Inspection on 18/10/05 for Burton Cottages

This inspection was carried out on 18th October 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Burton Cottages 18/12/08

Burton Cottages 22/10/08

Burton Cottages 20/06/07

Burton Cottages 26/04/06

Burton Cottages 27/04/05

Burton Cottages 24/09/04

Burton Cottages 26/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Burton Cottages Bishop`s Lane Robertsbridge East Sussex TN32 5BA Lead Inspector Caroline Johnson Announced Inspection 18th October 2005 10:00 Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 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 Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 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. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Burton Cottages Address Bishop`s Lane Robertsbridge East Sussex TN32 5BA 01580 881715 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) Sussex Autistic Community Trust (Care Services) Limited Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That service users on admission will be diagnosed with an autistic spectrum disorder The maximum number of service users to be accommodated must not exceed twelve Service users accommodated must be between the ages of nineteen (19) and sixty-five (65) years of age on admission. 27th April 2005 Date of last inspection Brief Description of the Service: Burton Cottages is registered to provide accomodation for twelve adults with an autistic spectrum disorder. The property is owned by Downland Housing Association and is run by the Sussex Autistic Community Trust. It is one of four homes in East Sussex run by the Trust. Burton Cottages is purpose built and is situated in a quiet residential area of Robertsbridge. The town centre with its shops and access to bus and rail services is a short walk away. The building is split into two units, each accommodating six residents. Each of the units has its own communal facilities and a kitchen. Accommodation is on two floors and all bedroom accommodation is in single rooms. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1 2005 to March 31 2006. The inspection lasted from 10.00am until 5.30pm. Mrs C Johnson, Lead Inspector was joined by Mrs R Shewan, Regulation Inspector until 4.30pm. Mr F Donati, General Manager for the Trust, was at the time of inspection, working in the home as the Acting Manager and he facilitated the inspection. During the inspection there were opportunities to interview four care staff and the deputy manager in private and to meet with the programme co-ordinator. There was an examination of four care plans. A wide range of record keeping was also examined including records of complaints, recruitment, staff meetings and medication. Inspectors met briefly with five of the residents and they were observed to be happy and content. In September 2005 the Commission received a complaint. An unannounced inspection visit was carried out on 29 September to investigate the complaint. The findings of this complaint have been passed to Social Services for further investigation under adult protection guidelines. Some of the issues highlighted during the September visit are referred to in this report. The complaint centred on staffing arrangements and incident reporting. However, it also became apparent that the home had been through a very stressful and difficult time. The healthcare needs of one of the residents had deteriorated and this had caused an increase in the behavioural problems they displayed. The impact of these behaviours caused upset to some of the other residents. Staff also found this period very stressful. The general manager advised that during this time the `staff and the organisation used high levels of expertise, commitment and external specialist input to support an individual during a very critical period’. Staff spoken with during the inspection also echoed that as a staff team, they worked very hard during this period to keep change to a minimum and to provide security for all the residents. There has been a high turnover in the staff team. The acting manager and one of the deputies left employment in the weeks prior to the inspection. For a short period of time there was a high use of agency staff and relief staff. Once the acting manager left her position the General manager took on the role of acting manager. The position for manager had been advertised and the Trust was hopeful that an appointment would be made in the near future. As part of the inspection process comment cards were sent to the home for distribution to relatives to seek their views about the quality of the care provided in the home. Eight responses were received, four of which were wholly positive. The other four raised issues about insufficient staffing. Two relatives also phoned the inspector to raise concerns regarding the changes to the management of the home and the turnover in the staff team. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 6 A number of measures have been put in place to reduce the levels of stress for the residents and staff. At the time of this inspection the home was more settled and staff reported that the new measures to improve communication were having a positive impact on the home. The Commission will continue to monitor the home closely in relation to meeting the requirements of this report. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that copies of incident reports are sent to the Commission. Record keeping in relation to incidents when restraint has been used should be more detailed. The Responsible Individual or a representative on their behalf reports monthly to the Trust and to the Commission on the conduct of the home. The format for carrying out these reports needs to be Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 7 improved to ensure that more detailed information is recorded in relation to the outcome of these visits. The acting manager needs to ensure that there is a minimum of five care staff (not including the manager) on duty at peak times through the day. A manager must be appointed to manage the home. In relation to staff recruitment the home needs to be more thorough in following up issues raised in application forms and references. Job descriptions for the acting manager and senior staff need to be revised to ensure that everyone is clear about their individual roles and responsibilities until a new manager is appointed. The organisation is currently reviewing their policies and procedures manual. A number of policies need to be introduced and a number of those in place need reviewing. This work will take some time however, it is recommended that the home prioritises this work in order of importance and that the whole manual be up and running within six months. 