Inspection on 27/04/05 for Burton Cottages

This inspection was carried out on 27th April 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 18/10/05

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 Bishops Lane Robertsbridge East Sussex TN32 5BA Lead Inspector Caroline Johnson Unannounced 27 April 2005 14:15 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 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 Stationary 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Burton Cottages Address Bishops Lane Robertsbridge East Sussex TN32 5BA 01580 881715 Telephone number Fax number Email 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 (LD) 12 registration, with number of places Burton Cottages Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. That service users on admission will be diagnosed with an autistic spectrum disorder. 2. The maximum number of service users to be accommodated must not exceed twelve (12) 3. Service users accommodated must be between the ages of nineteen (19) and sixty-five (65) on admission. Date of last inspection 24 September 2004 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1 2005 to March 31 2006. The inspection lasted from 2.30pm until 7.45pm. At the time of inspection the acting manager had only been in post three weeks. Although she was on duty on the day of inspection, the deputy manager facilitated the inspection with time built in periodically with the acting manager. Time was spent going through various records and documentation. A full tour of the building was not undertaken on this occasion but all communal areas were seen along with approximately five of the bedrooms. During the tour, which lasted approximately three-quarters of an hour there was an opportunity to meet briefly with the residents most of whom have communication difficulties. In addition it was possible to observe staff interactions with residents. Two staff members were interviewed. Although the acting manager had only been in post for three weeks, she was aware of all the issues highlighted during the inspection process. It was acknowledged that she and her deputies, one of whom was also new to the Trust, would need time to address the issues raised. What the service does well: What has improved since the last inspection? The home has almost reached their target for having 50 of the staff team trained to a National Vocational Qualification at level two or above. A number of staff have received training in adult protection and prevention of abuse. Hot water temperatures accessible to residents have been controlled to a safe temperature. Introducing a pictorial timetable of activities for one resident has assisted in helping the resident to know what he is doing each day. Burton Cottages Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Burton Cottages Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Burton Cottages Version 1.10 Page 8 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 standard(s) 1 There is a very detailed service user guide in place but as the majority of residents have communication problems and cannot read the guide, it is therefore not appropriate to meet their needs. The home also needs to review the availability of the guide. EVIDENCE: The statement of purpose was not seen on this occasion. There is a detailed service user guide in place. The guide is very comprehensive and has been produced in pictorial format to aid comprehension. However, in discussion with staff it was acknowledged that the majority of the residents would not be able to understand the document. In addition the guide is stored in files in the office. Staff were not sure if a copy of the guide had been sent to relatives and/or their representatives. Burton Cottages Version 1.10 Page 9 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 standard(s) 6,9 Care plans include very detailed and valuable information along with information that is out of date. By reorganising the way the care plans are presented and removing old material, staff would be able to pick up the key points more easily. Progress made in achieving the identified goals should be recorded in more detail. This would make evaluating and reviewing care plans easier. Staff need further training on the difference between development and training plans and all training plans need to be measurable and achievable. EVIDENCE: One resident’s care plan was examined in detail and this resident and another resident’s needs were discussed with staff. Care plans include a detailed assessment of the needs and abilities of each resident and an autistic spectrum assessment. In addition there are risk assessments, behavioural guidelines, development and training plans. There is a keyworker system in place and keyworkers have responsibility for updating and reviewing care plans. Staff spoken with were not clear about the difference between development and training plans. Burton Cottages Version 1.10 Page 10 In respect of the care plan seen there was lots of information provided but it was not easy to pick out the key information in respect of the resident’s current needs. When speaking with the resident’s keyworker the key issues they highlighted in terms of meeting the resident’s current needs had not been identified in the development or training goals. Parts of the care plan had been written a long time ago and there were areas that are no longer applicable. Daily records are kept in respect of each resident. The format refers to goal plans but it is a tick system. Records did not show details of the progress made in respect of the individual goals so it was not easy to see how progress is measured or evaluated. The deputy manager advised that there is a lot of work needed to review and update all the care plans. Burton Cottages Version 1.10 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 standard(s) 11,12 Staff observed during the inspection were skilled in communicating effectively with the residents accommodated in the home. Arrangements need to be put in place for the one resident who does not have a programme of activities to ensure that he regularly attends planned activities that are fulfilling and enjoyable. The home needs to monitor staffing levels to ensure that there are sufficient numbers of staff on duty at all times. EVIDENCE: A number of the residents have communication difficulties and use non-verbal communication, so time was spent observing how staff communicate with the residents. Staff observed were good at interpreting residents wishes and gave clear concise instructions when making requests of them. Burton Cottages Version 1.10 Page 12 All but one resident attends one of the organisation’s two day centres. There is a structured timetable of activities in place for each resident. In respect of the resident who chooses not to attend a day centre there is no timetable of activities in place and activities are arranged spontaneously. Staff reported that they would like to see a more structured timetable of activities in place for this individual. The management of the home were in agreement that this should be put in place. A staff member advised