Inspection on 26/04/06 for Burton Cottages

This inspection was carried out on 26th April 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 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 18/10/05

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 Key Unannounced Inspection 26th April 2006 10:15a Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 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.V288945.R01.S.doc Version 5.1 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.V288945.R01.S.doc Version 5.1 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.V288945.R01.S.doc Version 5.1 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. 18th October 2005 Date of last inspection Brief Description of the Service: Burton Cottages is registered to provide accommodation for twelve adults with autistic spectrum disorders. 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 there own communal facilities and a kitchen. Accommodation is on two floors and all bedroom accommodation is in single rooms. The home makes CSCI reports available to prospective residents and their relatives/representatives upon request. The gross weekly fee inclusive of income support is £1,194 to £2,323 as at 17 May 2006. In addition residents need to pay for hairdressing, chiropody and toiletries and they pay a contribution towards the use of the home’s vehicles. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The site visit lasted from 10.15am until 6.15pm and the acting manager facilitated the inspection. During the inspection there were opportunities to interview four care staff and to speak with a number of other staff generally. Five care plans were examined in detail. A wide range of record keeping was also examined including records of complaints, recruitment, staff meetings and medication. Residents have very limited communication skills and any contribution towards the inspection process could only be minimal so observations were made of residents and of staff interactions with residents as the inspector toured the home. In addition to the site visit an appointment was made at the head office to view staff recruitment records and residents’ finances. As part of the inspection process surveys were sent to residents for their comments on the quality of the care provided at Burton cottages. Due to the complex needs of the residents, contributions made were minimal. However, three residents were able to complete the surveys, one independently and two with staff support. One resident added a comment `the staff look after me well’. The inspector also attempted to contact three relatives of residents. One did not take up the opportunity to contact the inspector during the time given. One relative spoke at length saying that `communication is good and they are made to feel very welcome when they visit the home’. They also stated that `they are always invited to reviews and feel able to make contributions to all discussions’. Generally they feel `the home manages their relatives care needs well’. A second relative stated that they have concerns regarding the continual turnover in the staff team. Their son has chosen not to attend day centres and has a very limited timetable of activities through the week. They acknowledged that their son’s keyworker is now trying to arrange a wider variety of activities. They also stated that since the new manager was appointed she has been in touch regularly and communication is improving. Prior to finalising this report the acting manager wrote to the Commission confirming the action she had taken since the site visit to address the requirements and recommendations made. She also provided supporting documentation for the work carried out. This is considered good practice. What the service does well: Staff spoken with during the inspection felt well supported in their individual roles within the home. The majority of the residents continue to attend one of the two day centres run by the Trust. In addition to this there are a greater selection of activities on offer at weekends. The Trust has a comprehensive training programme that is available to all staff. Residents observed during Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 6 the inspection appeared content and happy. Residents’ bedrooms have been personalised to reflect their individual tastes and personalities. Staff spoken with during the inspection had a clear understanding of the needs of the residents and they were clear about the action required of them in relation to meeting the needs identified. What has improved since the last inspection? What they could do better: There is a very detailed service user guide and licence agreement in place but it was not clear if residents had seen the document or if copies had been sent to relatives or their representatives. As stated above further work is required to get the new care planning system working to its full potential. Record keeping in relation to daily records needs to be more detailed. Detailed record keeping will ensure that progress made with the individual care plans can be focussed and measured more easily and will inform future practice. The home must continue to source new activities for the two residents who choose not to attend day centres. There were a number of staff vacancies at the time of inspection and although the home uses regular relief staff it is essential for consistency and stability that the vacant positions be filled. In relation to recruitment records seen it was noted that files contained Criminal Records Bureau (CRB) checks that had been carried out within the last twelve months. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 7 Although the Trust had submitted a fresh application to the CRB as part of good recruitment procedures and they home should always obtain a Protection of Vulnerable Adults (POVA) first, check prior to staff commencing employment. 