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. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 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 Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards have not been assessed on this occasion. There have been no new admissions to the home since the last inspection. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 The new format for care planning once implemented should ensure that all staff are kept up to date about the needs and abilities of the residents. There will also be scope to record information that the old system did not allow and should make the job of evaluating individual goals much easier. EVIDENCE: Four care plans were examined in detail. All care plans and risk assessments had been reviewed in recent weeks. The importance of signing all documents was highlighted. The general manager advised that the format for care planning would be changing and that it was hoped that the new format would be completed by the end of January 2006. The new format allows for more detailed information to be recorded including a pen portrait of each resident and, in respect of the individual goals for residents, space to record progress made. Staff are to receive training on the completion of the new documentation. In respect of one of the care plans seen it was recommended that staff record more detailed information about the type of seizures experienced by the resident. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14, The majority of residents receive a varied programme of activities through the week. More emphasis needs to be placed on providing a more varied timetable of activities for the resident who currently chooses not to attend a day centre. A review of the activities on offer at weekends should be undertaken. The new TEACCH system used for assisting in communicating with residents is proving to be a valuable tool and will hopefully be expanded upon to assist the residents to make more decisions and choices. EVIDENCE: The majority of residents attend one of the two day centres owned by the Trust. In addition to this there are a choice of activities on offer in the evenings. Feedback from one of the relatives was that there did not always appear to be enough activities at the weekends. One of the staff interviewed also stated that there were limited activities at the weekend. At the time of the last inspection it was recommended that a programme of activities be put in place for the one resident who did not have one. There was a timetable in place but there were very few activities highlighted. The general manager advised that due to the complex needs of the resident, to achieve the Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 12 small number of activities had involved significant work on behalf of the staff team. He also stated that the home had put in a request to the resident’s social worker for additional funding for social activities and he hoped that this would be agreed in November. The home has recently started introducing a new system to aid communication with residents. The system is known as TEACCH (Treatment and education of autistic and related communication of handicapped children) programme, and it involves the use of symbols, widgets or words to aid communication. The programme is to be used in everyday tasks such as planning meals, shopping for food and meal preparation. It will also be used in assisting residents to choose activities. One of the staff spoken with stated that residents are more responsive since the system has been implemented. A staff on duty photo-board is to be introduced. It is hoped that this will provide reassurance to residents and ensure that they know who is on duty at any given time. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21 A central record should be kept in each resident’s file of all appointments in relation to healthcare visits. This would assist the home to monitor when appointments are due and if for any reason an appointment is missed they could arrange an alternative appointment. Policies relating to the administration of medication need to be reviewed as soon as possible as the current system could lead to confusion. The introduction of a homely remedies policy would enable unprescribed medications to be administered when required without having to go to the Doctor each time to seek permission. Keeping more detailed records of the type of seizures experienced by one of the residents would assist medical staff in determining the most appropriate form of treatment to be given. A written assessment of the ability of each resident to understand this subject should be carried out. If following assessment it is still considered inappropriate to relate such information, the organisation should seek specialist support to assist them in dealing with this subject so that a similar situation could not reoccur in the future. EVIDENCE: Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 14 Residents generally receive chiropody treatment approximately every six to eight weeks. The home had made arrangements for one resident to be seen by a local Consultant Psychiatrist in an effort to determine if changes noted in his behaviour are as a result of a health problem or if it is a behaviour problem. Procedures for the storage and handling of medications were examined in detail. Record keeping of medication administered was generally satisfactory, however the importance of signing hand written entries to the MAR (medication administration records) sheets was highlighted. The home does not have a homely remedies policy so if medication such as paracetamol is required it has to be prescribed by the resident’s gp before it can be administered. Half of the staff team have received training on medication. The deputy manager advised that