Inspection on 02/11/06 for Buttercups & Railway Cottage

This inspection was carried out on 2nd November 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buttercups & Railway Cottage 12/10/09

Buttercups & Railway Cottage 29/04/09

Buttercups & Railway Cottage 24/11/08

Buttercups & Railway Cottage 13/11/07

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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 Buttercups & Railway Cottage 8 Ford Road Arundel West Sussex BN18 0BH Lead Inspector Mrs K Allen Unannounced Inspection 2nd November 2006 1:30 Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buttercups & Railway Cottage Address 8 Ford Road Arundel West Sussex BN18 0BH 01903 884105 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) Corich Community Care Limited Mrs Jacqueline Hooper Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first key inspection Brief Description of the Service: Buttercups and Railway Cottage is a newly registered service which provides care and accommodation for up to twelve people with a learning difficulty. Although it is under one registration it comprises of two adjacent premises one for three people and the other for nine. It is situated in a rural location yet next to Ford railway station. All residents are accommodated in single rooms with en-suite facilities on two of the three floors. There is no passenger lift. There are ample grounds which are accessible to residents and the smaller house has it’s own private courtyard. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspection a review was made of the contact between the home and the Commission for Social Care Inspection (CSCI) since it’s registration. This included an analysis of incident reports and those of other statutory bodies such as the fire service as well as complaints. The manager was sent a pre-inspection questionnaire and this is still to be completed and returned. The inspection took place from 1.30pm until 7pm. During the inspection all of the residents were seen in communal areas and in the company of staff. Four care staff, the cook and the manager were interviewed. In addition a number of records were seen. Due to the nature of resident’s learning disability it was not possible to get their direct views about the service. Three requirements and five recommendations have been made as described below under “What they could do better”. What the service does well: What has improved since the last inspection? Upon registration it was recommended that more light be available in the two bedrooms in Railway Cottage. This has been achieved by the installation of dormer windows and both rooms now provide good accommodation. It was further recommended that the small radiators in two bathrooms be covered for residents safety. This has been carried out. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 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 the following standard(s): 2 The outcome for residents is good. Prospective service users individual needs are assessed. EVIDENCE: Written details were available showing the assessment carried out for each person prior to them coming to live at the home. This information is gained through contact with other professionals but also by a series of visits to the home by the person concerned and their relatives as well as staff meeting the individual in their own situation. The process for admission is thorough and enables everyone to make the transition at a pace, which suits the individual and those already living at the home. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 & 9 The outcome for residents is good. Their assessed needs are reflected in their individual care plan. They can make decisions about their lives with assistance as needed and they are enabled to take risks as part of an independent lifestyle. EVIDENCE: All residents have a written care plan which is kept up to date and regularly reviewed. They include individual procedures for residents who are likely to be aggressive or cause harm or self harm. Families and other interested parties are involved in drawing up the plan and it’s review. Key workers are designated to work with individuals and oversee their care. Residents are enabled to make decisions although their limited capacity means that these are necessarily about day-to-day matters. Any larger decisions include family and other representatives. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 10 Individual choices are made on a daily basis with regard to what to eat, how to spend leisure time, when to go to bed, what to wear etc. The home manages resident’s money on their behalf in partnerships with relatives or other representatives. (See Recommendation 1) A number of limitations are placed on residents. They include locked rooms throughout the house and one person has equipment to restrict their movement. These measures are taken to prevent harm to self and others and are kept under review. In the case of restraining equipment, this is used with the consent of relatives and at times when that person is particularly distressed and most likely to hurt themselves. Some people have developed more skills and awareness since coming to the home and it is anticipated that restrictions will be modified to accommodate this as time goes by. Written risk assessments are kept as residents lead an active life which includes taking risks. Areas which have been assessed include eating, nighttime care, drinking, challenging behaviour in public spaces and activities such as swimming and horse riding. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 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, 13, 15, 16 & 17 The outcome for residents is good. They are enabled to take part in age and culturally appropriate activities and are part of the local community. Residents have appropriate relationships and their rights are respected. A healthy diet is offered and residents enjoy their meals. EVIDENCE: Two people regularly attend a local college and two more will recommence at the beginning of the next academic year. Everyone uses community facilities including the cinema, swimming pool, pubs, cafes and restaurants. The establishment is adjacent to a private dwelling and since registration work has been carried out to reassure the neighbour and to meet any requests for quiet etc. This has lead to a good relationship which is now based on mutual respect for all parties. There is a dedicated activities co-ordinator and each resident has a weekly programme. The home provides good facilities within it’s own activity centre where residents can do trampoline, cooking, ball games, art and craft etc. They also have regular trips out to places of interest, go for walks or just for a ride in the country. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 12 All except two residents have some contact with family. The extent of this contact varies from one person going home every other weekend and another person seeing their parents on birthdays and for Christmas. There is a visitors room with tea and coffee making facilities so that residents can meet in some privacy, it is however off the main lounge and quite small. Daily routines are flexible and take account of outings and activities. Residents get up and go to bed at various times and most are able to indicate when they wish to do so and this is respected. Time for residents to be alone is limited as their behaviour often means they need supervision at all times. However, they have their own rooms and ensuite and this space is used whenever it is safe to do so. Residents in the main house do not have unrestricted use of the home and grounds, again as it would not be safe. However, staff are alert to residents wishes and respond to any indication that they may wish to go outside, use their room or go the bathroom. Residents in the smaller house have freedom of movement and access to all parts of their accommodation. Residents preferred name is recorded and used. A cook is employed throughout the week to provide meals and care staff are responsible for cooking at the weekend. However, in the smaller house the residents are involved in their own menu planning and cooking of their own meals, with staff assistance as necessary. A good diet is provided which includes plenty of fresh fruit and vegetables. It is varied and takes account of likes, dislikes and special diets. Meals are taken in a separate dining room which is pleasantly decorated. Staff sit with residents and support those who need it. Residents weight is monitored and some people are on diets to reduce their weight. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 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): 18, 19 & 20 The outcome for residents is good. They receive the personal support that they require and their health needs are met. They are protected by the homes medication procedure. EVIDENCE: All residents are able to get around the house independently although one person relies on a wheelchair when they go out. This was due to be serviced but unfortunately some staff were unaware of this and the wheelchair was not on the premises. (See Recommendation 2) Staff help everyone with personal care and this is carried out in the privacy of the persons room/en-suite. Residents are helped to choose what they wear usually by being shown different items so they can indicate which they prefer. Specialist staff are consulted if necessary for example, social workers from the community team for people with a learning disability, psychiatrist and speech therapist. Parents are enabled to accompany residents to appointments if they wish. All residents are registered with a GP and staff said that they had no hesitation in contacting them if they had any concerns about the wellbeing of a resident. There were clear records showing when appointments had been made and what the outcome was. Staff support residents to access general health services such as the dentist, optician and chiropodist. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 14 None of the residents are able to manage their own medication. This is done by senior staff who have been trained. There is a written policy and procedure for the administration of medication and good arrangements are in place to store it safely. When giving out medication staff are required to sign the records to show that this has been done. There were a small number of omissions where it was not possible to determine if the medicine had been given or not. Whilst this was not a persistent problem the manager agreed to follow it up and make sure that every time residents receive medication it is recorded. Good records were kept for the receipt and disposal of medicines. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 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 outcome for residents is good. Their views are listened to and acted upon. They are protected from abuse. EVIDENCE: There is a written complaints procedure. Residents would have difficulty in understanding the concept however the details are made available to relatives. One complaint was received from a neighbour and the home notified CSCI. Records show that it was dealt with to the satisfaction of all concerned. Representation was made by some parents and this was dealt with promptly thereby making it unnecessary to invoke the homes complaints procedure. There is a written policy and procedure for staff to follow to ensure the protection of residents. This information forms part of their induction when they first come to work at the home. They were able to describe how they would deal with any suspicions or allegations and were also aware of how residents may indicate that something untoward had happened to them. As previously stated the home manages resident’s money. It is safely kept however the accounting was not accurate with one person apparently having less money that they should have had and another having too much. The manager agreed to look into this matter and ensure that more frequent checks are made so that any errors can be detected earlier. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 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 the following standard(s): 24 & 30 The outcome for residents is good. They live in a comfortable and safe environment which is clean and hygienic. EVIDENCE: Although an existing premises, the building was completely redesigned and refurbished prior to its registration. Both recommendations made at the point of registration have been met and the building provides good accommodation. It remains in good repair and is free from any odours. Some bedrooms are less personalised than others which reflect individual residents, some of whom are obsessively tidy or would not feel at home with lots of pictures or other items of interest in their rooms. There is a well-equipped laundry which is located away from food preparation areas. It has a large washing machine with a wash cycle suitable for soiled linen. A wash hand basin is supplied to prevent infection. Whilst it is a large room there is insufficient shelving for safe storage and use of the area. The manager confirmed that this was in hand and shelving would be provided. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 17 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): 32, 34 & 35 The outcome for residents is adequate. They are supported by competent staff although the homes recruitment procedure does not always protect them. Staff receive training although their induction is not always recorded. EVIDENCE: Staff were enthusiastic and at ease with residents. They were interested in them and their wellbeing. Systems were in place for good communication although at times this broke down. For example, two people had moved into the home and links with their college were broken which meant they lost their place for a year. It was evident that staff understood the needs of residents and the manner in which they communicated. They pre-empted most of their difficult behaviour and managed it well with a safe outcome for all concerned. There is a training programme in place however the recommendation that 50 of staff have obtained an NVQ is yet to be met. Staff have done training in, for example lifting and handling, first aid, food hygiene and understanding learning disability and medication. Staff stated that they were provided with a two-week induction when they first come to the home. They felt that it covered what they needed to know however there was no record of this and no checklist to ensure that all of the necessary areas were covered. There is a thorough recruitment procedure at the home although records do not demonstrate that this is always followed. For example, two people had only Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 18 one reference and there was no record of a Criminal Records Bureau (CRB) check in one case. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 19 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, 39 & 42 The outcome for residents is adequate. The home is run by a manager who is fit to do so however there is no evidence that residents views underpin it’s development. The health and safety of residents and staff is protected. EVIDENCE: The manager is suitably experienced and qualified. She is clear about her responsibilities and there are good lines of accountability. There is currently no quality assurance system in place. Safe working practices are assured by staff training in such areas as lifting, fire safety and food hygiene. Hazardous chemicals are safely stored, restrictions are fitted on windows, radiators are covered or ‘low temperature’ and equipment is serviced. The heating was on although areas of the home were cold. The manager confirmed that the heating needs adjusting and that it was being attended to. Good records are kept of any accident or incident involving residents and staff. Fire fighting equipment is regularly checked although there was no record of this having been done for the emergency lighting. Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 1 X X 2 x Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA34 YA39 YA42 Regulation 19 24 13 Requirement A thorough recruitment procedure must be followed A system for quality assurance must be established All fire fighting equipment must be checked regularly Timescale for action 03/11/06 01/04/07 03/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA23 YA32 YA32 YA35 YA42 Good Practice Recommendations The accounting of residents money should be improved Communication between staff should be improved The NVQ training programme should be developed Staff induction should be programmed and recorded The storage arrangements in the laundry should be improved Buttercups & Railway Cottage DS0000066692.V314726.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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