Inspection on 02/10/08 for The Old Rectory

This is the latest available inspection report for this service, carried out on 2nd October 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 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

The Old Rectory 23/05/07

The Old Rectory 11/12/06

The Old Rectory 10/11/05

The Old Rectory 16/12/04

The Old Rectory 21/07/04

The Old Rectory 23/01/04

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Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

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Dovedale Court

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 The Old Rectory 45 Sandwich Road Ash Canterbury Kent CT3 2AF Lead Inspector Mark Hemmings Unannounced Inspection 2nd October 2008 09:00 The Old Rectory DS0000023705.V372337.R02.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 The Old Rectory DS0000023705.V372337.R02.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. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address 45 Sandwich Road Ash Canterbury Kent CT3 2AF 01304 813128 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) helene@theoldrectoryash.co.uk Mr Rex Slade Cadman Manager post vacant Mr Rex Slade Cademan Care Home 40 Category(ies) of Learning disability (40) registration, with number of places The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 22nd October 2007 Brief Description of the Service: The Old Rectory (the Service) can give accommodation and personal care to 40 younger adults who have a learning disability. Some are older people who have been there a number of years. Some of the people have special communication needs. This means that they do not have easy use of spoken and written words. The premises are a detached three-storey older detached house. Over the years, extensions have been added to the sides and at the back. When full, five of the bedrooms can be shared by two people each. All of the other bedrooms are singles. Each bedroom has a wash hand basin. Eleven of them also have a private toilet and shower or bath. The Service is in Ash. This is a small village that is about three miles from Sandwich. There is village shop. There is also a bus service from the village that goes to Sandwich and Canterbury. The Service has its own transport and so people can get about without having to rely on the limited local public transport. The Registered Provider is a private individual. He is also the Registered Manager, so is assisted by a person who carries out a whole range of management type things. In this report we refer to her as being the Manager, although she is not registered with us. People who might want to move in can find out things about the Service. There is a Service Users’ Guide. This is a brochure that outlines the main things available in the Service. There is also a document called a Statement of Purpose. This is more detailed than the Guide. The Registered Provider makes sure that a copy of our most recent Inspection Report is available for people to see. The range of fees charged currently for each person to live in The Old Rectory starts at £590.00 per week. The fees paid for some of the people are higher. This is because they need additional support. The fees cover the cost of accommodation, personal care, meals at home, laundry and some activities. They do not cover things like personal toiletries, the costs of petrol for the vehicles and meals out. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 5 The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this Service is 2 star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006 we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. The Inspector arrived at the Service at 09.00 and was in the Service for about seven and a half hours. It was a thorough look at how well things are going. We took into account detailed information provided by the Registered Provider in his self-assessment. This is called the Annual Quality Assurance Assessment. Further, we considered any information that we have received about the Service since the last inspection. Before we went to the Service we asked some of the people who live there and some members of staff to fill out a questionnaire for us about how things are going. We got 13 of them back. When in the Service, we spoke with seven of the people who live there and more generally spent time with about 20 people. This was done to get a first hand feeling of how things run in practice. We spoke with the Registered Provider, the Manager, three support workers, the cook and two administrators. We looked at some key records and documents. We had a look around the accommodation including lounges and the bathrooms. Some people invited the Inspector into their bedrooms and so we saw about five of them. We looked around the grounds. What the service does well: There is a relaxed and friendly atmosphere. The people who live in the Service say that support workers are kind and attentive. People say that they have good meals. People receive the support and assistance they need. Support workers know what they are doing and they have a detailed knowledge of each individual’s needs and preferences. People lead active lives and they are helped to keep in touch with their families. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 7 Medication is given safely and people are helped to promote their good health. Sensible steps are taken to reduce the chance of accidents. What has improved since the last inspection? 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. The Old Rectory DS0000023705.V372337.R02.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 The Old Rectory DS0000023705.V372337.R02.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): Standard 2. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. People who might want to move in are asked about what support they want. They are then helped to settle in. EVIDENCE: The Registered Provider says that he and the Manager complete an assessment of each prospective person’s needs for assistance. This is done before a decision is made about whether or not the Service can meet the person’s needs. He says that an important part of the process is talking with the person. This is done so that he can find out what support they need and how they want this to be given. As appropriate, members of the persons family and care managers (social workers) are involved. Whenever possible, the person is encouraged to visit the Service beforehand. This is so that they can see what it is like in practice. The Registered Provider and the Manager emphasise that they want to do everything possible to help make the move into the Service a positive experience for the person concerned. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 10 We looked at what had been done for someone who moved into the Service since our last inspection. Information about the person’s needs for personal support, about their health and about their special communication requirements had been gathered. We asked support workers if this information had been shared with them in advance. They say that it was. In consultation with the care manager, special arrangements had been made to help the person settle in. These included kitting out the persons new bedroom with their own things so that when they saw it the place felt familiar and welcoming. None of the people who live in the Service wanted to talk much about when they moved in. They were much more interested in chatting about what they do at the moment. The Old Rectory DS0000023705.V372337.R02.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): Standards 6, 7, 9 and 10. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. There are individual written plans of care. There is a sensible approach to everyday risk taking. EVIDENCE: People say that the support workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important documents. This is because they form one of the means by which people can decide about the support they need. Also, they are a way for them to show their agreement with how this is going to be delivered. The plans are a source of information for staff. This then helps them to provide support in the right way. We looked in some detail at four sets of these plans. They contain information about a number of relevant things. For example, there is The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 12 information about how to help the people say what they want and about how to support them in managing parts of how they go about things. There is stuff about how to help them with practical things such as getting dressed and using the bathroom. We spoke with three of the support workers about what is in these plans. They have a good knowledge of the needs and wishes of the people concerned. They know about the particular aspects of the support they need. Most parts of the plans are not written in a user-friendly manner, which is a pity. There is a lot of management-type material. Also, there is a good deal of rather complicated-looking paperwork with various different forms to go through. This makes for dull reading. It will be very difficult for the people who live in the Service to see it as something that relates to them. The Registered Provider is going to look at new ways of presenting this information. This is so that it is easy to use and interesting for people. All of the people who live in the Service are helped to manage their financial affairs by the local authority. This involves it keeping a track of money coming in for them and then paying their bills. The Registered Provider does not get involved in any of this side of things. This is a good idea because it helps to avoid any conflict of interests. However, he has worked out a system with the local authority to make sure that people get their weekly personal spending allowance. This involves him giving people cash each week to spend as they want and in him paying for things like some of the activities. The Registered Provider then gets paid for this by the local authority from the money it holds for each person. There are lots of records that have to be kept to run this system. Again, its all quite complicated and dull. We think that more can be done to make it interesting and meaningful to the people who live in the Service. In the interim, we checked some of the records to make sure that the system as it is now is working okay. For example, we looked to see if there are receipts for things said to have been bought for people and there are. Sensible consideration is given to the personal safety of the people concerned. They are not over-the-top and so people are still free to do things that they want to. For example, one person likes to help out in the garden. We saw them using a big petrol-driven strimmer. They were wearing suitable protective clothing and seemed to have no trouble getting on with cutting back some grass. A support worker was working alongside them. He kept a tactful eye open to make sure that things were going okay. There are written plans that say what potential risk is being considered and what needs to be done. Again, the information is presented in a management style. Some of the people concerned may find it to be boring and difficult to understand. We think that more can be done to make it interesting and user friendly. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 13 All in all there is quite a lot of written information about each of the people who live in the Service. Most of the people who live there dont bother much about it. We think that once the plans of care and risk assessments are opened up people might want to know more about what is written in their name. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14, 15, 16 and 17. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. People can do occupational and social things that interest them. They are helped to keep in touch with their families. They can spend their days as they wish. Good quality meals are served. EVIDENCE: People are free to do things that interest them. Several people regularly go to a local college where they do a cookery course. Other people do various arts and craft activities. People are expected to help out around the place. We saw one person helping in the kitchen. They were busy buttering bread for tea. Another person told us that they like doing things like laying tables and clearing away. People can get a small payment in recognition for their work. The Registered Provider says that it is important for people to be encouraged The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 15 to take care of their home. The Annual Quality Assurance Assessment says that people will be encouraged to try new and different occupational activities. The Manager confirmed this. She says that she speaks with each person every now and then to see if there are any new things that they would like to do. People have the opportunity to take part in social activities. Some of these take place in the Service. Others involve going out with support workers in the people carriers to events further afield. We looked at the records of what two people have done recently over a week or so. One of them had been out to the village on several occasions, had been to see a musical and had been into town shopping. The other had been to two boot fairs and had been to the local fish and chip shop. We asked a third person about how often they get out. We did this because unlike the first two people, this person has difficulties with walking. They say that they went out into the village the day before we came and that they are quite happy about being able to do things. On the day of the inspection, some people went out in one of the people carriers with one of the support workers. We asked another support worker about how often the people who live in the Service get out and about. They replied, people can go out pretty much every day if they want to. If they dont its because theyre home birds. Thats fair enough if thats what they want. People say that the pace of daily life in the Service is relaxed and unhurried. While they have considerable choice about how to spend their day, there are broad expectations about some of the things they will do. For example, they are expected to adopt reasonable personal practices such as not going to bed too late. This is so that they are not too tired the next day to do things. People are helped to keep in touch with members of their families. Family members and friends are welcome to call to the Service at any reasonable time. Everyone has contact with someone just for them outside the Service. In most cases this is a member of their family. Or it might be their care manager. The Manager in consultation with the person concerned, keeps in touch with family members and care managers. This is done so that they know how things are going. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant experience. There is a choice of dish available at each meal time. At lunch and dinner, there is a main meal and then people can have something different if they prefer. When we arrived, breakfast was being served. This was a large plate of fried bread, tomatoes and sausages. Everyone was tucking in. The meal time was a lively affair with people talking about what they planned to do that day. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 16 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): Standards 18, 19 and 20. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. People are helped in ways that are right for them. They are helped to stay well. There are safe systems to manage medicines. EVIDENCE: People are assisted in ways that are right for them. For example, some people need more personal space than do others. Or another example is that some people need more support than do others when choosing clothes that are right for the weather at the time. Support workers are courteous in their manner and they respect each person’s individuality. People are confident that they can rely upon support workers to be there when they are needed and to be approachable. We observed support workers giving people the time they need to express themselves. They then responded in a helpful manner to their requests. One of the questions we ask in our questionnaire is do the staff treat you well? All of the people who answered say that they always do. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 17 People are helped to stay healthy. Support workers note when someone is not well and they make sure that medical assistance is obtained. Since the last inspection, people have been supported to see their family doctors and other medical personnel. People are encouraged to promote their good health. For example, they are helped to go for regular checkups with people such as the dentist. When we were in the Service once person was not well and was becoming quite distressed. The Manager was keeping an eye on this. The next day she arranged for a special medical assessment to be done. This is so that the person can be admitted to hospital for further treatment. Some of the people who live in the Service dont take any medicines. For those that do, all have their medicines managed by staff at the moment. When they are delivered to the Service one of the senior support workers checks them in to make sure that they are correct. They are then stored securely and in an organised manner. The support workers who dispense medicines know what they are doing. They have been assessed by the Manager to make sure that they follow a clear procedure. We think that this double-check is a very good idea. The procedure is designed to ensure that each person takes the right medicine at the right. We looked at three sets of records relating to the medicines dispensed. There are no errors. In more detail, we looked at two medicines in particular. This was done to check that the record of their use matches the stock that was left in the store. Again, there are no mistakes. We think that some people might be able to do more to manage their own medication, or to do bits of the process. The Manager says that she is going to look into this so that people can be offered any support they need. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 18 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): Standards 22 and 23. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. There is a complaints procedure. The wellbeing of people is safeguarded. EVIDENCE: There is a written complaints procedure. The main one is written in normal management-type words. So it probably wont be that interesting for the people who live in the Service. The Registered Provider recognised this and decided to develop another more user-friendly version of the procedure. He asked people who live in the Service what would be most helpful for them. They said that they wanted a straightforward thing that uses a picture to show that they can go to the Registered Provider about anything that might be on their mind. The Registered Provider has since drawn this up. Its best to sort out complaints as soon as possible and with as least fuss as possible. This usually means that complaints are sorted within the Service. However, people do have the right to come straight to us about something. For example, they might not feel comfortable speaking about a particular matter to someone in the Service. This direct route to us is not explained in the procedure that uses the picture. The Registered Provider says that he is now going to include this in the procedure. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 19 People say and indicate by their manner that they feel safe living in The Old Rectory. The Registered Provider has a written policy and procedure that tells support workers what to do if they become concerned about someone’s wellbeing. For example, if someone is being bullied or having their freedom limited without good cause. We spoke with two support workers about this matter. They are aware of what to look out for and who to contact if they become concerned. They say that they havent seen or heard anything to worry them. Indeed, they are confident that the people who live in the Service are safe and well supported. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 20 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): Standards 24, 25, 27, 29 and 30. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. People live in a generally comfortable setting that promotes their independence. The kitchen is clean and well equipped. There is a separate laundry. EVIDENCE: Most areas of the accommodation are decorated and furnished to a normal homely standard. The Registered Provider displays a lot of his own things around the place. For example, model cars and things in general to do with engineering. There is so much stuff around that it could easily be oppressive. However, it isnt. The place has a real lived-in feeling to it. There are one or two problems that need to be sorted out. There is an area of damp damage in one of the stairwells. One of the bathrooms is in a poor condition. The floor is The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 21 uneven, the walls are a bit off colour and there is a broken towel rail. The Registered Provider says that he has already planned to sort out all of these problems by this Christmas. We asked some of the people who live in the Service if their home is kept warm enough in winter. They say that it is. The radiators are fitted with guards. This has been done to reduce the risk of someone being burnt if they fall against one. Support workers say that there is a good supply of hot water. This is temperature controlled to help reduce the risk of someone being scalded. We tested a few of the hot taps. The water isnt too hot. The premises are fitted with an automatic fire detection system. This provides a high level of fire safety protection. The Kent Fire and Rescue Service called earlier this year. It says that the fire safety measures in place meet the national standard. Since then, the Registered Provider has prepared a fire risk assessment. This has been done to ensure that the fire safety system continues to work as intended. The assessment says that two quite minor improvements need to be made. The Registered Provider says that these have been done. The local Department of Environmental Health last called to the Service in March this year. It says that the food handling arrangements in the Service are satisfactory. However, it did recommend that more attention be given to cleaning difficult-to-reach places in the kitchen such as where the walls meet the floors. We looked at the kitchen. It is quite small and so its just as well that it is well organised. We looked to see if it is clean. We looked behind the waste bin because this is a difficult area to reach. Its clean. There is a system to make sure that foods are used within their best-by dates. There is also a system to make sure that the refrigerators are cold enough to store foods safely. Sensible steps are taken to promote hygiene. For example, there are different chopping boards for use when preparing uncooked meats. As we have said earlier, some of the people who live in the Service are older people. We asked about how they manage to get about in general. We also wanted to know in particular about the help they need in the bathroom. Some of them are not able to use a bath. This is not a problem because there are showers that they can use. The Manager says that she is aware of the need to keep this matter under review. This is because as people become older more specialist equipment might be needed. For example, it may be necessary to get a hoist so that people can be assisted in and out of the bath if they dont want to have a shower. The Registered Provider says that all of the people who share a bedroom at the moment are quite happy to do so. We didnt have the chance to ask any of them. However, support workers say the same thing. We did speak with people about their bedrooms. They say that they have been encouraged to make them into their own private space. We saw lots of examples of this. For The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 22 example, one person has displayed their model aircraft and cars. Another person has some football memorabilia out on display. When we were there one of the bedrooms had just been re-carpeted. We were pleased to see that the person had been encouraged to choose the colour themselves. Even though this had resulted in a rather loud colour being used that might not be everyones first choice. Since our last inspection, some of the bedroom doors have been fitted with locks. Also, some of the bedrooms have furnished with bits of lockable furniture. This is a good thing because people may want to have space that is completely theirs and is secure. The Manager says that more bedrooms will have locks and lockable furniture in the future. The laundry is equipped with a commercial washing machine and dryer. People are encouraged to do their own laundry. However, in practice most rely upon support workers to organise this for them. The arrangements used work well. Each person has a sufficient supply of clean and presentable clothes from which to choose. There are new regulations that have been introduced to ensure that used water does not leak back into the main pipe-work. The Registered Provider is going to check with the local water supply company to make sure that he meets whats needed. This will be done by 1 November 2008. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 23 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): Standards 32, 33, 34 and 35. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. There are enough staff on duty to make sure that people get the support they need. Security checks are completed on staff. Support workers know what they are doing. EVIDENCE: There are seven (and sometimes eight) support workers on duty from early in the morning until the evening time. Then the number reduces to three. There is a waking staff presence in the Service at night. During the day, there are other people around such as kitchen staff and housekeepers. We looked at the roster to see if the various shifts are being filled reliably. We found that they are. We asked some of the people who live in the Service if there is enough staff on duty. They say that there is and that they get all the support that they need. We asked three support workers about the staff cover. They also think that it is adequate to enable them to give people the support and attention The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 24 they need. They say that even if there were more staff around it wouldnt really add anything to the Service. The Registered Provider completes a number of security checks for new support workers. These include checking the person’s identity and their employment history, seeking references and obtaining a police check. This is done to ensure that they are suitable and trustworthy people. We looked at the personnel files of two support workers who have been appointed recently. The files are neat and organised. The main security checks have been completed. However, for one person their employment history is a bit muddled. There are gaps and some of the dates dont make sense. This means that we cannot be sure that all of the necessary references have been obtained. The Manager is going to sort this out by 1 November 2008. By this time she is also going to check the employment histories of all other support workers appointed since the start of 2007. This is so she can be sure that all of the necessary references have been obtained. The Annual Quality Assurance Audit says that the people who use the Service are actively involved in the recruitment process. This entails them meeting applicants so that they can say if they want someone to come to work in their home. New support workers receive introductory training before they work without direct supervision. This is done by using a method that focuses on the knowledge and skills that people can bring to their work. We think that this is a good idea. We looked at how it has been used for one recently appointed support worker. It has been used in the right way. After their introduction to the Service, support workers have extra training in a number of important subjects. For example, in first aid, health and safety, food hygiene, administering medication, supporting people who express themselves through difficult behaviour, the safeguarding of vulnerable adults and fire safety. We looked at the records of who has done what training. We found that everyone is up to date. Since we were last in the Service, some support workers have done additional training courses in useful subjects. These include helping people have a healthy diet and supporting people who have problems understanding things. When we spoke with support workers we asked them about points of detail to do with their work. We wanted to see what their knowledge is. They have a sound understanding of important things such how people prefer to express themselves and we saw them using their expertise to good effect. They also know about how some people need special reassurance when they are anxious. Again, we saw them helping people to manage okay if they became distressed. The Manager already checks out with each support worker how they are going about key bits of their work. For example, how they go about respecting peoples privacy. She is planning to develop this a bit more. This is so that The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 25 more subjects are included. We think that this is a very good idea because it helps to make sure that support workers dont get stale. All of the support workers have obtained a relevant National Vocational Qualification (NVQ) at Level 2. Seven people have the qualification at level 3 and three people have it at Level 4. These qualifications are designed to help support workers provide high quality support for people who live in residential care settings. The Annual Quality Assurance Assessment says that all new support workers will be encouraged to study for the qualification. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 26 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): Standards 37, 39, 40, 41 and 42. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. The Service is reliably managed. People are asked what they think about how things are going. People’s health and safety is promoted. EVIDENCE: As we have already said, the Registered Provider is also the Registered Manager. However, in practice he is assisted in the day to day running of the service by the a person acting in the manager role. She says that they work together well as a team. Both of them have a thorough knowledge of how things are going in the Service. When we ask them questions about points of The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 27 detail they know the answers without having to search around for bits of paper. We noted that the Manager wrote down the developments that we agreed with her and the Registered Provider. She says that she does this so that she wont forget anything. The Manager has both of the formal qualifications that we expect. These are important. This is because they are intended to help managers ensure that people receive high quality residential care services. There are various systems used to promote good team-work. These include handover meetings at the beginning and end of each shift. Also, there are monthly staff meetings. We looked at the records of two recent meetings. A range of useful subjects was discussed. For example, support workers were encouraged to bear in mind that The Old Rectory is home to people who live there and as such is not a place of work. Other things were more practical, such remembering not to prop fire doors open when they are not in use. Support workers say that there is good team work. We saw plenty of evidence of this. Support workers check out with each other who is going to do what, with whom and when. Also, they plan their work in advance so that they use their time to the best effect. For example, they know who needs the most support when they go out and they organise themselves accordingly. People are asked about how well they think things are going in their home. These include informal everyday discussions and more organised housemeetings. All of the people who live in the Service are invited to attend these meetings. They can raise anything they like. We looked at the records of the meetings held in July and August this year. A number of subjects were discussed. For example, one person said that there had been no jam available at tea time for a couple of days. The Registered Provider promised to sort this out without delay. Another thing was about some disputes about who sits where at the dining room. The Registered Provider helped people to sort this out for themselves. He suggested that it might be best not to have set places so that arguments dont happen. In addition to this, the Registered Provider asks relatives to complete yearly satisfaction questionnaires. The results of this are then added up and a summary is sent out to relatives attached to a quarterly newsletter. We think that the newsletter is a very good way of telling people whats going on. We looked at the results of the most recent questionnaires. They show that relatives are very happy with the quality of the support provided in the Service. In more detail, 27 out of 32 responses say that the personal support provided for people is excellent or very good. There are similarly positive comments about the meals provided and about the range of things people can do. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 28 However, members of staff are not included in this process. This is a shame because they have a detailed knowledge of how things work. We gave 10 of our questionnaires to staff and we got seven of them back. They paint a very positive picture about what it is like to live and work in The Old Rectory. One person summarises the overall mood when they say, I feel that the support I get from the manager is more than adequate …the home provides a warm family atmosphere. People have a wide choice of activities and outings and are usually always busy. The Registered Provider is going to develop the present arrangement so that in future members of staff are asked how things are going in the same way that relatives are. Also, he is going to summarise what everyone has said about the Service. This is so that each of the people who live there can be told what has been said and what is going to be done to respond to any improvements that might have been suggested. This is going to be done in time for us to be told about it when the Registered Provider sends us his next Annual Quality Assurance Assessment in 2009. The Registered Provider has got lots of policies and procedures. These are mainly to do with management things. For example, reminding staff about health and safety matters. The ones we looked at are quite detailed. Again, they are long and quite heavy-going to read. Earlier in this report we have talked about how the people who live in the Service might become more engaged with written stuff. If this happens, some of the procedures may need to be made more user-friendly. Regular checks are done to make sure that the Service’s fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells and quarterly more detailed checks completed by a contractor. There are unannounced fire drills. Each member of staff attends an annual fire lecture. The next one is due quite soon. After this has been held, the Manager is going to introduce a new system that will make sure that people who miss the training event can still have the tuition they need. This will mean that everyone will have been checked to make sure that they know about fire safety things by 1 November 2008. This is very important because the actions taken by staff largely determine the level of fire safety protection available in the Service. The electrical installation and the gas-fired appliances have been certified as being in a safe-worthy condition. We looked at the record of accidents and other untoward events that have occurred in the Service this year. There is nothing out of the ordinary in the sense that we need to make further enquiries. The Registered Provider checks the place over each week to make sure that things are as they should be. The records show that he looks at relevant things. For example, he checks that there is nothing that might cause someone The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 29 to trip over and that things like the lights are working okay. We didnt notice any particular hazards. Things like bleach are stored securely when not being used. The windows above the ground floor dont open too wide so that there is less chance that someone might fall or get stuck. The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 30 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 2 25 3 26 X 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 3 3 X The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 31 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Old Rectory DS0000023705.V372337.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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