arrangements are being made for the remainder of the staff team to receive appropriate training. There were two medication policies in place both contains relevant information but each individual policy does not contain all the relevant information required. This could lead to confusion so it is recommended that the policies be reviewed and one policy be put in place. One resident who has epilepsy is prescribed invasive medication for treatment of seizures. This medication is not required very often. A small number of the staff team have received training on the administration of such medication but it has been some time since this training was updated. Inspectors were advised that the use of such medication is to be reviewed in November with the resident’s Consultant Psychiatrist. If it were to be prescribed following this review, training would be arranged for staff on the use of such medication. There has been one death since the last inspection of the home. A senior management decision has been made that residents should not be informed of the death as to do so could cause significant problems for a number of the residents. Inspectors were advised that staff had not taken up the opportunity for bereavement counselling. Two of the staff spoken with stated that they had not been offered bereavement counselling. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home needs to ensure that complaints are investigated as soon as possible and the outcome reported to the complainant. Restraint should only used if it has been agreed as apart of a multi-disciplinary process and staff have received appropriate training. Detailed records of restraint must be kept. They should be copied to the Commission and the use of restraint should be kept under continual review. The new format to be introduced for recording residents’ finances will ensure that tracking of individual monies is easier. EVIDENCE: Prior to this inspection the Commission received a complaint that had been made by an ex member of staff. An unannounced visit was carried out on 29 September 2005 to investigate this complaint. The complaint centred on staffing arrangements and incident recording. The findings of the investigation into this complaint have been passed to Social Services for investigation under adult protection guidelines. During the visit on 29 September, the home’s complaint records were examined and it was noted that two complaints had been received by the home but neither had been investigated appropriately. However, action had been taken to address both complaints at the time of the announced inspection. Both of the complaints were founded. Both complaints related to the level of noise coming from the home. A further complaint had also been recorded since the unannounced visit. This complaint was dealt with in line with the home’s procedure. This complaint was founded. This complaint related to poor communication between the home and the relatives of a resident; concerns regarding the staff turnover and concerns regarding poor record keeping. Following the complaint a staff meeting was held to discuss the issues raised and the actions to be taken by staff in the future. As required at the last inspection of the home the complaint procedure has been reviewed and updated. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 16 The majority of staff have now received training on adult protection and prevention of abuse. Three new staff have yet to be booked on a course. The findings of the investigation of the complaint received by the Commission, referred to above, have been passed to Social Services and are currently being investigated under adult protection. The home keeps a record of every time restraint is used in the home. The form used to record restraint is very similar to the form used for recording incidents. Records do not always show the exact nature of the restraint used, how long it was used for or an evaluation. The Commission needs to receive a copy of every incident where restraint is used in the home. The deputy manager advised that arrangements are being made to train staff not yet trained in Studio three, which is the form of restraint used in the home. The arrangements in place for the management of residents’ finances have been reviewed since the last inspection of the home. Residents are in receipt of personal allowance and disability living allowance. In addition the Trust provides a clothing allowance and a social and recreational allowance. For the majority of residents both allowances are paid directly to a SACT account. The disability living allowance is used to pay for the upkeep and running of the transport vehicles. Records in relation to the management of these monies were not seen during this inspection, as they are stored at the head office. An appointment will be made to see these at a later date. Money is transferred as required from the SACT account, to the home for individual residents. Records were seen in relation to the management of three residents’ monies and these were in order. The deputy manager advised that the format used to record incoming and outgoing monies would be adapted to a more simplified format. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not inspected fully on this inspection. Whilst examining quality assurance systems it was noted that nine of the twelve bedrooms were being redecorated. Seven bedrooms had been recarpeted and alternative flooring fitted in another two bedrooms. Five bedrooms had been repainted. One of the residents was to have new furniture and the programme coordinator stated that the resident had chosen the furniture they wanted from catalogues. Some of the residents were purchasing easy chairs. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34, The turnover in the staff team has had a detrimental effect of the home. Most of the positions have been filled but the remaining vacancies need to be filled and appropriate training provided. A fifth member of care staff at peak times during the day would ensure that the complex needs of residents could be met more easily. The home needs to be more thorough in exploring issues raised in references and applications as part of the recruitment process. The emphasis on NVQ training will assist in building upon and improving the quality of the care provided to the residents accommodated. EVIDENCE: There has been a high turnover in the staff team. The acting manager, deputy manager and five care staff have left employment since the last inspection. For a period of time there had been a high use of agency and relief staff. Some of the vacant posts have been filled. The positions for manager, deputy manager and one full time support worker have been advertised. The rota supplied for inspection showed that the use of agency staff had been significantly reduced. The home is divided into two units and generally there has been two care staff on duty on each unit. In addition the manager would be on duty mainly working nine to five. Inspectors were advised that there is capacity within the budget for a fifth member of care staff to be on duty. Following discussions Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 19 with staff and examination of care plans and incident reports it is recommended that the fifth member of staff is necessary at peak times to meet the complex needs of the residents. Records were seen in relation to the recruitment of two members of staff. Procedures followed in relation to one of the staff were thorough. In relation to the second staff member there were issues raised in references and in the application form. It was not clear from the records if these issues had been discussed with the staff member or if the issues had been discussed with the previous employers. At the time of inspection three staff members were working through their induction package. Two staff had completed NVQ training, one at level two and one at level three. Another three staff were studying for level three. The deputy manger was studying for level four and the programme co-ordinator had just completed level four. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42,43 The home has been through a very stressful and difficult time. The healthcare needs of one of the residents had deteriorated and this had caused an increase in the behavioural problems they displayed. The impact of these behaviours caused upset to some of the other residents. Staff also found this period very stressful. The Commission was not kept informed of any of the changes in the home. Monthly reports carried out on behalf of the Trust by the Responsible Individual or a representative on their behalf and copied to the Commission also did not highlight the changes in the home and the stress that staff and residents were under. The format needs to be changed so that more detailed records can be recorded. The home is now more settled. It is essential that a manager be recruited as soon as possible. In the interim job descriptions need to be revised to ensure that everyone is clear about their individual roles and responsibilities. A number of issues have been highlighted through the recent quality assurance process. The home needs to write to the relative of residents advising them of the action they are taking in response to the issues raised. Appropriate action has been taken in the past two weeks to improve communication and to ensure that staff are clearer about the need for detailed recording of information. The plan to hold staff meetings every two weeks in the short-term will assist in this process. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 21 EVIDENCE: At the time of inspection the General manager was working in the home as acting manager. He was assisted by the deputy manager and a programme co-ordinator, (normally working throughout the Trust), who was also working predominately in the home. The general manager advised that the manager’s position had been advertised and the Trust were hopeful that they would be able to appoint a suitable manager in the near future. The general manager stated that he would be working in the home for another few weeks and then withdrawing to leave the deputy manager working in an acting manager capacity supported by the programme co-ordinator. It was recommended that job descriptions for the management and senior workers be reviewed and that attention be given to ensuring that all staff be clear about the extent of their and others’ role and responsibilities. Staff spoken with during the inspection stated that the home had been through a very unsettled period. During this period some of the residents displayed an increase in behavioural problems and this also wasn’t helped with the changes to the staff team. However, in the past three weeks there have been a number of changes, more staff have been recruited, a staff meeting has been held to ensure that everyone is working consistently. In the short term there are plans to have staff meetings every two weeks. In addition communication has improved and staff are clearer about what is expected of them. They stated that the general manager is very approachable; he has met with most of the staff individually since commencing work in the home. Since the last inspection a satisfaction questionnaire has been sent to the relatives of residents. Seven out of twelve of the relatives responded. The home has confirmed in writing that they have written to relatives individually detailing the action they are taking, in relation to the areas highlighted. A residents’ questionnaire has also been completed using the TEACHH programme. The majority of residents required support to complete the questionnaire. As part of the inspection process comment cards were sent to the home for distribution to relatives. Eight responses were received. Four were wholly positive, one relative stating that their son `has made good progress’ and `seems very happy’. They also stated that he was looked after well by trained staff. Another relative stated that they have `always been happy and satisfied’ and that they `have a good relationship with staff’. The other four all raised concerns regarding insufficient staffing levels and the rate of the turnover of the staff team. Two felt that they were not kept informed of important matters or consulted on decisions about the care of their relative. One stated that they Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 22 were not aware of the home’s complaint procedure. In addition to the comment cards two of the relatives also telephoned the inspector and raised concerns regarding the