Inspection on 16/12/08 for Cashel Cottage

This inspection was carried out on 16th December 2008.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cashel Cottage 08/01/07

Cashel Cottage 01/03/06

Cashel Cottage 20/09/05

Cashel Cottage 13/10/04

Cashel Cottage 23/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOME ADULTS 18-65 Cashel Cottage 39 Raffin Lane Pewsey Wiltshire SN9 5HJ Lead Inspector Elaine Barber Unannounced Inspection 16 and 18 December 2008 10:55 th th Cashel Cottage DS0000028392.V373288.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 Cashel Cottage DS0000028392.V373288.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. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cashel Cottage Address 39 Raffin Lane Pewsey Wiltshire SN9 5HJ 01672 563710 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) Steven@StevenAbbott.wanadoo.co.uk Mrs Jane Abbott Mr Patrick Jones Mrs Jane Abbott Mr Patrick Jones Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th January 2007 Brief Description of the Service: Cashell Cottage is a care home registered for four people with learning disabilities. It is run by Valued Lives, which is a private organisation, which operates 5 care homes for adults with learning disabilities. All are small establishments, intended to offer a normal domestic lifestyle. The main lead for the organisation is taken by one of the registered persons, Mrs Jane Abbott. She is supported by other senior colleagues, including family members. Cashel Cottage is in Raffin Lane, Pewsey. The town of Pewsey offers a range of amenities. The market towns of Marlborough and Devizes are within 15 minutes’ drive and the larger towns of Salisbury and Swindon are easily accessible. The organisation has a number of vehicles used by the people who live in the homes and they contribute towards the costs. Valued Lives also operates Harlequins, which is a day service used by most people who live in the homes for at least part of each week. They pay a small weekly sum towards this. Recently Valued Lives have bought a farm, which offers more opportunities for day time occupation. All bedrooms at Cashell Cottage are on the first floor. There is one shared bedroom. The bathroom is also upstairs. There is a small bedroom where staff sleep in. Communal space is on the ground floor. There is a sitting room and dining room, which was being used as a sitting room for one person at the time of the inspection. There is also a large garden. The fees for Cashel cottage vary according to people’s individual needs. Information about the service is available in a statement of purpose. Inspection reports are available in the home and from the CSCI website, www.csci.org.uk. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. We asked the agency to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys to the agency so that these could be completed by the people who used the service, staff, and by health professionals. We did not receive any back. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during our inspection. We made two visits to the home on 16th and 18th December. We met with one of the managers of the service. They were the registered manager for another home run by the organisation. We also met with two members of staff. We read some of the home’s records and we talked to the people who lived in the home. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: Each person had had their needs assessed before they moved into the home so that their needs could be met. Each person also had a written contract with the home so that they knew what they had to pay for. Each person had care and support plans which provided information for staff about how to support the person. People made decisions about their lives with assistance as needed. People were supported to take risks and given opportunities for independence. People were provided with a range of activities and opportunities to go out into their local community. Recently people had been on a trip to Southampton, Christmas shopping, to the pub for a meal and to church. Activities were suited to their individual needs and choices. A range of activities was offered at the day service run by the organisation, including art and craft, bingo and music. People were able to maintain and develop appropriate relationships Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 6 with family and friends. People’s daily lives had an appropriate balance between necessary routines, and individual choice. People were involved in choosing their meals and shopping for food. They were offered healthy, nutritious and enjoyable meals. People received support in ways they preferred and required and people’s physical and emotional health needs were met. People had appointments with a range of health care professionals, including the GP, dentist, optician and podiatrist. They also had access to specialists including a psychologist and psychiatrist. Medication was stored in a locked cupboard and appropriate records were kept. People were protected by the home’s policies and practices about medication. There was a complaints procedure and information about safeguarding adults. Staff knew how to involve outside agencies in investigating allegations of abuse if needed. People were safeguarded by the home’s policies and procedures for complaints and protection. People lived in a comfortable, clean and safe environment, suitable to their needs. The home was in a residential area on the outskirts of Pewsey and was in keeping with the other houses in the street. There was a large living room downstairs with soft furnishings, artificial flower arrangements and mobiles which gave it a homely feel. At the time of our inspection there were also Christmas decorations and a Christmas tree. There was also a kitchen and a separate dining room, which had been turned into a sitting room for one person. There were two single bedrooms and a shared