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.V288945.R01.S.doc Version 5.1 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.V288945.R01.S.doc Version 5.1 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): 1,2,4, Quality in this outcome area is adequate. The statement of purpose needs to be updated to reflect the changes in the management team. The service user guide is a good and comprehensive guide to the home and how residents’ are to be met. It is essential that all keyworkers take time to go through the document with their key client so that as far as possible residents are clear about what they can expect in terms of service and what is expected of them. A record should be kept that this has happened. EVIDENCE: There is a statement of purpose in place. The acting manager confirmed that this document would be amended to reflect the changes in the management team. Each of the residents has a service user guide and licence agreement, which is located in the office. The guide is in pictorial and written format and provides detailed information of the service provided. One of the guides seen, had not been signed by the resident or a relative on his behalf. Staff spoken with, were not clear if the documents had been discussed with residents or if a copy had been provided to their relatives. Pre-admission documentation was seen in relation to one recently admitted resident. The home had obtained very detailed reports from the resident’s previous placement, there was a detailed pen portrait and management guidelines in place. There was no information included on any visits to see the resident in their previous placement or of contact with the relative’s family. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 10 The acting manager was clear that this happened and that records were kept but it is thought that these were located at the head office. An appointment was made to see the records at head office. The general manager and the deputy manager described a very thorough assessment process that had been carried out and a well-planned transition. However, the records detailing the action that had been taken had been mislaid. There was a report from the Trust’s day centre, which commented on the weekly visits by the resident and his dad in the weeks leading up to the admission to the home. The acting manager advised that the residents’ parents were very involved in the preadmission and that regular trips were made by staff to the resident’s school. The resident visited the home on a couple of occasions for tea and there was also a weekend stay as part of the preparation process. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is adequate. The task of introducing a new format for care planning is enormous and it is acknowledged that the home has made very good progress since the last inspection in this area and that work is still ongoing. The home’s quality assurance system should pick up the variation in the quality of the work undertaken. Further work is required to improve the quality of the record keeping in relation to daily records but with further staff training the new system used to its full potential could be excellent. Great progress is being made with the teacch system and residents are now making more informed choices and decisions. More thorough recording of the work undertaken needs to be in place so that evaluation of progress made can be accurately measured. EVIDENCE: Since the last inspection the home has introduced a new format for care planning. Four care plans were examined as part of this inspection. Two were very detailed and two also included very detailed information but there were some sections not completed. Sections not completed included religious or cultural needs. Staff spoken with advised that they are currently assessing some of the residents in relation to their cultural needs. Information provided Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 12 includes a detailed assessment of abilities and needs and an assessment of how autism affects each individual. There are detailed management guidelines and individual goals and training activities. A detailed discussion was held with staff about one individual needs, however it was noted that the main issues that staff identified were not included in the care plan. Daily records are used to record information about each resident’s day and there is also a record kept of progress made with individual goals. Information included in the daily records and goal charts is very limited. An example of this is that on one given day records showed that a particular resident walked for half an hour but their behaviour was inappropriate at times. Records did not state if the walk was cut short because of the behaviour or what the behaviour involved. Staff spoken with stated that they did not always have time to complete daily records. They acknowledged that they might be able to complete some of the records prior to going to day centres allowing more time to complete the remainder when they returned form the centre. The acting manager acknowledged the work that is needed to improve the daily records and advised that the same issue had also been raised by seniors at their senior meetings. Training in report writing is to be arranged. In addition the acting manager hopes to introduce monthly keyworker reports. A relative of a resident spoken with stated that they are always invited to reviews and feel able to make contributions to all discussions. Generally they feel the home manages their relatives care needs well. The home uses the Teacch system to enable residents to make choices and decisions. The Teacch system is designed to be applicable to the individual needs of the residents and samples of the methods used for four residents were seen. Some were in pictorial format and included pictures of drinks and snacks, timetables, activities for the evening such as writing a diary, arts and crafts, bath-time and relaxation time. For some it was a picture of the resident involved in each activity. For those who could read it was just the word and for some it was just a picture of an activity. Staff discuss with each resident the plan for the evening, for some this will be one activity at a time for others they could choose which activity to do in order of preference. Staff gave various examples of how residents make choices. What was not evident was record keeping backing up the work undertaken in encouraging residents to make choices and decisions. Risk assessments seen clearly defined the perceived risks and there was advice included on the action to be taken to reduce the risk of accidents and incidents. Some included very detailed advice and for others the action to be taken was not very detailed but there was more specific information on the action to be taken elsewhere within either behaviour or management guidelines. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 13 There is a policy on place in relation to confidentiality. It does not refer to times when information given in confidence to someone might need to be breeched due to the nature of the information. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,17 Quality in this outcome area is adequate. The majority if residents have a very full and varied timetable of activities. For a couple of the residents who choose not to attend day centres, their day is much less structured and therefore not of such a good quality. The home needs to continue with their plan to find a wider variety of activities for these two residents so that they can receive more stimulation. EVIDENCE: The majority of residents attend one of the two-day centres run by the Trust. Timetables seen show that there is lots of variety in the activities provided. Residents have access to the wider community from the day centres such as attending swimming, trampolining, bowling, cinema, shopping and visiting cafes and restaurants. There is an activity plan in place for one resident showing that he attends the day centre Monday to Friday. However, this resident generally refuses to attend the day centre. In relation to another resident who continues to refuse activities, the manager advised that the home have reassessed their individual needs and they are continuing to seek funding to increase the range of activities provided. Staff spoken with stated that they Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 15 are continuing to try to find activities that are stimulating for this resident. The timetable in place for this individual shows limited activities but staff stated that it has taken a lot of work to encourage the resident to participate in these activities. The manager advised that the majority of residents have regular contact with their relatives. A relative spoken with stated that they are made very welcome in the home. Staff keep in regular contact with them and keep them up to date with any changes. They are invited to all reviews and encouraged to make contributions of approaches that work best in their home. Progress has been made in increasing the number of activities provided at weekends. There is a large cupboard housing a wide variety of jigsaws, games and arts and crafts equipment. Staff spoken with also stated that trips out are arranged through the day. A record is kept of all activities that occur. Menus seen show that residents receive varied and well balanced diets. The menu is the same in both units. One resident is on a specialist diet at the request of their relative. At the weekly house meetings, residents are encouraged to choose what they would like to eat at the weekends. What is not evident from record keeping is how the decision is reached. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. Staff are good at ensuring that the healthcare needs of the residents are met and specialist advice and support is sought when required. EVIDENCE: Residents are supported to attend a wide range of healthcare appointments as necessary to meet their individual needs. Records show that where specialist advice or support is required to meet individuals’ needs then arrangements are made for this to happen. There is a policy and procedure in place on the administration of medication. As recommended at the last inspection a new homely remedies policy has been introduced and this has been agreed with the home’s general practitioner. Record keeping in relation to medication administered to residents was up to date and no errors/omissions were noted. The acting manager advised that all the senior staff were up to date with medication training but arrangements need to be made for the remainder of the staff team to receive training. A requirement was made at the last inspection that a written assessment be carried out in relation to each resident’s ability to understand the subject of dying and death. It was acknowledged that this is a long-term piece of work. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 17 The acting manager has carried out some research into this subject and she agreed to devise a questionnaire to send to relatives to seek their views and following this to assess what contribution, if any, residents would be able to make in an assessment of their individual wishes. The acting manager advised that they recently consulted with the family of one resident when a close relative died and agreed how they would mark the death of this relative. A recommendation was made at the last inspection that staff should be offered bereavement counselling. Staff spoken with confirmed that this had happened. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Communication between the home and the Commission is good and there are clear procedures in place to ensure that staff report all notifyable events and adult protection alerts. The organisation needs to clarify with relatives and placement authorities the changes made to the management of DLA (Disability Living Allowance) monies received by residents so that everyone is clear about the new arrangements. EVIDENCE: The acting manager confirmed that there have been no complaints made to the home since the last inspection. In addition the Commission have not received any complaints about the service. As required at the last inspection the home now sends copies of all notifyable incidents including incidents where restraint has been used to the Commission. The Commission received three adult protection alerts. Where necessary Social Services convened adult protection strategy meetings and the outcomes were satisfactory. Records of residents’ finances were not inspected at the home. However an appointment was made at the head office to see some financial records. Money received on behalf of residents is placed in an interest bearing account and the interest earned is divided between each of the residents. The arrangements for DLA (disability living allowance) payments have changed this year. The General Manager advised that he would be writing to relatives and/or placement authorities advising of the changes. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 Quality in this outcome area is good. The building is well maintained and the ongoing programme for redecoration will ensure that the standard of accommodation remains good with a good quality of environment for the residents that live there. EVIDENCE: Almost all areas of the home were seen during this inspection. New curtains have been fitted in all communal areas. Tables and chairs have been ordered for the dining rooms. New cookers have been purchased and new cupboards doors are to be fitted in the kitchens. The majority of bedrooms have had new carpets fitted. There are plans to repaint all bedrooms, to replace all bedroom curtains and to supply new chairs and bed linen in all bedrooms. A number of bedrooms have already been completed. Each of the bedrooms is decorated differently to reflect the individual tastes and personalities of the residents. There are no pictures, ornaments or plants in the bathrooms. Following discussion with the acting manager it was agreed that they would look to find ways of making the bathroom areas more homely. All areas of the home seen were clean and there were no unpleasant odours. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 20 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): 31,33,34,35,36 Quality in this outcome area is adequate. Revised job descriptions, regular meetings and individual supervisions have helped to ensure that all staff are clear about their individual roles and responsibilities. The numbers of vacant staff hours is of concern. The use of regular relief staff alleviates some of the problems in the short-term but is not a long-term solution. As part of thorough recruitment procedures and for the protection of all residents a POVA first check should be made in respect of all new staff if they are to commence work prior to receipt of a full CRB check. EVIDENCE: Since the last inspection of the home six staff have left and four staff were appointed. At the time of inspection there were 154 hours vacant each week. The acting manager advised that one post had been filled (39 hours) but they were awaiting confirmation that all relevant recruitment checks had been carried out. A recruitment drive is underway, recent advertisements have been positive and interviews are to be held in the next few weeks. The staff rota has been redesigned to show all the vacant hours and how they are covered. The rotas seen showed that vacant hours are being covered mainly by regular relief staff but there is occasional use of agency staff. The rota also shows five hours, Monday to Friday, one to one support for one resident. However, as this resident is funded for fourteen hours seven days a week this also needs to be shown on the rota. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 21 The management structure has changed since the last inspection. Alongside the acting manager there is now one deputy manager and four senior care workers. The acting manager advised that roles and responsibilities are now more evenly distributed and staff work to their job descriptions. One of the senior staff spoken with echoed this stating that they are now much clearer about the extent of their individual responsibilities. One new task that he is due to take on is staff supervisions and arrangements are being made for him to receive training on this subject. Staff spoken with confirmed that they receive regular supervision. A discussion was held with staff about access to supervision records. The majority of staff spoken with thought that their supervision records were confidential to them and their manager. The acting manager agreed that they should clarify with staff that senior managers and inspectors would have access to such records upon request. The staff training matrix supplied following the site visit shows that staff training needs to be arranged in the following areas, medication, first aid, basic food hygiene and fire safety. However, the home were aware of the shortfalls and training courses were being booked. The pre inspection questionnaire refers to four staff that have NVQ level two or above. Over the past year some of the staff have received training on Autism Focus, Health and Safety, First Aid, Role of the Keyworker, Introduction to Teacch, Epilepsy and The Protection of Vulnerable Adults. An appointment was made to view staff records at the head office. Two files were examined in detail. In both cases there were completed application forms, two references, identification and details of qualifications. In one case it was not clear in what capacity the referee was know to the applicant. Both staff members came to the Trust with Criminal Records Bureau checks that had been carried out within the past twelve months. In both cases a fresh application had been made to the CRB. However, a Pova first check had not been carried out. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 22 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 Quality in this outcome area is adequate. Since commencing in post a few weeks ago the manager has made a strong impression on her staff team. She has put in place some new systems to ensure a smoother running of the home. The updating of the policies and procedures manual needs to be completed so that there are clear guidelines in place for staff to follow. As part of health and safety hot water accessible to residents must be delivered at 43°C. EVIDENCE: Prior to her appointment at Burton Cottages the acting manager had also worked previously with adults with autistic spectrum disorders. She hopes to commence studying for the Registered Manager’s Award in September 2006. The acting manager has yet to apply for registration with the Commission. Staff described her as `supportive’. They stated that `she listens to you and if you have a problem she takes action’ to resolve it. They were pleased about the changes that she had made since starting in post and felt that the regular staff meetings are very important. All staff spoken with stated that it had been a difficult year for the home but that they were very optimistic about the future Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 23 for the home and for the residents. The acting manager advised that she receives monthly supervision from the General Manager. As recommended at the last inspection the Trust has written to the relatives of the residents advising them of the changes in the staff team and keeping them informed of progress with the recruitment of the new manager. The acting manager has carried out an annual development plan for the year 