changes to the management of the home and the fact that staff that had worked in the home a long time had also left their employment. The general manager advised that he had spoken with staff about the role of the Commission and about the availability of inspection reports. Staff spoken with during the inspection, were able to confirm that they had been given this information. As is required the Responsible individual or a representative on their behalf visits the home monthly and writes a report on the conduct of the home. This report is copied to the manager, the directors of the Trust and to the Commission. On this form there is no space to record staff vacancies, use of agency/relief staff, details of complaints, numbers and nature of incidents occurring in the home or space to record the views of staff and residents interviewed. During the monitoring visit carried out on 29 September it was noted that the home had not been sending the Commission copies of reports of events that had occurred in the home where the well being of residents was affected. It was strongly recommended that a system be set up whereby incident reports are copied to the Commission. Since this date copies of incidents have been reported to the Commission. It was also noted that in a recent staff meeting this issue had been discussed to ensure that everyone was aware of the need to copy such reports to the Commission. A working parting was set up within the Trust to review the policies and procedures and to identify policies and procedures that need to be introduced. A report was produced in July detailing the outcome. A lot of work is required to produce a comprehensive list of policies and procedures. The general manager advised that that the Trust would need twelve months to complete this task. Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X 2 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Burton Cottages Score X 2 2 2 Standard No 37 38 39 40 41 42 43 Score 1 3 2 1 X 2 2 DS0000021064.V250596.R01.S.doc Version 5.0 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 17(1)(a) Sch3 para (m) 12(1)(b) Requirement Timescale for action 15/12/05 2 YA12 Record keeping in relation to seizures experienced by one of the residents must be more detailed. A review must be undertaken of 15/01/06 the activities provided at weekends to determine if there are sufficient activities provided. 3 YA21 4 YA22 5 YA23 In relation to one of the residents, the home must continue to develop a wider range of activities to meet their needs and wishes. 12(3)(4)(a) A written assessment must be carried out in relation to each resident’s ability to understand the subject of dying and death. If necessary specialist advice/support must be sought in relation to discussing this subject with the residents. 22(3)(4) Complaints to the home must be fully investigated and the complainant must be informed of the action taken by the home within twenty-eight days. 13(7)(8) When a complaint form is completed attention must be given to ensuring that there is DS0000021064.V250596.R01.S.doc 15/04/06 15/12/05 30/12/05 Burton Cottages Version 5.0 Page 25 6 YA33 18(1)(a) 7 YA34 9 Sch 2 para.(1-9) 8 9 YA37 YA37 9(1) 17(2) Sch4 para 6(e) 10 YA40 17(2) Sch 4 11 YA42 37(1)(2) detailed information provided including the length of time the resident was restrained, the number of staff involved and what happened following the restraint. In addition the manager must evaluate whether the restraint was effective. A copy of the restraint form must be copied to the CSCI. Restraint must only be used if it has been agreed as part of a multi-disciplinary process and all staff involved have received appropriate training. Staff must be appointed in numbers that are sufficient for the wellbeing of residents. (There must be a minimum of five care staff on duty at peak times not including the manager). In relation to recruitment procedures, the manager must follow up issues raised in application forms and references and keep a record of the outcome. A suitably qualified manager must be appointed to run the home. Until a manager is appointed, job descriptions for the acting manager and senior staff must be revised. All staff must be clear about the roles and responsibilities of staff members. The home must prioritise the revision of the policies and procedures manual to ensure that all policies and procedures required by the Regulations are reviewed and if not already implemented introduced as soon as possible. Should an incident occur in the home where the wellbeing of a DS0000021064.V250596.R01.S.doc 30/12/05 15/01/06 28/02/06 01/12/05 30/04/06 30/11/05 Burton Cottages Version 5.0 Page 26 12 YA43 26 resident is affected, this must be reported to the Commission without delay. Written details of the incidents must also be sent to the Commission. Monthly reports carried out by the Responsible Individual or a representative on their behalf must include information relating to the staff vacancies, use of agency/relief staff, details of complaints, numbers and nature of incidents that occur in the home and information about the views expressed by residents and staff. 30/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA19 Good Practice Recommendations In respect of care planning, all computer-generated documents must include a hand written signature and date. A record should be kept in each case file detailing all appointments attended by residents (including hair, chiropody, dentist and opticians) along with a date of the next appointment due. In respect of medication the home should introduce a homely remedies policy. In respect of the administration of prescribed medications, the two policies currently in placed should be reviewed and replaced with one detailed policy. All staff should be offered bereavement counselling. The Trust should write to the relatives of the residents to advise them of the recent staffing problems and the action taken to resolve the matter. In addition they should confirm the action they are taken to recruit a manager for the home and the interim management arrangements. 3 YA20 4 5 YA21 YA39 Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Burton Cottages DS0000021064.V250596.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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