Inspection on 17/11/08 for The Cottage

This is the latest available inspection report for this service, carried out on 17th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Cottage The Cottage Old Hill Longhope Gloucestershire GL17 0PF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: The Cottage The Cottage Old Hill Longhope Gloucestershire GL17 0PF 01452830373 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Brandon Trust care home 4 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 4. 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 category: Learning disability (Code LD) Date of last inspection Brief description of the care home The Cottage is a detached house in the village of Longhope. It is registered to provide care and accommodation for four learning disabled adults. The home is staffed at all times. In addition to providing personal care and other support as required, the home aims to offer a range of activities both on site and in the community. There is an enclosed garden at the rear of the home and a visitors room has been developed in an outbuilding. The weekly fees charged by the home range from are 65 pounds and 20 pence to 102 pounds 90 pence. 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 24 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 inspection took place in November 2008. During the inspection visit records were examined including care plans, staff files, health and safety systems and quality assurance documentation. An (Annual Quality Assurance Assessment) AQAA was completed and provided for the inspection. Some surveys previously collected for the Annual Service Review (ASR) in June 2008 were also used for this inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 5 of 24 Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 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 8 of 24 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. People who may use the service would be assessed as to how their needs would be met, and the suitability of the home before they move in. Evidence: There had been no admissions to the home since before the previous two inspections. The registered manager described the various approaches that may be used to assess the suitability of a person for the home. The registered provider has a designated person who deals with any admissions to the groups homes. Care Homes for Adults (18-65 years) Page 9 of 24 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. A person-centred approach to care planning with comprehensive risk assessment, gives staff clear information on how people can be supported to live their lives. Evidence: People using the service had care plans for a number of assessed needs. Those looked at were in a format describing,need,aim,and background. They were also written in a person centred way as though the person was speaking. Care plans had been reviewed on a six monthly basis and were very specific and personalised. The care plans included clear instructions for staff to follow and gave examples of the best response to certain behaviours. One person had a detailed plan describing how they needed staff to communicate with them. People using the service were enabled to make decisions about their lives through an Essential Life Plan where identified goals were recorded in a pictorial form suitable for Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: the person. One plan had been shown to the person using a Power point computer presentation. The home had access to advocacy services for people with a learning disability should this be needed. Risk assessments had been completed described as risk taking plans, these were detailed and individualised and described actions to be taken to reduce any identified risks. They had been reviewed on a six monthly basis. One person had a risk assessment for going out of the home and for carrying out recycling.The home stated in its AQAA document We assess risks whilst enabling people to try new activities. Care Homes for Adults (18-65 years) Page 11 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in appropriate activities inside and outside of the home, maintain relationships and have some links with the local community. Evidence: People using the service were taking part in a number of activities outside of the home. These included swimming and an art and music course. Activities and leisure interests are part of the essential life plan for each person using the service. One person had visited a safari park as part of their plan and this had been recorded in photographs. The home has enabled people using the service to develop some links with the local community. People are registered with local General Practitioners (GPs) and people Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: attended the local village hall to receive their influenza vaccines there. People also go out for lunches at local pubs. Links have been made with a horse and donkey sanctuary where a donkey has been adopted by the home. People are able to maintain contact with family members through visits to the home. Facilities for visitors had been improved with the development of the visitors room. This provides an area away from the main house with comfortable seating and facilities to make drinks. Although there are restrictions on the access of people using the service to areas of the home such as the kitchen on safety grounds, people have unrestricted access to the enclosed rear garden and one person was observed spending time there during the inspection visit. The main meal in the home is offered in the evening with lunch being a snack. A record of meals provided is kept. The home receives support from a dietitian to provide meals that are both healthy and in line with peoples known favourite dishes. The registered manager described how peoples choice of meals can be checked by showing them various foods before they are served.Takeaway meals are also ordered on occasions. At the time of the inspection visit there were no special diets being provided to people in the home. Care Homes for Adults (18-65 years) Page 13 of 24 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. Despite the need for an improvement in some aspects of medication storage and recording, people who use the service have their health needs met and receive good personal care and support. Evidence: Personal care and support needs for people are recorded in specific plans that are written in a person centred way and take into account individual preferences as well as needs. One survey form received by us from a relative of a person in the home in June 2008, indicated that the home Always gave their relative the support or care they expected. There was evidence of peoples health care needs being met by good liaison with General Practitioners (GP) over a number of issues concerning their health needs. People had health action plans and an at a glance summary of their health care history. A plan had also been drawn up for one person for health care staff to understand behaviours in the event of the person being admitted to hospital. Another had a specific medical condition and the home had obtained information on this which Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: was kept on the persons file. One person had been receiving input from the Community Learning Disability Team (CLDT) for a referral about managing certain behaviours. Medication was stored securely although there were no checks being carried out on storage temperatures. These should be monitored in line with directions indicated on medication containers. The medication storage cupboard was in need of a clean and this was carried out during the inspection visit. Medication administration records included handwritten changes and entries that had not been dated and signed by the person making the entry or checked for accuracy and signed by another member of staff. In addition correction fluid had been used on one medication chart, this should not be used in the interests of accurate record keeping. A flowchart was in place to guide staff in the event of any medication dose being refused by a person or an error being made in administration. Medication charts included photographs of people as an aid to correct