Inspection on 08/08/07 for Cosin Lodge

This inspection was carried out on 8th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cosin Lodge 15/09/06

Cosin Lodge 08/11/05

Cosin Lodge 20/05/05

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Cosin Lodge Cambridge Avenue Willington Co Durham DL15 0PW Lead Inspector Ms Kathy Bell Key Unannounced Inspection 8th August 2007 10:15 Cosin Lodge DS0000062455.V344062.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 Cosin Lodge DS0000062455.V344062.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. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cosin Lodge Address Cambridge Avenue Willington Co Durham DL15 0PW 01388 748702 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) londonroad@tiscali.co.uk Milbury Care Services Ltd Miss Caroline Ann Cadywould Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th September 2006 Brief Description of the Service: Milbury care services are the owners of Cosin Lodge which is based in Willington, County Durham. The home is situated in a quiet residential area within close reach of the town centre and shops, pubs etc. The home was first registered in January 2005. It is registered to provide care (but not nursing care) for 4 residents who have a mental disorder or learning disability. The home is a purpose built bungalow with each pair of bedrooms having direct access to a shared bathroom. The home is fully adapted to meet the needs of residents who are physically disabled as well. The homes fees range from £1537 to £1724. This information was provided to CSCI in July 2007. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home for this inspection took place during one day in August 2007. The inspector also received further information in the month following the inspection. During the visit she looked around the home (although not every bedroom), looked at records and spoke to the acting manager and three of the staff. Two of the residents had filled in survey forms, giving their views on the home, but did not want to talk to the inspector on the day. One relative and three professionals responsible for the care of residents had completed survey forms. Four of the staff filled in surveys after the visit to the home. At the time of the visit to the home, the registered manager was not working at the home. In her absence, it was being managed by an experienced manager from another Milbury home. This arrangement was due to last until the 24th August 07. After this the home was to be managed by a senior carer, with a visit one week from the previous acting manager and the alternate week by a senior manager from Milbury. What the service does well: What has improved since the last inspection? Staff had consulted with the care manager of one resident about restrictions in a care plan. This was important, because it is safest for residents and staff if Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 6 someone responsible for a resident s care, outside the home, agrees that they are acting correctly. More information is available to help residents complain if they wish to and explain what is wrong. Risk assessments, which identify when any activities might put residents at risk, and describe what the home must do to stop people coming to harm, have been reviewed to make sure they are up-to-date. Staff have been checking that hot water is at a safe temperature. What they could do better: Care plans must be kept up-to-date and advice given by healthcare professionals must be included in them to make sure that all staff always know what to do. Any restrictions in care plans must be agreed with care managers. Behaviour guidelines must explain clearly how staff can best avoid people becoming angry or upset in the first place. Then they must explain what works for each person in terms of calming them, and, as a last resort, what techniques for restraint work best and most safely for them. The process of producing these guidelines should use the knowledge staff have of each individual. The guidelines should be discussed with care managers and relatives, and residents where possible, to make sure everyone involved agrees with them. Medication must be stored at the correct temperature. Staff can start work after the home has confirmed they are not on the Protection of Vulnerable Adults List, but before a Criminal Records Bureau check has been received, if a home is short staffed. But if they do,the home must be able to show it has made proper arrangements to supervise them, until the Criminal Records Bureau check comes back. All staff must receive essential training such as fire safety and moving and handling. Records must be kept of training provided. New staff must receive planned training when they first start work, to teach them what they need to know. Staff should receive specialist training relating to the needs the home is registered to meet. The system for reviewing the quality of care must include seeking the views of residents and their representatives. The fire alarm system must be tested correctly each week and doors fitted with self closers must not be held open. Ground floor windows must be made secure. Please contact the provider for advice of actions taken in response to this Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 7 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. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home makes sure it receives full information before admitting a resident so it can be sure it will meet their needs. EVIDENCE: All the residents had been assessed by care managers before they were admitted and written assessments had been completed. The admission of a new resident has been delayed because she is in hospital and the acting manager explained how she is seeking more information to make sure they will still be able to meet their needs. The home already had full information about her, including a very detailed care plan. Records had been passed over from her previous home so that Cosin Lodge would be up-to-date on what had happened recently in her life. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan to describe the care they need. These have not always been updated and reviewed. Some are very good in parts but in other areas do not provide enough detail to guide staff. But staff have generally been able to continue providing a good standard of care because of their knowledge of each person and their needs. Residents can have choice in their daily lives. The home looks at the risks of any activities and how they can keep people safe: these risk assessments have been reviewed recently. EVIDENCE: Each resident has a care plan to explain the help they need. Some of these contained a lot of good detail so that staff knew exactly what they were meant to do. They described how someone should be helped using hoists and other moving and handling equipment. They included information about peoples likes and dislikes, what they liked to do for leisure activities, if they needed help to eat or special food and if they had communication problems. But staff must check the care plans to make sure that all the details they need are included. One example, is the guidance on carrying someone safely in a Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 11 wheelchair in the homes vehicle. The senior staff member explained the various systems to securely hold the person in the wheelchair and a wheelchair in the vehicle, but the guidance missed one part of this. For the current staff, who regularly carry out this task, this is not likely to be a