2006/07. The plan details the tasks that she hopes to carry out within the year along with projected timescales. A questionnaire was sent to the relatives of residents last September seeking their views on the quality of the care provided in the home. Following this an action plan was drawn up and sent to the relatives. The manager advised that a partnership day has been arranged for May 2006. Relatives will be invited and it will be an opportunity for the acting manager to introduce herself and to discuss her annual development plan for the home. She also hopes to introduce a monthly newsletter providing updates on any new developments in the home. As part of the inspection process the Commission sent surveys to the residents seeking their comments on the care provided in the home. Staff completed the surveys on behalf of nine of the residents stating that they receive support from keyworker and family and that in most cases the residents would be unable to answer the questions. One resident completed the survey independently and they were happy with the support provided to them. Another two required some support to complete the form but one wrote `the staff look after me well’ and the other also responded positively to the questions asked. Three relatives were contacted via telephone and invited to make comments about the quality of the care provided. At the time of writing this report, two relatives chose to share their comments. One was very happy with the care provided and said that `communication is good and they are made to feel very welcome when they visit the home’. In addition to visits to the home their relative is also supported to phone them periodically. A second relative raised concerns about the continual staff turnover and reliance on agency staff. As their son’s needs have changed in recent years the home have not been able to manage his needs so well. He has become more unsettled and less willing to participate in activities. However, they also stated that since the new manager has been appointed she has been in touch and communication is improving. The revision of the policy and procedure manual is still ongoing. The Trust has recently recruited a new member of staff with a specific remit to review and update the policies and procedures. Policies seen included the confidentiality policy and the whistle blowing policy. On 9 May 2006 the General manager Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 24 advised that the Trust hope to have the new policy and procedures manual up and running within the next three months. Hot water temperatures were tested at two outlets and both showed readings that are within agreed safety limits. The home monitors water temperatures weekly and records showed that for some of the baths, hot water temperatures have regularly been 28° - 36°. Staff spoken with stated that the hot water temperatures can be cool at times but it can depend on the time of day the water is tested. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 25 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 2 2 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 3 2 X 2 X Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 26 YES 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 YA1 Regulation 6(a)(b) 5(2)(3) Requirement The home’s statement of purpose must be updated to reflect the changes in the management team. A copy must be sent to the Commission. The service user guide should be discussed, as far as it is possible to, with individual residents and a record kept of this. A copy should also be given to each of the resident’s relatives/representatives. All information obtained as part of the homes pre-admission procedures must be stored safety and available for inspection. In relation to one of the resident’s activities, the programme of activities in place is not accurate. If it is not possible to have a programme in advance one must be done retrospectively and a plan must be in place to show how over the coming months the home will increase the level of activities provided. Staff must be appointed in numbers that are sufficient for DS0000021064.V288945.R01.S.doc Timescale for action 30/06/06 2 YA2 17(1a) Sch 3 para 1(a) 12(1b) 30/06/06 3 YA12 30/05/06 4 YA33 18(1a) 15/07/06 Burton Cottages Version 5.1 Page 27 5 YA34 19 Sch 2 para 7-9 6 YA35 13(2)(4), 16(2j), 23(4) 7 8 YA37 YA40 9(1)(2) 17(2) Sch 4 the wellbeing of residents. [This was a requirement of the previous inspection, timescale given 30/12/05]. In addition all one-to-one hours must be shown on the staff rota. A POVA first check must be obtained in relation to all new staff employed to work in the home where there is no full CRB in place. Arrangements must be made for staff that have not received training in the following areas to do so: - medication, first aid, basic food hygiene and fire safety. The acting manager must apply to be the registered manager of the home. 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. [This was a requirement of the previous inspection timescale 30/4/06] The Trust has asked for three extra months to achieve this requirement. See standard 10 re confidentiality and standard 36 on supervision. Hot water accessible to residents must be maintained at 43°C. 30/05/06 31/08/06 30/05/06 31/07/06 9 YA42 13(a,c) 30/05/06 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 Good Practice Recommendations DS0000021064.V288945.R01.S.doc Version 5.1 Page 28 Burton Cottages 1 Standard YA1 2 YA6 3 4 YA23 YA34 The service user guide should be discussed, as far as it is possible to, with individual residents and a record kept of this. A copy should also be given to each of the resident’s relatives/representatives. Daily records should be more detailed in describing the actions taken in relation to achieving the ICPs and teacch records should be more detailed in describing the choices and decisions made by individual residents. The Trust should advise relatives and/or placement authorities of the revised arrangements in relation to the management of residents’ DLA monies. It should be clear from staff recruitment records the capacity to which referees are known to the applicants. Burton Cottages DS0000021064.V288945.R01.S.doc Version 5.1 Page 29 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.V288945.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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