bedroom, which were individually decorated and furnished. The accommodation looked fresh and clean. People were supported by sufficient staff, who were trained and qualified to meet their needs. All the staff who worked in the home had a National Vocational Qualification at Level 2. Staff received induction training and a range of other training including food hygiene, medication, health and safety, protection of vulnerable adults and basic Makaton so that they could meet people’s needs. The registered manager was appropriately qualified and experienced to run the home and kept their training up to date. They had started a system for reviewing the quality of care and identified service developments such as buying a farm. There was a range of safety measures to make sure that people were on the whole kept safe. What has improved since the last inspection? We made a requirement at the last inspection that each person must have their individual plans and risk assessments reviewed and updated to reflect current needs and support. Each person had had a new support plan and some new risk assessments had been developed to ensure that people were protected from harm. In response to a recommendation care plans were Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 7 signed and dated to show when they were developed and when they were due for review. The registered person had expanded the day services provided by the organisation by buying a farm. This provided additional opportunities for day time activities for people and for working with animals. What they could do better: It would be good practice for a representative to sign the contract when a person is not able to sign themselves so that their interests are safeguarded. The system of care planning should be reviewed so that is simpler for staff to use, it is accessible to people who use the service, it covers all people’s assessed needs and is person centred to ensure that each person’s diverse needs are met. Each person who lives in the home or their representative should sign the care plan to show they have been involved in developing their plan. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed so that any controlled drugs that are prescribed can be stored safely. The objects obstructing access to the wash hand basin by the shower should be removed so that people can wash their hands easily. The toilet roll should be removed from the kitchen as it poses a risk of cross infection. People were not benefiting from being cared for by staff who were supervised and whose performance was appraised. A regular system of supervision and appraisal must be introduced. People were not protected, by the home’s recruitment practices, from staff who may be unsuitable. Staff must not work with people until all the required checks are returned. Staff should receive training about person centered planning and person centred care to help them to work with people in a more person centred way. Further work is needed to the quality assurance system to ensure that any service developments are based on people’s views. The Annual Quality Assurance Assessment sumitted to the Commission should contain information about the specific outcomes for people in this home. Some risks to people need be assessed, for example the use of bedrails, exposure to hot water and hot surfaces and unrestricted windows and measures need to be indenitified to reduce risks and keep people safe. Up to date advice should be sought about risk assessment and control measures. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 9 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 Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. Each person’s individual needs were assessed so that their needs could be met. Each person had a written contract with the home so that it was clear what they had to pay for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No-one had moved into the home since the last inspection. At previous inspections we found that each person had their needs assessed when they moved into the home. When we looked at the records we saw that each person had an individual placement agreement with the local authority. At the last inspection we made a recommendation that it would be good practice for each person or their representative to sign their contract to show that they were in agreement with it and their interests were safeguarded. The manager had told us that a care manager had said that it was not appropriate for people to sign their own contracts as they were not able to understand the contracts. It would therefore be good practice for a representative to sign on their behalf to ensure that their interests are safeguarded. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. Each person had care and support plans but these were not always fully completed and were not person centred to ensure that people’s diverse needs were met. People made decisions about their lives with assistance as needed. People were supported to take risks and given opportunities for independence but further attention is needed to the management of risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We made a requirement at the last inspection that each person must have individual plans and risk assessments reviewed and updated to reflect current needs and support. This had been addressed. We looked at the personal files of three people. We saw that each person had had a new support plan dated 20th April 2007. We also made a recommendation at the last inspection that care plans should be signed and dated when they are developed, care plans should be updated as circumstances change, all changes to the care plans should also be signed Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 12 and dated and the service user or their representative should sign the care plan to show they have been involved in developing their plan. This had been addressed in part. The new care