identification by staff. There was also good guidance in place for the administration of medication prescribed to be given on an as required basis with flowcharts and individual plans. At the time of the inspection visit there was no controlled medication stored or in use in the home. It was reported that an annual audit is carried out by the supplying pharmacist. Care Homes for Adults (18-65 years) Page 15 of 24 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. Systems are in place that safeguard people from possible harm or abuse and allow for complaints and concerns to be raised on their behalf. Evidence: The home has a complaints procedure that is available in pictorial form. Copies of these were kept on the files of people using the service. A survey form received from a relative of a person using the service indicated that they knew how to make a complaint. The home had received two complaints since November 2007 and both of these were known to us. All staff in the home have received training from the provider in protecting vulnerable adults. Additionally the subject is included in induction training. Staff also receive Positive Response Training (PRT) on how to respond positively to any aggressive behaviour. This is a three day course on using pro-active as opposed to reactive responses. It was reported that no restraint is used in the home only removals and there had been no occasion to use removals recently. All people using the service have bank accounts. The home has secure storage for money or valuables. Records were checked for one resident and these accurately reflected the amount of money held in safekeeping in the home. Care Homes for Adults (18-65 years) Page 16 of 24 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. The physical design and layout of the home enables people to live in a wellmaintained and safe environment. Evidence: The environment both inside and outside of the home was looked at. The home was clean,well maintained and with a good standard of decoration. Various adaptations had been made such as unbreakable mirrors sited in a number of places as an aid to staff observation in managing any challenging behaviour. The communal areas had recently been redecorated and new furniture had been delivered for the lounge. There was an enclosed garden at the rear of the home with seating. The development of a sensory garden beyond the enclosed garden had been abandoned and this area was not generally accessible to people using the service. People were seen making use of the enclosed garden during the inspection visit. An outbuilding that had previously been a sensory room, had been developed for the use of visitors. There was a small laundry that was clean and had suitable wall and floor surfaces. It was also equipped with hand washing facilities. Care Homes for Adults (18-65 years) Page 17 of 24 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. Recruitment and selection procedures are robust ensuring that people using the service are safeguarded. Staff receive training that will equip them to meet the specific needs of people using the service. Evidence: Staff in the home have undertaken training relevant to the needs of people using the service such as person centred planning and Mental Capacity Act 2005. Although four members of staff were undertaking a National Vocational Qualification ( NVQ) the home had less than half of its staff group with an NVQ and this should be improved. A number of staff had also completed some units of the Learning Disability Awards Framework (LDAF). In order to recruit suitable staff the home uses a profile that gives a set of qualities and attributes that staff should have in order to effectively support people with Autism. Four staff survey forms were received by us in June 2008 and all of them gave positive respones about the training they had received being relevant to their role in supporting people in the home. The information obtained for the most recent member of staff recruited to the home was looked at. The correct information and documentation had been obtained for the Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: staff member prior to employment including written references and Criminal Records Bureau (CRB) checks. Care Homes for Adults (18-65 years) Page 19 of 24 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. The home is well managed with a robust quality assurance system in place and staff trained in safe working practices. Evidence: The Registered Manager had achieved the registered managers award with an NVQ level four in Health and Social Care. She had been registered for around a year and prior to that had been acting manager for a year and a half. The Registered Manager has completed training in the Mental Capacity Act 2005, Health Action Plan Facilitator training, Person Centred Planning Facilitator training and was working towards a University Certificate in Autistic Spectrum Disorders. The home has a comprehensive quality assurance system that involves a selfassessment of the service and produces an annual quality assurance action plan. Questionnaires had been returned from relatives of people using the service. It was reported that responses on one questionnaire about facilities for visitors had led to the development of a facility for visitors in the outbuilding. The home was also working Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: towards accreditation by the National Autistic Society.( NAS). This is an Autism-specific quality assurance system that involves a self audit against standards followed by a review. At the time of the inspection process the home was undertaking self audits against standards set by the NAS. A review would then take place in April 2009 and if successful the home would then achieve its accreditation for a year. In addition a representative of the registered provider carries out inspections under regulation 26 of the Care Homes Regulations 2001. Reports are kept in the home and three were looked at during the inspection visit. The home has plans for introducing stakeholder surveys to gain further views on how it is delivering the service in the interests of the people using the service. Staff in the home have carried out training in safe working practices in the areas of fire safety, moving and handling, first aid, food hygiene and infection and contamination. The central heating system and the electrical system had been checked. Portable electrical appliances were due to be checked in he week following the inspection visit. Cleaning materials are stored securely in an outbuilding although some substances had been decanted in to small containers that were not correctly labelled. However during the inspection visit the registered manager was able to order suitable labels from the supplier. A legionella risk assessment had been completed with a series of actions to be carried out to reduce the risk to people using the service. Water temperature checks were being carried out from hot water outlets on a monthly basis and one low temperature discovered being reported to the plumbing contractor. The home had completed a fire risk assessment which included individual evacuation plans for residents. There was good awareness amoung management and staff about fire evacuation procedures. This was demonstrated during the inspection visit when the use of the grill in the kitchen activated the fire alarm. Care Homes for Adults (18-65 years) Page 21 of 24 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 22 of 24 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 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 20 Correction fluid should not be used on medication administration records in the interests of accurate record keeping. Where any handwritten changes or entries are made these should be dated and signed by the person making the entry and checked for accuracy and signed by another member of staff. The temperature in the medication storage cupboard should be monitored and recorded to check that residents medication is being kept at the correct temperature. More staff should undertake an NVQ. 2 20 3 20 4 32 Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 24 of 24 - 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!