and support for up to ten adults with a learning disability or mental disorder from the ages of 18 to 45 years. The home aims to provide an Autistic specific service for people with complex and challenging needs and is accreditation with the Autistic Society. Cromwell House is a detached two-storey property situated just a short walk from the town of Torrington, offering shops, pubs and other facilities. To the rear of the property there is a large back garden with a vegetable plot, fishpond and pleasant patio area with garden furniture. The current service users, of which there are two, are accommodated in ground floor bedrooms, but further accommodation is available on the first floor. There are eight single bedrooms, with three en-suite facilities and one double bedroom. Cromwell House, due to its layout, is unsuitable for wheelchair users. Copies of CSCI inspection reports are available within the home. The charges for these services range from £1500 to £2500 per week. Additional charges are levied for toiletries, chiropody and magazines, which vary. Cromwell House DS0000071360.V373584.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 two stars. This means the people who use this service experience GOOD quality outcomes. This was the first key inspection of Cromwell House under the Inspecting for better lives arrangements as a ‘newly registered service’ following the provider’s decision to become a Limited Company. We were at the home with people for 8.5 hours over one day. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. Several weeks before this inspection took place an Annual Quality Assurance Assessment (AQAA) document, which contains general information about the home and the people living there, was completed and returned by the new registered manager of the home. At the same time we sent surveys to 2 people that live at the home and their comments are in the report. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care outcomes for 2 people both had different needs. We spoke to people alone in private, with their key workers and together about their life at the home. We took an Expert by Experience to meet people at the home on 19th December 2008. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. They are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. The expert spoke to people for 3½ hours about their experiences of living at the home for as well as making some general observations. Their comments are included in the report. We met a healthcare professional and a health and safety inspector during the visit and their comments are included in the report. As at December 2008, the fees ranged from £1500 to £2500 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 6 fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People living at Cromwell House tell us that they “like it” and enjoy “working in the garden”. Staff we spoke to told us that the provider is “supportive” and ensures they have “opportunities to do training”. The Expert by Experience wrote that the ‘staff seemed to know the residents needs and work with them in a person centered way’. We did a random inspection on 11th August 2008. This was because we were told about an incident involving a person who lived at the home. We wrote a report about our visit, which is available on request from the Commission. What the service does well: What has improved since the last inspection? Staffing levels have increased and allow greater independence and choice for people living in the home. Staffs have had more regular recorded formal supervision. This has ensured that they get the right support, guidance and training so that they understand the needs of people better. Since the random inspection in August 2008, the provider has reported some incidents that have affected the well being and/or safety of people to the Commission, which we required them to do. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 7 Plans of care have improved and clearly record any limitations agreed with the individual as to their freedom of choice, liberty of movement and power to make decisions. They now show what processes have been agreed and risk assessed when an individual is likely to be aggressive and give clear directions to staff as to how and when certain medications are to be used. Medication records have improved and ensure that people are given the right dose of medication. 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. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 8 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 Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 9 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 Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since the last inspection. In the previous inspection there was examination of the files of people who live in the home and discussions with staff and a manager regarding the admissions policy. This showed that people living at the home and their relatives had visited the home to meet the staff and take a tour of the home itself. They also received written information about the home. This assisted them in making an informed choice both about whether the home could meet their needs and whether the environment was suitable to them. The manager told us that people living at the home were visited at their previous places of residence before being accepted to move into Cromwell House. During these visits, assessments were carried out and were seen in individual’s care files. This ensured that staff had sufficient knowledge about Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 10 both people to make a decision about whether or not the home could meet their needs. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good People are involved in planning their care and quality of life at Cromwell House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care files for two people that live at the home. We spoke to each person about his or her care plan and were shown their own copy that was in a format that they could understand. We were also shown comprehensive information about the individual’s that was kept in the office. In both cases, the individual’s care plan had been regularly reviewed with them. The people who live at Cromwell House make decisions about daily events in their lives. Their files had records of meetings with key workers, which had taken place every month and focussed on what had been ‘good’ or ‘bad’ for the Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 12 individual during the previous month, what ‘goals’ they wanted to achieve to make things better for them, and what they wanted help with the following month. In a survey 100 of people responding verified that they make their own decisions about what they do during the day, during the evenings and at weekends. We observed this to be the case whilst we were at the home. All of the people living at the home have one to one support from staff when learning skills like meal preparation, which we observed an individual doing. This means that people get the support they need to learn new skills and staff have the time to completely focus on the needs and wishes of that person. At the same time, we observed that people living in the home are treated as individuals and given respect by the staff looking after them. We talked to a person about their care plan which was in ‘widget’ to assist the person understand it. Staff told us that they use flash cards to help the person work through daily tasks within the home. The home had policies or procedures about risk assessment and management. In practice comprehensive risk assessments had been completed and were detailed. For example, one person whose file we looked at needed careful monitoring and sometimes early intervention with medication to manage difficult behaviour. The file clearly laid down ways to minimise identified risks and hazards, whilst at the same time encouraged the individual to be as independent as possible. We observed that staff followed the measures set out. Similarly, we spoke to a healthcare professional who were visiting people that live at the home. They told us that the team are “excellent” and “very skilled” and have managed the individual’s needs well. They said, the team “know how to read” the person and “prevent incidents happening” which means that the person is “much more settled” and “very happy living here”. People were kept safe; whilst at the same time had freedom to do what they wanted to do. We looked at two peoples financial records. Balance sheets had been completed and were audited and found to be in order. One signature was seen on balance sheets denoting withdrawals. Receipts for purchases tallied with entries seen in the records. The manager told us that a qualified accountant audits the accounts. Additionally, records demonstrated that transactions are regularly audited as part of the internal quality assurance processes. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good Individual’s preferences are encouraged in respect of hobbies, meals and activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The lounge looked festive with the Christmas tree up. We had discussions with the manager, staff and people living at the home about activities and choice available at Cromwell House. People showed us the decorations that they had made and the presents they had bought each other and had wrapped up ready for Christmas Day. The expert by experience commented in their report ‘Staff seemed to understand the residents and act on what they wanted. I observed one of the residents being given a different pudding when he wanted to change it. I saw Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 14 the staff offer the residents choices around food for lunch. The residents are involved in the running of the home and are included in decisions that were made. The residents can use the kitchen anytime and make drinks and cook with support.’ The home is very close to the shops and the expert by experience commented that the people living at Cromwell House are ‘very much a part of the community. They enjoy going to the local pub. They have a car so they can go to different places.’ Entries in the daily records demonstrated that people lead fulfilling and varied lives. During the day, people went shopping into the town accompanied by staff. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good People are treated with dignity and respect. Cromwell House has good systems for capturing medical information, which means that healthcare is individualised and takes account of people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a meeting with his key worker every month. These are recorded. These showed that there is discussion between them and the allocated member of staff regarding day-to-day issues and the type of support they need or expect. We discussed a behavioural plan with an individual and their key worker. to assist with communication, agreed time of going to bed and agreed level of assistance to enable staff to assist the person when he was having behavioural problems. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 16 People told us that they choose the clothes they wear or have bought. We observed that people needed varying levels of prompting to ensure that they had the right clothing on to go out shopping for example. Records, including letters, demonstrate that the home has regular contact with healthcare professionals and that advice is sought from community psychiatric staff and a consultant psychiatrist regarding medication and other support that those living at the home may need. A healthcare professional said that the team “do everything that is asked of them and more”. In a survey 100 of people responding felt that staff listened and acted on their needs. From information that the manager sent us, the gender balance of people living at the home is not well matched to that in the staff team. Currently, there are 2 males living at the home with an all female staff group. The expert by experience also raised this as an issue and felt that people might also benefit from being supported to use local advocacy services. We spoke to the manager who told us that they were actively trying to recruit male staff and had had a good response to the latest advert. Medication Administration Record charts were in use and no gaps in the records were seen. We looked at the outcomes of care for both people living in the home. Records demonstrated that medicines had been administered as prescribed. We looked at how ‘when needed’ medication was given to an individual to help them calm down. The home had a written procedure covering this, which gave clear guidance to staff about when this particular medication should be used. A healthcare professional told us that the team had become very skilled at caring for the individual and as a result the person was very settled and the frequency with which the medication had needed to be used had significantly reduced. The team had developed a medication profile for individuals that included an assessment of risks. This highlighted whether the individual would be able administer his or her own medication or not. This had been completed when the person moved into the home and had comprehensive medical and allergy information for staff to refer to. All medicines were seen to be stored in a locked cupboard, which was securely affixed to the wall. Information provided by the manager demonstrated that key staff involved in administering medication had received in house training on this. We looked at training records and spoke to staff whilst they were giving out medication after the evening meal. All of the staff had had training covering safe medication systems in 2008 and we observed that best practice was followed when medicines were given to people prescribed them. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 17 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 People living at Cromwell House are protected and understand that they can voice their concerns, if they have any, safe in the knowledge that these will be dealt with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cromwell House has a written complaints procedure. We spoke to staff that were all aware of the procedure. The procedure includes timescales for completion of investigations and also contains contact details of the Commission for Social Care Inspection (CSCI) and the right of complainants to contact the organisation at any time during the complaints process. It was also written in ‘widget’ in an attempt to make it more understandable to those who live in the home. As stated in the previous inspection, in order that those who live in the home could understand the complaints procedure, staff had further explained it to them. We spoke to two members of staff regarding how those who live at the home were protected from abuse. Both staff reported having viewed the training video, ‘No Secrets’ and having covered the subject of abuse during NVQ training. A training pack is used for in-house training entitled ‘Abuse in the Care Home’. Both staffs was both able to give appropriate examples of what Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 18 constituted abuse and what action they would take both to protect any person living in the home and who they should inform regarding the abuse. As discussed previously, records are kept regarding the money held by the home on behalf of people. It was kept securely and receipts are retained. We also did a random inspection on 11th August 2008. This was because we were told about an incident involving a person who lived at the home, which needed to be looked into. We wrote a report about our visit, which is available on request from the Commission. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 19 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, 25 & 30 Quality in this outcome area is good Cromwell House is clean and provides appropriate accommodation for the people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cromwell House is a detached, older style property situated near the centre of the market town of Torrington giving those who reside there easy access to local facilities. It is registered to accommodate up to ten people, although at the time of the inspection, two people were residing there. Both of the current residents live on the ground floor in adjacent bedrooms. On the ground floor there is a lounge, dining room and conservatory, which people moved freely in and out of whilst we were there. The two front rooms Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 20 are used as an office and sleep in room for staff and a main office for the manager. Access to the kitchen is restricted and we were told that people only accessed this room when supervised by staff for “safety reasons”. The upstairs rooms in the home are unoccupied and are currently not used. They were not inspected as part of this inspection. The dining room, lounge and conservatory were adequately furnished. One resident has a room, which has an ensuite facility. The expert by experience remarked that one person’s bedroom was ‘very homely with photos on the walls with lots of personal things’. Conversely, they commented that other person’s bedroom was ‘quite bare’. Handles had been removed from the windows and the sink had also been removed. The wwallpaper was torn and there was no curtains, wardrobe or any other personal items. We discussed this matter with the manager who told us that sometimes the person’s behaviour meant that they were very destructive and everything that would make the room more homely had been removed for the person’s safety. The visiting healthcare professional explained that the person had complex needs, which are being met at Cromwell House, and that this approach had been agreed with the Community Learning Disability Team. We looked at the person’s care file and read risk assessments and care plans that had been agreed with the individual, which clearly documented why this approach had been taken and who had been involved in the decision making. We discussed ways in which the person’s room might be made more homely with wall murals and frosted patterned covers for windows that would increase privacy and dignity for the person for example. Externally, to the rear of the property is an enclosed garden area, which contains a fishpond. People living in the home told us that they feed the fish and grow vegetables in the summer. The laundry is situated in the garden area away from areas where food is stored, prepared or eaten. The home had a good standard of hygiene and cleanliness throughout. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 21 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 & 36 Quality in this outcome area is adequate Recruitment practices at Cromwell House are not robust and therefore fail to protect people living there. However, training and staff development ensure that competent and knowledgeable staffs care for people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 100 of people responding in a survey felt that the staff always treated them well and listened to them. We examined duty rosters for December 2009, which accurately recorded the names of staff, and duties that had been worked. The number of staff on duty has increased since the last key inspection and means that people had 1:1 support at particular times of the day when learning new skills like meal preparation and cooking. We observed that staff were attentive and supported people in an unhurried way that was totally person centred. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 22 We examined 4 files for staff that had been working at the home at the time of the last key inspection. Satisfactory references, including a CRB and POVA check had been obtained. Information received from the provider verified that recruitment practice had improved since the last key inspection. At that time we reported that checks had not been taken up before employment and made a requirement. We were shown another file for a new member of staff who started employment on 4/12/08, which was verified by other records and the manager. CRB and POVA checks had been obtained prior to employment. However, no written references had been obtained for the individual that included their last place of employment in the care sector. We discussed our findings with the manager who was reminded about the Commission’s publication ‘Safe and sound? Checking the Suitability of new care staff in regulated social care services’ [available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf]. We also clarified best practice in relation to recruitment procedures. We examined 4 staff files, which demonstrated that new staffs go through the Learning Disabilities Award Framework (LDAF) induction. This is the recognised induction for staff that works with people who have learning disabilities. Information provided by the manager verified that 100 of staff holds the NVQ award, which exceeds the National Minimum Standard and is commendable. Staff had also received training in ‘Autism Awareness’, which will assist them in understanding the needs of people who live at the home. We spoke to staff during the inspection, which told us that they had regular 1:1 supervision sessions with the provider. Staff told us that they “enjoy working at Cromwell House”. We looked at 4 staff files; all recorded that a recent supervision session had taken place. This was also borne out when we spoke to staff that told us they felt well supported by the manager and provider. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 23 Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 24 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 The people that live at Cromwell House do so in a home that is well run. People’s views are valued and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Brian Coates and Diane Taylor-House own the home. As stated in the home’s Statement of Purpose they have ‘over 25 years experience in the care industry’. Ms Taylor-House has participated on a Diploma in Social Work course and they have both attained their NVQ 4 and Registered Managers’ Awards. In the last key inspection report we highlighted that the provider must apply for registration as the ownership of the service had changed when it became a Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 25 Limited Company. The registered providers applied to the Commission for registration as a Limited Company, which was approved as a ‘new service’ on 12th December 2007. The provider gave the Commission a clear picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment), which we promptly received. The information provided was clear and enabled us to know what to focus on during the inspection. Additionally, it was clear that the manager/provider fully embraces quality assurance and puts the people living in the home at the centre of everything they do. At the same time, they were open about what they could do better and able to demonstrate continous improvement in various areas throughout the course of the inspection. Our main concern at the inspection has been that the recruitment procedure was not robust and should have improved since our last inspection. However, we are confident that this will be addressed and audited in the future to ensure that this does not happen again. The certificate of registration was displayed in the hallway, which is a legal requirement. We also saw the public liability certificate, which was valid. We met a Food & Safety Officer from Torridge District Council who was also inspecting the home. He told us that the provider had not done an asbestos survey, which is a legal requirement under Health & Safety legislation. We both saw that fire extinguishers were not fixed to the walls. We discussed this with the registered manager who told us that those these had been removed for safety reasons with regard to a particular individual living at the home. However, the fire extinguishers had also been removed from the positions where they might be needed in the event of a fire. We discussed the possibility of obtaining robust covers so that the extinguishers remain in the correct position and the manager told us that she would look into this. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. Staff we spoke to told us that they had been regular training. We were shown the induction pack and saw that completion of this had been recorded in the files we looked at. We toured the building and observed that cleaning materials were stored securely. Records of accidents were kept and showed that appropriate action had been taken. For example, two of the people whose care we tracked had had minor accidents and received first aid from qualified staff. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home told us that the alarm was regularly sounded. Certificates verified that an engineer had installed the fire alarm. First aid equipment was clearly labelled. Maintenance certificates were seen for fire alarm and electrical systems. The provider had verified in information sent to the Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 26 Commission that a local electrician had inspected both the electrical system and appliances. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 27 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 3 25 2 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 1 35 4 36 3 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 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19(4)b(i) Requirement The registered provider must ensure that people living at the home are safeguarded by ensuring that thorough preemployment checks have been carried out on all new employees prior to their commencement of duties at the home. Timescale for action 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA25 YA42 Good Practice Recommendations Steps should be taken to make a named individual’s bedroom more homely for them. People living in the home should be protected from the risk of fire by ensuring that fire extinguishers remain in position and are covered in a way that ensures the safety of individuals with challenging behaviours. Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA 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 Cromwell House DS0000071360.V373584.R01.S.doc Version 5.2 Page 30 - 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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