Inspection on 07/12/08 for Bishops Croft

This inspection was carried out on 7th December 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

Bishops Croft 12/12/06

Bishops Croft 31/01/06

Bishops Croft 05/05/05

Bishops Croft 01/10/04

Bishops Croft 26/05/04

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Thorndene

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bishops Croft Bishops Lane Robertsbridge East Sussex TN32 5EB two star good service The quality rating for this care home is: 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: Deborah Calveley Date: 0 7 1 2 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Bishops Croft Bishops Lane Robertsbridge East Sussex TN32 5EB 01580880556 01424421684 admin@newdirections.gb.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : New Directions (Robertsbridge) Ltd care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whsoe primary care needs on admission to the home are within the following categories: Learning Disabilities (LD). The maximum number of service users to be accommodated is 7. Date of last inspection Brief Description Bishops Croft is a care home providing social and residential care for seven young adults with learning disabilities, in particular those with Prader-Willi syndrome and associated challenging behaviours. The home is owned by New Directions (Robertsbridge Ltd) and is situated on the outskirts of the town of Robertsbridge. The house is a detached, having sufficient bathrooms, showers and toilet facilities property with accommodation on two floors. There are large mature gardens. Residents rooms are individually furnished and decorated in keeping with individual choices. Three rooms have en-suite facilities. The two communal lounges and dining room are furnished and decorated to a good standard. The domestic-style kitchen and laundry are suitably equipped. The premises also include a single storey building, which is used as an arts and crafts workshop for residents. A variety of off-site activities are arranged and Bishops Croft has its own people carrier vehicle for trips and outings. Inspection reports can be read at the home and reference to how to obtain a copy is also made in the homes statement of purpose. 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 How we did our inspection: This was a key inspection that included an unannounced visit to the home and follow up contact with service users representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6 hours on the 07 December 2008 There were 6 service users living in the home on the day (one service user was away for the weekend), of which two were case tracked and spoken with. During the site visit, four other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Two members of care staff were spoken with in addition to discussion with the registered manager. Telephone contact was made with visiting professionals following the visit and their views and comments are incorporated into the report along with the information received verbally during the site visit. An Annual Quality Assurance Assessment was received from the Manager completed in full prior to this key inspection. What the care home does well What has got better from the last inspection What the care home could do better: The home needs to confirm in writing to the prospective service user or their representative that with regard to the needs assessment completed the home can meet the identified needs of the prospective service user. This ensures that decisions around admission to the home are informed. 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 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 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 . The home provides a good information to prospective service users. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Evidence: There is a comprehensive Statement of Purpose in place which has been updated to reflect the current managerial structure of the home. A copy was provided during the site visit. The service user guide was seen and informative, it is however written in a formal format and since meeting the people living in the home it would be beneficial if it was made more service user friendly and include photographs of the home. The service users could be consulted and involved in the development of this important document. The complaint procedure is in pictorial format The registration certificate is clearly displayed and correct at this time. There has been one new admission to the home since the last key inspection and there is a prospective service user who is currently visiting the home with a view to moving in the New Year. The care plan for the recent admission to the home was viewed and evidenced that the pre-admission process is thorough and the manager assesses the service user prior to admission and involve the service user, their family and health professionals as appropriate. From discussion with the manager it is confirmed that the needs of prospective service users are assessed and their personal goals and Evidence: aspirations are discussed and it is then decided if the home can meet the needs and assist the service user to meet their personal goals and aspirations. It was however noted that the home does not at this time confirm having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the manager who was advised that this should be completed in writing in accordance with the required documentation. There are service user contracts and agreements kept in each service users care file. 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 . Staff are fully committed in supporting individuals to lead purposeful lives as independently as possible. The support plan is clearly written and includes guidance for staff and others supporting the person using the service to provide a consistent approach. Evidence: As part of the inspection process two care plans were viewed in depth. Since the last inspection the manager has developed the care plans and associated risk assessments. The care plans include a detailed pen portrait, which include triggers for behaviour traits and leads into individualised assessments and personal goals. The care plans viewed demonstrated personalised goals and the steps taken to meet the goals with support from the staff team. There was evidence of regular review and of the goals being updated to reflect how progress is made. All service users are enabled to take risks as part of an independent life style, they are assessed within a risk