that a new pictorial timetable has been put in place to assist one resident in coping with his revised timetable of activities. Problems had arisen when the timetable changed and he had been refusing to go to the day centre. Some improvement has been noted but on occasions problems still arise and staff advised that the new timetable would be kept under review. A staff member stated that on the days when this resident refuses to attend the day centre until later in the day, there is usually one carer working with this resident plus the second resident in the home and there are also a list of other tasks that need to be completed. They stated that they found these mornings very stressful. These situations were discussed with the manager and her deputy. It was noted that on these occasions a member of the management team would have been on duty but working in the office. It was agreed that should similar situations occur in the future the senior on duty would provide assistance to care staff. Burton Cottages Version 1.10 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 standard(s) 20 Staff observed during the inspection treated residents with respect and dignity. The arrangements in place for the storage and handling of medication are good. Record keeping in terms of staff training in relation to medication needs to improve. EVIDENCE: A staff member was observed for a short period supporting a resident who had been given medication as she was in pain. The staff member was very empathetic and she was gentle and caring in her approach. The resident responded well to the staff member. Recording of medication administered was clear and detailed. A record is kept of all medication returned to the local pharmacy. Records showed that staff training in medication was booked for January and May 2004 but there were no records to indicate how many staff attended the training. Only senior staff administer medication to residents and they are assessed in-house to determine their competency. Burton Cottages Version 1.10 Page 14 There is no record kept of the assessment process other than the tick system in the induction pack. It was not clear how many of the staff team had received training in the use of rectal medication but staff spoken with were clear about when such medication should be given. One member of staff stated that they would be confident administering medication if there were another member of staff present but would not feel confident if they were on their own. Burton Cottages Version 1.10 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 standard(s) 22,23 The complaint procedure needs to be updated and staff need to be advised of the content. The current arrangements for managing some of the residents’ finances are unsatisfactory and need to be revised as a matter or urgency. EVIDENCE: The home’s complaint procedure could not be located. However, there was a complaint procedure included in the service user guide. The procedure does not include reference to the name, address and telephone number of the Commission. There had been no complaints recorded since the last inspection. Staff advised that if they had a complaint or concern they would speak with their manager. They did not know that they could approach the Commission regarding complaints. The deputy manager advised that the majority of the staff team have received training in adult protection. Neither of the care staff spoken with had received training but one of the carers had only been in post a few weeks. Residents’ monies are managed in a variety of ways. Some are supported in this process by relatives; others hold their own bank accounts and are supported by staff to manage them. There are a number of residents that do not have individual bank accounts and currently their entitlements are paid into one account, details of which are stored at the head office. A record is kept of all money received from head office but the money is for general use. The home keeps a record of the individual monies spent but they do not know how much money each resident is entitled to and how much they each have in the general account. At the time of inspection the home was contacting banks and building societies to try to set up individual accounts. Burton Cottages Version 1.10 Page 16 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 standard(s) 24,27,28,30 Overall the property is well decorated. There are some minor works to be completed but these are in hand. The manager was aware that some areas of the home could be personalised more. EVIDENCE: The property is divided into two units and within each unit there is a lounge, dining room and kitchen. There is also an activity room positioned between both cottages that is used by residents from both units. The manager advised that there are some minor maintenance issues to be addressed and that the home’s maintenance person has started addressing them. At the time of inspection the lounge in cottage two was being redecorated. The broken drawers identified in the last inspection as in need of repair are on the maintenance list and will be attended to in the coming weeks. A full tour of the building was not undertaken on this occasion. All communal areas were seen and approximately five of the bedrooms. All areas seen were clean and decorated well. Bedrooms have been personalised. It was noted that there were no pictures in the lounge in cottage one. However, there were pictures in other parts of the cottage. The deputy manager advised that they would look to making the lounge and the bathroom areas more homely. Burton Cottages Version 1.10 Page 17 The manager advised that there is a generous budget for maintenance and redecoration and there are plans to replace all the carpets in the home and the cookers in both units are also due to be replaced. Burton Cottages Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,36 The home is well on the way to achieving 50 of staff trained to NVQ level 2 or above. The Trust provides a wide variety of training courses to staff. However, the home’s record keeping in respect of tracking which members of staff have attended courses is poor. The home is good at inducting new staff members into the home. EVIDENCE: There are fourteen care staff plus one housekeeper and one sleep-in member of staff. There are two vacancies one for a full-time carer and one part-time. The vacant hours are being covered by bank staff, use of overtime and very rarely, the use of agency staff. The deputy manager advised that an activity co-ordinator has been appointed and is due to start in May. Five of the care staff have received training in NVQ level two or above. In addition the acting manager and deputy manager are trained to NVQ level four. Three care staff are currently working towards level three and another two care staff are due to commence training in two months. Burton Cottages Version 1.10 Page 19 Staff recruitment records are stored in the head office so were not available for inspection. Staff advised that it is the home’s policy to ensure that full CRB checks are obtained prior to new staff starting in post. This meant a