plans had been updated. We saw that the new plans had been dated when they were written and they contained the name of the member of staff who had developed them. However, neither the person nor their relative had signed the plans to show that they had been involved in developing them and were in agreement with them. We noted that the three care plans were very similar. They were not person centred and did not reflect the individuality of people. The name had been changed on the plans otherwise they looked the same. Each person also had additional support guidelines to meet particular needs. These were not dated so it was not clear which were the most up to date. One person had a behaviour management policy, which was dated and contained the names of the members of staff who had been involved in developing them. This included a physical intervention policy and guidelines. The manager told us that they were waiting for the community nurse to review and update this plan. We saw that each person also had a person centred plan. These had not been completed fully for each person so they did not reflect people’s individual and diverse needs. They were not integrated into the rest of the plans and their purpose was not clear. Overall the system of care planning and support plans was very complicated. There was a lot of information to take in making it difficult to use them as a working document. Some of the information was duplicated in different plans. The system of care and support planning would benefit from being simplified to make it easier for staff to use and to ensure that they can meet people’s needs. Examples of how people exercised choice and decision making were recorded in the care plans and daily records. They chose the activities they followed at their day service. When people returned home at the end of the day they were observed choosing what to do and where to spend their time. People had also chosen the colours for the rooms in their house. Some restrictions were in place, which were agreed with people’s representatives. We made a recommendation at the last inspection that the practice of locking the kitchen at night should be reviewed to ensure that it is for the benefit of people who currently use the service. The manager told us that they no longer locked the kitchen so this had been addressed. As stated above, we made another requirement that all service users must have individual plans and risk assessments reviewed and updated to reflect current needs and support. When we looked at people’s risk assessments we Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 13 saw that this had been partly addressed. We saw that each person had several new risk assessments. Staff had signed a sheet and dated it when they had read each risk assessment. The risk assessments were in words and pictures to help the people to understand them and they included the risk and the control measures to reduce the risk to the person. There was a summary of all the risk assessments in a risk management plan. This had been signed and dated by the staff involved and there was a date for the next review. However, the manager, who was present throughout the inspection, told us that there used to be health and safety risk assessments but these had been taken out of people’s care notes and they were focusing on more individual risks. One person used a stairlift and a risk asessment had been conducted by the community nurse. However, we noticed that one person had bedrails and they did not have a risk assessment about the use of bedrails which identified control measures to ensure that they were kept safe when sleeping. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. People were provided with a range of activities and opportunities to go out into their local community. Activities were suited to their individual needs and choices. People were able to maintain and develop appropriate relationships with family and friends. People’s daily lives had an appropriate balance between necessary routines, and individual choice. People were offered healthy, nutritious and enjoyable meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we looked at the files we saw that each person had a time-table of daily activities. All three attended the day centre run by the organisation and there was a record of the activities they took part in. One of the people also occasionally went to the new farm, which had been set up by the organisation as another learning opportunity for people. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 15 We saw that people’s spiritual needs were recorded in their support plans. The manager who was present during the inspection told us that each person was offered the opportunity to attend church and there was a special service, at a church nearby, for all the people who lived in the homes run by the organisation. We read the daily records of three people. These showed that people had contact with the local community. Over the last month the records showed that people had had a Christmas meal out at a local pub. They had been on trip to Southampton. People went food shopping, to church and to a social club. On the first day of our inspection people had gone Christmas shopping with staff support. The records also showed that people had different leisure activities. At the day service they had bingo, art and craft, drawing, helping to decorate the Christmas tree, music and puzzles. At home people had their own interests. These included watching TV and DVD’s, drawing, cutting out, writing, lego and reading magazines. They attended a social club once a fortnight. The manager told us that staff supported the people to maintain contact with their family. They assisted people to make phone calls and visit relatives. Two of the people had regular contact with their family and one person saw their family less frequently. The people also had friends in other houses owned by Valued Lives. When we read the personal notes we saw that people saw these friends when they went to the day service. The daily records showed that people were involved in the routines of the home and helped with the household chores. They also did the food shopping with support. The manager told us that people chose the menus by looking at recipe cards. She said that that the staff would put together a menu using one of each person’s choices for each day. People were also involved in shopping and buying ingredients. Healthy eating was promoted. We looked at the menu and saw that it was varied. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. People received support in ways they preferred and required and their physical and emotional health needs were met. People were protected by the home’s policies and practices about medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we looked at the records we saw that each person’s preferred daily routines were recorded in their care plan. These included how they liked staff to support them. Personal care was provided in private. They chose their own clothes and hairstyles. They had specialist support when needed. One person had had specialist advice from an occupational therapist about installing a shower and another was having advice from an OT about a new bed. We saw that details about support with health care were recorded in the care plans. Contacts with a range of health care professionals were recorded. These included the GP, dentist, optician, community nurse, psychologist, psychiatrist, occupational therapist and chiropodist. Each person had a health action plan and an annual health check. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 17 There was a medication policy and staff received training about medication. Medication was stored in a locked cupboard. This did not meet the requirements for the storage of controlled drugs. However, no one had any controlled drugs. Each person’s medication was kept separately in a plastic box and there was a medication record book. There were appropriate records of medication received, administered and returned to the pharmacist. A list of homely remedies had been compiled for each person and agreed by the GP. We saw from the records that each person’s medication was regularly reviewed by a GP or psychiatrist. Each person who had ‘as required’ medication had guidelines about the circumstances in which these could be given. The ways in which people consented to take their medication were recorded in their care plans. One person had an epilepsy profile and management plan completed by the community nurse. Staff had received training about the particular way they had to give this person their medication. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. People were safeguarded by the home’s policies and procedures for complaints and protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that there was information available about how to make a complaint. The procedure was last updated in September 2004. There was a simplified version in words and pictures within the Service User Guide. Contact details for the CSCI were included. The manager told us that no complaints had been received. The aim of the organisation was to minimise any likelihood of this, by having strong recording systems that made all staff accountable for the actions during each particular shift period. There was a wide range of information about safeguarding adults. This included details about multi-agency procedures within Wiltshire. There had been one safeguarding issue since the last inspection, which the manager had referred appropriately using the multi-agency safeguarding adults procedure. This had been investigated and concluded. One person who lived in the home had a behaviour management plan and physical intervention guidelines. These had been drawn up by all the staff and community nurse. Physical interventions were described and there were Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 19 guidelines about which holds may be used and in what circumstances. Staff had received training in these techniques. The manager told us that the behavioural support guidelines and the physical intervention training were to be reviewed following the safeguarding issue. Staff assisted people to manage their money and appropriate records were kept. These records were audited. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. People lived in a comfortable, clean and safe environment, suitable to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was in a residential area on the outskirts of Pewsey and was in keeping with the other houses in the street. There was a large living room downstairs with soft furnishings, artificial flower arrangements and mobiles which gave it a homely feel. At the time of our inspection there were also Christmas decorations and a Christmas tree. There was also a kitchen and a separate dining room, which had been turned into a sitting room for one person. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 21 A shower room with toilet had been installed for one person and advice had been sought from an occupational therapist about this. The wash basin for this toilet was in the room next door. There was no water to this basin on the first day of our visit but the manager said that it had been repaired by the second day. It was difficult to get to this basin because there was a large doll hanging over it. Upstairs there was a bathroom with a shower, two single bedrooms, one double bedroom and the staff sleeping in room. The three bedrooms were individually decorated and people had brought their own things into their rooms. People had chosen the colours of their bedroom walls and those of the living room. At the last inspection improvements were being made to the accommodation. The kitchen ceiling had been replastered, the kitchen cupboard doors and work-surfaces had been replaced. A new boiler had been fitted. Since then the kitchen had been redecorated. There was a domestic washing machine in the kitchen. We made a recommendation at the last inspection that the environment could be improved by dusting the mobiles and flower arrangements. These had been dusted and the house was clean throughout. We noted on the fist day of our visit that there was a toilet roll on one of the kitchen work surfaces. The manager explained why it was not kept in the toilet and said that it was usually kept in a cupboard. However, it was still there on the second day we visited. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. People were supported by sufficient staff, who were trained and qualified. People were not benefiting from being cared for by staff, who were supervised and whose performance was appraised. People were not protected, by the home’s recruitment practices, from staff who may be unsuitable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the rota and saw that there were three staff who worked in the home regularly and two who worked there occasionally. There were two staff on duty all the time during the day and evening and one sleeping in at night. The two staff who worked in the day took the people to their day service and supported them there. The manager told us that the three regular staff who worked in the home each had a National Vocational Qualification (NVQ) at Level 2. She also said that the two staff who occasionally worked in the home also had NVQ level 2. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 23 There had been two new staff appointed since the last inspection. Each had completed an application form including a declaration that they had no convictions and that they were physically and mentally fit. One member of staff had only one written reference, and a Protection of Vulnerable Adults (POVA) First check before they started work. Their Criminal Records Bureau (CRB) check arrived six days after they started work but no second reference had been received. A copy of their birth certificate and passport were kept as proof of identity. Only one written reference was received for the other member of staff before they started work. Their second reference, POVA first and CRB checks were not received until after they started work. A copy of their birth certificate and passport were kept as proof of identity. The manager said that at first the member of staff would have worked under supervision and read information. There was no written evidence of when these staff started to work with people. The two new members of staff had received induction training and basic food hygiene training and then NVQ level 2. At previous inspections we had noted that staff received training in health and safety, food hygiene, first aid, medication, including special methods of administration, and abuse awareness. There were also courses about epilepsy, challenging behaviour, person centred planning, physical intervention, autism, and dementia in people with Down’s Syndrome. We looked at the staff training records and saw that since our last inspection staff had received training about basic Makaton, and refresher training about food hygiene, protection of vulnerable adults and medication. As stated earlier, we found that person centred plans were not being completed fully and their purpose was not clear. This suggests that staff would benefit from updating their training about person centred planning and person centred practice. The manager told us that they aimed to provide supervision for staff every two months. We looked at the supervision records and saw that it was not happening so regularly. The two newer members of staff had supervision recorded in their induction booklets. One of the other staff had a record of supervision in February 2008 and March 2008. A second member of staff had supervision in March 2008 and the third had supervision in January, February, March, April and May 2008 and nothing afterwards. There was a new appraisal format. The manager said that they planned to conduct appraisals and start supervision every two months after that. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. The registered manager was suitably experienced, and was supported by senior colleagues. Failures in care planning, recruitment and health and safety show that service users are not always benefiting from a well run home. Further work is needed to the quality assurance system to ensure that people’s views underpin all self-monitoring, review and development by the home. People’s health, safety and welfare were not wholly promoted and protected by the health and safety measures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered person was Mrs Jane Abbott. She was also the registered manager for Cashel Cottage. She had lengthy experience of working with people with learning disabilities and had owned and operated her own services Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 25 for many years. She had a learning disability nursing qualification and was working towards NVQ Level four in management. We looked at her training record and saw that she kept her training up to date and had done the same training as the staff. She was supported by other senior staff within the organisation. Together, they oversaw all five services run by Valued Lives. The other registered managers within the organisation provided support to the various homes if needed. We made a requirement at the last inspection that the registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care at the care home. The registered person shall supply to the commission a report in respect of any review conducted by him and make a copy of the report available to service users. We advised that in order to comply with this requirement the registered person must supply to the Commission a copy of the report about the quality assurance survey and make a copy of the report available