assessment framework and then these are regularly reviewed. Service users are supported and enabled to make decisions for themselves. As previously found on inspections there are occasions due to the nature of the service provided by the home it becomes necessary to restrict/limit choices and decisions. Where this is the case, for example in relation to the food provided, agreements are reached with the individual service user and contracts/agreements are written, if this is not working a review is undertaken and a new contract agreed. The need to balance individuals rights against health and safety is kept under constant review. Each person is assessed individually on how they manage money. If a person is unable Evidence: to manage their finances effectively, the manager will act as their appointee to ensure they are protected from financial abuse and that their moneys are managed effectively. Observations were made during the visit of how staff support individuals with managing their money and the different levels of support were demonstrated between relative independence and full support. Records were viewed and the procedures were discussed with the manager. 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 . The service actively supports the people who live in the home to be independent and involved in all areas of daily living. People who use the service are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Evidence: The service users living in the home have busy and fulfilling lives. Some of the service users have work placements, some attend college courses and some attend the day centre run by the company. Activities that service users participate in include: gym work, swimming, pottery, basketball, horse riding and trampoline. A recent trip to wrestling match was thoroughly enjoyed and still being talked about by the service users. The home have their own activity centre in the rear garden and a service user proudly showed the pottery and the other projects being undertaken at this time. There is also a communal pet(guinea pig)which all the service users take responsibility for. Some service users also have their own pet hamsters and they take full responsibility for looking after them. The activity centre also has a computer and a sewing machine for service users to use plus tea and coffee making facilities, which service users use under close supervision. The service users individual life programme is designed to keep everyone very active and fulfilled through the day allowing them leisure time in the evenings and weekends Evidence: for pursuing their individual hobbies. The home has an eight-seater people carrier which is used for the benefit of the people who use the service. Service users attend different church services on a regular basis and the home supports one to attend and a parishioner from one of the churches takes another service user. This inspection was undertaken on a Sunday and demonstrated that the service users could choose how they spend their leisure time and the atmosphere was relaxed. Six of the seven service users were present for the inspection and the feedback from them regarding their home and their lives were very positive. The interaction between the staff and residents was seen to be positive and warm whilst maintaining professional boundaries and treating each other with respect. All of the service users were looking forward to going away for the Christmas Holiday to their parents and families. There are no imposed restrictions to access around the house, it was discussed that service users that have been out on their own have to ring the doorbell for access to their own home. The manager is going to review this with the service users. One service user is looking forward to moving into his self contained bungalow which is adjoined to the home, he is involved in the process and will be hopefully moving in in the New Year. The meals in the home are based on the service users preferences home cooked and varied. The service users take turns in helping in the preparation of the meals. The inspector was kindly invited to join everyone for Sunday lunch, which was well presented and tasty. The staff join the service users for their meals on a regular basis. The service users were seen to enjoy their meal and talked to each other and staff throughout. The dining room is homely and comfortable and the atmosphere inclusive and relaxed. 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 . Service users are supported by staff who are trained and competent in health care matters. The home ensure that service users receive specialist advice and support where necessary to meet their individual health care and emotional needs and medicine practices are robust and protect the service users. Evidence: The service users receive personal support as required, at present one resident is receiving support and this is recorded in the care plan with appropriate goals and an action plan in place. Specialist support is accessed as required and the home ensures that the appropriate agency is approached and this is then recorded clearly in the care plan. All service users receive input from health professionals regarding sexuality and relationships and are supported in realising personal relationships and friendships. This is discussed and documented during the reviews and discussed with the family. Appointments are made for service users to receive regular chiropody, dentistry and eye examinations. The deputy manager takes responsibility for the medications and they were seen to be well managed There are policies and procedures in place for staff to refer to regarding the safe administration storage disposal and recording of medication. Homely remedies are agreed with the GP and a recommendation is that the sugar content is considered. Self medication of special tooth paste is monitored and documented and reviewed regularly. The medication administration records seen in relation to medication administered to residents were competently completed. It was confirmed that staff who administer Evidence: medication receive training on the medication in use in the home. The medications in use are explored and side effects and the reason for usage included in the individual care plans. 