threemonth wait for one member of staff between appointment and being able to start in post. A new member of staff advised that their induction was `very thorough’. They stated that they were shadowed by staff until they felt confident in their role. They `never felt pressured’ and advised that `if need be shadowing is extended until an individual feels competent and comfortable with their role’. Another staff member spoken with stated that the deputy manager is very supportive and `notices when staff are stressed and need assistance’. A good practice recommendation was made at the last inspection to introduce individual staff training records. There were individual files in place for staff and some contained certificates but others had no records of staff training. Records show the training dates planned since the last inspection of the home and who should attend but there were no records in place of actual attendance. A wide range of training courses are made available to staff. A staff member advised that they had attended courses on first aid, health and safety, general autism, studio three (physical restraint), medication, fire safety and food hygiene. Staff receive regular supervision and as recommended at the last inspection of the home a wall chart is maintained that shows when supervision is due and when it is provided. Burton Cottages Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42, At the time of inspection the acting manager had only been in post for three weeks. She was aware of all the issues highlighted during the inspection process and it was acknowledged that she would need time to address the issues. The home’s policies and procedures need to be revised and updated, where applicable, and staff need to ensure that they have read and understood them. In addition staff need to be aware of the role of the Commission, they need to see inspection reports and have some understanding of the Regulations and National Minimum Standards. EVIDENCE: The acting manager is a qualified nurse and has completed NVQ level four in management. She has been a registered manager prior to taking up this post and brings a wealth of experience to the position. Burton Cottages Version 1.10 Page 21 The home has National Autistic Society accreditation and Investors in People accreditation. A requirement was made at the last inspection that the home keeps a record of questionnaires sent to relatives of residents. The acting manager and deputy manager had not been able to locate a format for questionnaires in relation to quality assurance. They agreed to devise an appropriate format to seek the views of relatives and residents. Another requirement made at the last inspection related to ensuring that hot water was delivered to baths and washbasins at a safe temperature. The deputy manager advised that since the last inspection hot water has been regulated at source. However arrangements are now being made to have the hot water controlled at the point of delivery. Records of incidents that have occurred in the home were seen. The deputy manager advised that in respect of one resident the numbers of incidents occurring have increased lately. Record keeping in respect of incidents need to provide more detailed information. The need to keep risk assessments under review and to revise them following incidents was highlighted. Some of the home’s policies and procedures have not been reviewed since 2002. There is also a need to introduce further policies and procedures and the home was referred to the Standards to identify those needed. Staff spoken with were not clear about the role of the Commission, they had not seen previous inspection reports and were not aware of the Regulations and National Minimum Standards. Burton Cottages Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 2 x x x x x Standard No 31 32 33 34 35 36 Score x 3 3 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 3 2 x Burton Cottages Version 1.10 Page 23 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. 2. Standard 6 12 Regulation 15(2)(b) 12(1)(b) Timescale for action Care plans must be reviewed and 12 July updated. 2005 A programme of activities must 22 July be put in place for the one 2005 resident who currently does not have one. A record must be kept of the names of staff that have received training in the administration of medication. In respect of invasive medication, the home must keep under review staffs willingness and competence to administer such medication. The complaints procedure must be reviewed to comply with National Minimum Standards. This was a requirement of the previous inspection. Timescale given was 24/12/04. Training must be provided for untrained staff in adult protection matters.This was a requirement of the previous inspection. Timescale given was 24/12/04. The arrangements for managing residents monies must be reviewed to ensure that detailed Version 1.10 Requirement 3. 4. 20 13(2) 30 May 2005 5. 22 22 15 June 2005 6. 23 13(6) 17 August 2005 7. 23 17(2) Schedule 4 para. 9 30 June 2005 Burton Cottages Page 24 8. 35 19 Schedule 2 para. 4 9. 39 24(1) 10. 11. 34 17(2) Schedule 4 para. 6 records are kept of all monies received on behalf of individual residents. Individual records must show details of all money either given to or spent on behalf of residents. Records must be kept of all training provided to staff. In addition a record must be kept of the names of staff in attendance and copies of any certificates provided. The home must introduce a quality assurance and monitoring system that uses questionnaires to seek the views of residents and others. Staff recruitment records must be kept in the home available for inspection. 15 June 2005 15 July 2005 15 July 2005 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. Refer to Standard 1 Good Practice Recommendations The service user guide should be revised to ensure that it is appropriate for the residents of Burton Cottages. A copy of the guide should be made to residents and to their relatives/representatives. Staff should understand the difference between development and training plans. Goals identified in care plans should be measureable and achieveable. Daily records should be used to monitor progress made in achieving the goals. In respect of the homes inhouse training on the administration of medication, the home should keep a record of the training given and the outcome. The home should refer to the NMS to identify any policies and procedure that still need to be produced. A number of the policies and procedures already in place should be reviewed. Version 1.10 Page 25 2. 6 3. 4. 20 40 Burton Cottages 5. 6. 7. 42 42 12 Staff should be informed about the role of the Commission, the Regulations and the National Minimum Standards. The home should ensure that inspection reports are available for staff to read. Senior staff need to monitor each shift more closely and if necessary provide assistance to care staff at key times. Burton Cottages Version 1.10 Page 26 Commission for Social Care Inspection 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. 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