to service users. This had been partly complied with. During our visit we saw a format for reviewing the quality of care and a strategic plan for 2007 to 2009. We saw that a questionnaire had been developed for people who use the service. The registered person had identified service developments and had developed a farm to provide day time activities for people. However, she needed to complete the audit of people’s views and the review process to obtain feedback from people and to ensure that any future service developments are based on people’s views. The registered person completed an Annual Quality Assurance Assessment (AQAA), which provided us with information about the service. We found that this provided much information about the overall service developments, for example the new farm. However, it was identical to the AQAA’s for the other homes in the organisation and did not tell us anything about particular outcomes for people in this home. There was a health and safety policy to comply with the relevant regulations. There were monthly health and safety checks and records were kept. The manager, who was present throughout the inspection, told us that there used to be health and safety risk assessments but these had been taken out of people’s care notes and they were focusing on more individual risks. We saw individual risk assessments in people’s files. These did not always focus on health and safety issues. One person used a stairlift and a risk asessment had been conducted by the community nurse. However, we noticed that one person had bedrails and they did not have a risk assessment about the use of bedrails which identified control measures to ensure that they were kept safe when sleeping. The occupational therapist was advising about a new bed for this person. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 26 There were arrangements for the training of staff in moving and handling, fire safety, first aid and food hygiene. Hot water temperature regulators had been fitted to the taps. There were Control of Substances Hazardous to Health (COSHH) assessments, equipment was regularly serviced and portable appliances were tested annually. There was a very detailed fire risk assessment covering all areas of the home and records of fire safety checks. We made a requirement at the last inspection that the registered person must ensure that the fire alarm system is tested at weekly intervals. This had been addressed. When we read the fire records they showed that the fire alarm was being checked weekly. Information was available about what to do in the event of a heat wave. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 27 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 3 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 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 3 33 3 34 1 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19 (1) Schedule 2 Requirement The registered person must not employ a person to work at the care home until all the required checks, including two written references, a Criminal Records Bureau check and a Protection of Vulnerable adults check have been received. The registered person must ensure that the staff receive the support and supervision that they need to do their jobs. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care at the care home. The system shall provide for consultation with service users and their representatives. In order to comply with this requirement the registered person must obtain the views of people in the home and make sure that any service developments are based on these views. Timescale for action 16/12/08 2. YA36 18 (2) a 31/01/09 3. YA39 24 (1)(5) 31/03/09 Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 29 4. YA9 YA42 13 (4) c The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In order to comply with this requirement the registered person must a) conduct a risk assessment for the use of bedrails and identify control measures to reduce risks b) conduct risk assessments about the risks from hot water, hot surfaces and windows and other general risks. 15/02/09 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. Refer to Standard YA5 YA6 YA6 Good Practice Recommendations It would be good practice for a representative to sign the contract on behalf of a person who is not able to sign so that their interests are safeguarded. Each person who lives in the home or their representative should sign the care plan to show they have been involved in developing their plan. The system of care planning should be reviewed so that is simpler for staff to use, it is accessible to people who use the service, it covers all people’s assessed needs and is person centred to ensure that each person’s diverse needs are met. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed so that any controlled drugs that are prescribed can be stored safely. 4. YA20 Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 30 5. 6. 7. YA24 YA30 YA35 8. YA39 9. YA42 The objects obstructing access to the wash hand basin by the shower should be removed so that people can wash their hands easily. The toilet roll should be removed from the kitchen as it poses a risk of cross infection. The staff should receive up to date training about person centred planning and person centred practice to help them to work in a more person centred way and meet people’s diverse needs. The Annual Quality Assurance Assessment sumitted to the Commission should contain information about the specific outcomes for people in this home as well as overall service developments. The registered person should consult the guidance on the Health and Safety Executive website about risk assessment and control measures. Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Cashel Cottage DS0000028392.V373288.R01.S.doc Version 5.2 Page 32 - 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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