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 . The ethos of the home is one that welcomes complaints and suggestions about the service uses these positively and learns from them. All staff understand working within the home are fully trained in safeguarding adults and know how to respond in the event of an alert. Evidence: The home has a complaints procedure that is both displayed in the home and given individually with the service user guide in a pictorial format. Suggestion boxes are located in the home so if someone wanted to complain discretely they could do so. There has been one complaint received since the last inspection and this was dealt with within the stated 28 days. One person spoke about what she would do if she had a concern and felt that staff are open and supportive. All staff working at Bishops Croft have been checked against the Protection of Vulnerable Adults (POVA) list and they have had training for safeguarding adults. Staff talked about their understanding of safeguarding adults and were knowledgeable. They said they felt confident about what they would do and the first action would be to report anything untoward to the manager. Staff attend courses on behaviour management which include deterring techniques, talking down and positive support. 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 people living here are encouraged to see the home as their own. The home is well maintained and decorated to a good standard. There are good measures in place in relation to fire safety. The kitchen and laundry are designed to enable and promote the involvement of people who live in the home in domestic tasks and as part of developing self-help skills. Evidence: The home is a detached property with accommodation on two floors, communal areas consist of a large lounge and a separate dining room. In addition there is a smoking lounge. The home is well decorated and homely. There is a notice board in the kitchen area with details of weekly activities and items of interest to the service users. A service user showed the inspector around the communal areas and the activity centre of the home and four of the service users shared their personal space the rooms were well decorated and very personalised. The manager confirmed that fire drills take place monthly and the outcome is formally recorded. The AQAA stated that fire alarms are tested weekly and emergency lights monthly. The home has a fire risk assessment and this is available in the home. Staff receive training on fire safety training and the home has fire safety DVDs which staff view and then answer multiple-choice questions. The home was clean and fresh smelling on the day of the inspection, the residents have the responsibility for cleaning their individual rooms. Both the staff and residents clean all other areas of the home. The AQAA and the training records evidence that staff have received training on infection control. 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 . The service is proactive in its staffing recruitment and training with planning for the potential needs of people moving into the service. People who use the service are positively involved in the choice of staff and their opinions are acted upon. Evidence: The staff team is now more stable than previously found and vacancies are being filled. The staff are aware of their job role and receive a job description with their contract. Training courses are provided for staff and there is a training matrix which tracks staff training. Mandatory training in first aid food hygiene and infection control is provided and training is also provided on Prader Willi syndrome, behaviour management, scip, protection of vulnerable adults and studio three. Some of the courses are run in-house and external trainers also provide training. Staff confirmed that they receive training necessary to perform their job well Two recent employed recruitment files were seen. All the documentation required by the Regulations was in place, it was discussed that formal interview notes are kept especially when there is little employment history available. The service users are involved in the recruitment process and confirmed that they help choose the staff. Records show that all staff are receiving regular supervision. Each staff member has an annual appraisal and they are required to complete a self-analysis form prior to the appraisal. It was confirmed that 74 staff have completed NVQ level two or above. 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 manager has a clear understanding of the aims and focus of the service. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The home works to a clear health and safety policy and the home is well monitored by the organisation. Evidence: There is a new manager in post, who was registered in August 2008 and she confirmed that she is due to commence the managers award in the near future. She was found enthusiastic and committed to her role in the home. Recent regulation 26 reports were viewed and the action points indicated had been carried out. It was confirmed that staff meetings and service users meetings are held regularly. Records were detailed showing that everyone is encouraged to share their opinions As part of the homes quality assurance system the residents are asked to complete satisfaction questionnaires This task had been completed recently and it was noted that most of the residents were able to write about issues that affect them. Written responses to each resident are done, and action is taken to address the issues raised. Staff have received health and safety, moving and handling, fire, first aid, food hygiene and COSSH training as part of their induction. There is a trained first aider on each shift. All staff and people who use the service have had fire training within the home and are aware of the evacuation procedure. Evidence: Home Risk assessments are in place. All home maintenance checks have been carried out as required. All electrical equipment used within the home is PAT tested and certified before it is used. Fire equipment has been checked and fire drills have been held. The accident logs were viewed and have been recorded appropriately. This information was cross referenced with the AQAA received from the home. Hot water temperatures tested on the day of inspection were within agreed safety limits Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 2 14 That the registered person 16/02/2009 confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those identified needs. To ensure that the admissions to the home are informed and clear. 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 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. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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