problem. But new staff could put someone at risk of a serious accident if they were not aware of everything they had to do. One of the care plans showed clearly when changes had been made. But information had not always been added when needs changed. In a small home like this, with not many changes of staff, it is easier for staff to keep up-todate with any changes. But care plans should always be kept up-to-date to make sure that everyone knows what to do if something changes. In the surveys, the staff who answered said that the ways they pass information about residents between staff usually worked well, but two said that communication could be better. There are guidelines to tell staff what to do if someone becomes upset or angry and may hurt themselves or staff. Staff said that these guidelines had been drawn up by the companys behaviour team and had not been discussed with care staff. This meant that the guidelines may not have had the full benefit of the knowledge of staff who knew these residents well. Where possible, guidelines should be discussed and agreed with residents. On one set of guidelines, the manager had noted that the resident had refused to sign them. Staff said that he had not had the chance to read them before the meeting to consider them properly. On the last inspection, the Inspector required the home to agree any restrictions with care managers if residents cannot consent themselves. On this set of guidelines, the care manager had signed their agreement. But there was no evidence that care managers or relatives had seen or agreed other guidelines. One of these guidelines described, as it should, what made that person upset. When staff know that, they can try and avoid the situations which make a resident upset. Other guidelines did not explain how to avoid someone becoming upset in the first place. But the staff could explain what they knew about this person, and how they could help them avoid becoming upset. Some parts of the guidelines told staff exactly what to do, but there were also on the file older guidelines which were different. Staff did not always follow these guidelines, but used their own knowledge of what worked for that person to calm them down. One care professional commented that staff usually have the skills they need to respond to behavioural problems. Discussions with staff suggested that they were working in a way which respected residents feelings. But when staff follow their own understanding of what works, rather than agreed guidelines which everyone follows, they may be inconsistent, causing more difficulties. There is also the risk that someone less experienced may act in a way which is not acceptable or too restrictive. Other areas of the guidelines did not contain enough detail to guide staff. Behavioural guidelines should be individual and refer to specific ways of talking to and responding to people when their behaviour is difficult. Stock phrases such as use NCI techniques are not enough. Also, one set of guidelines Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 12 contained a phrase which neither the acting manager nor staff, when she asked them, understood. Since the inspection, the companys behaviour team has been reviewing these guidelines and are to send them to the care managers and CSCI. Two of the residents, who are fairly independent and mobile, clearly choose how they spend their time in the home. They pursue their own leisure interests, TV, music, computer etc in their rooms or spend time together in the lounge. Each week they agree a rough timetable of activities with staff. In the surveys, these residents said they could choose what they wanted to do. Most of the time I know what I want to do and can make my own choices and decisions. Care managers said that the home supports individuals to live the life they choose, usually or always. In the surveys, staff said that they felt the home does well in promoting independence and choice. Staff have to help the third resident exercise choice in her life. Her relative commented that they are trying to improve her communication. This should help her express her wishes more easily. Her care plan included information about her likes and dislikes. The records of the meals provided showed that people make different choices. The home has carried out assessments of activities which might create a risk for residents. These explain, for example, whether someone needs staff with them to work in the kitchen safely. These risk assessments were not looked at in detail on this inspection but, since the acting manager has been in place, staff have been reviewing these and recording their reviews. The homes Service User Guide commits it to respecting peoples individual faith, culture etc although it does not mention sexual orientation. However the home has a booklet providing information to residents on relationships and sexuality and this treats equally peoples different sexual orientations. Staff believe that diversity training is planned but have no dates for this yet. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents take part in a range of activities, which suits their individual interests and abilities. They use local facilities in the town where they live. Where possible, they have been able to keep up contact with their families and staff provide support to make this possible. Staff respect residents rights and encourage them to share responsibility for the good running of the home. The home provides satisfactory meals and residents can make choices about what they eat. EVIDENCE: The daily records showed a range of different activities, including walks, visits to the library, TV, go-karting, cinema and swimming. On the day of the inspection, two residents were going to the cinema and one was shopping for personal items, with a meal afterwards. One resident attends college and another has done so in the past. In the home, two residents enjoy music, TV, DVDs and their computers in their rooms. Staff help a third resident watch TV Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 14 programmes she likes, and to enjoy music. Her mother confirmed that the home supports her to do what she likes, which is going out and about. Record showed how the home supports residents to stay in touch with their families, either by taking them to their families or by families visiting the home. One relative said they are willing to bring her home whenever I ask. We can visit Cosin Lodge at any time. The daily records show that the more able residents are involved in the daily tasks of running the home, cleaning their rooms, washing-up etc. They all go shopping for food with staff so they can make choices. Care plans and records showed the clear expectation that residents will be able to make choices in their lives. There is a planned menu for each week but the records of meals actually provided showed that this often changes and people eat different meals. The home tries to promote a healthy diet and residents can help themselves to fruit, but staff recognise that residents will not always choose a healthy option. Residents can help themselves to snacks from the fridge although staff explained they do try and limit this with agreement. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 15 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): Standards 18, 19, & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In most ways, personal and health care needs are well met. But the home has not always made sure that advice from specialists is recorded and acted upon. Medication is given out safely but might not be stored at the right temperature. Staff have not yet had the external, assessed training in handling medication which is recommended, although they have had basic training in the home. EVIDENCE: The home has cared for people with complex needs and records show that they have obtained advice from specialists in health and social care and obtained recommended equipment. In the surveys, care professionals said that health care needs are met always or usually. One care professional commented that staff usually have the skills they need to respond to behavioural problems. One relative said that, my daughter has been in care now 43 years and the care she gets now is the best she has ever had. But one care professional reported in May that the manager had not written down or passed on to staff important information about safe eating. This could have had serious consequences for that resident. During this visit, the Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 16 inspector found that advice from a speech and language therapist about eating had not been included fully in the care plan . In her letter, she said she had provided guidance about making meals more nutritious but this information could not be found in the home. See also, the section of this report on Individual Needs and Choices. The last inspection, almost a year ago, noted that medication was stored in an internal room which gets very hot. The home was required to check the temperature of this room and make sure that medication was stored at the recommended temperature. No action has been taken on this. The acting manager agreed that it was too hot in this room and said that she is trying to arrange for the medication cabinet to be moved. Staff have had training within the home but have not yet had external accredited training which is recommended for all staff who handle medication. A check of the record of medication given to residents showed that it was being completed properly. Medication which residents had bought themselves had not always been labelled. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The company which runs the home has continued to try and make it easier for residents to complain. However residents have not always felt able to say what they thought. The home has failed to protect residents from financial abuse and procedures to protect residents when new staff are recruited have not been followed. EVIDENCE: The company has a satisfactory complaints procedure and this is available in a simple written text version. Some people might find a version with pictures easier to understand. But they have provided a card which people can fill in and send to the company if they are worried about something. There is also a picture format to help people express what they are unhappy about. No complaints have been recorded. In surveys completed recently, the residents said they knew who to speak to if they were not happy and how to make a complaint. However staff described a situation where a resident had not been able to express their views to the manager. But staff had acted correctly in encouraging that person to talk to a senior manager in the company. Care professionals in the survey said that the home had always or usually responded appropriately if concerns were raised. The relative in the survey Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 18 said that she knew how to make a complaint and the home had always responded appropriately if she raised concerns. An internal audit has shown large sums of residents money is not accounted for and this is being investigated. The company which runs the home has cooperated fully with investigations into the missing money and other concerns. Records of the recruitment of staff who were to work on a bank basis, covering shifts when the regular staff were not available were looked at. These showed that two of them started work after the home had been advised they were not on the Protection of Vulnerable Adults list, which would have barred them from working in a care home, but before they had received a clear Criminal Records Bureau check. Homes are allowed to do this if they need staff urgently but only on condition that firm arrangements are made for the supervision of the new worker until their Criminal Records Bureau check is returned. There was no evidence that this supervision was provided. Most of the staff have received training in the protection of vulnerable adults. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. Quality in this outcome area is excellent . This judgement has been made using available evidence including a visit to this service. The home provides a comfortable place to live which meets peoples needs. Although some redecoration is needed it appeared clean and to be a pleasant place to live. EVIDENCE: The home was designed to meet the needs of people with physical disabilities. Each pair of bedrooms share a large bathroom equipped with a special bath, hoists etc so that staff can provide personal care safely and with dignity. The home has a large kitchen/dining room and a separate lounge. There is a private garden which all the residents can use. The acting manager explained how she would like to develop the home in ways which residents have suggested. Some areas of the home need redecoration, with paintwork and wallpaper scuffed. Staff described how residents have been involved in agreeing the colour scheme for the redecoration which is planned. The acting manager Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 20 arranged for the carpets to be cleaned and there is a cleaning schedule which staff have to complete, to make sure that all areas of the home are kept clean. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 21 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): Standards 32, 33, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are good and meet the needs of residents. The home has achieved the recommended target of staff qualified to level 2 of the National Vocational Qualification in care and staff show the personal qualities expected for care staff. Recruitment procedures are satisfactory except for a lack of supervision of new staff. New staff have not always received satisfactory initial training, to make sure they can work safely. There is a training programme and most staff have completed most of the core training expected for care workers. However the home should be looking at more specialised training to reflect the needs this home is registered to care for. EVIDENCE: Staffing levels are high, to reflect the complex needs of residents. A least two staff are on duty during the day and mostly three or four are on duty. This allows staff to work individually with residents and provide an active lifestyle. At night, there is one person awake on duty and one sleeping in. In the surveys, staff said that they always covered the shifts and worked as a team to cover holidays, sickness etc. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 22 There seemed to be good relationships between residents and staff, with staff having a good knowledge of each resident as an individual. Despite recent problems in the home, staff seem to have remained committed to the welfare of residents. 11 of the 18 staff have achieved the National Vocational Qualification in care at level 2 or above. This is the recognised qualification for care staff. The National Minimum Standards for care homes recommend that at least 50 of the staff achieve level 2 so the home has done well to achieve 61 qualified. There is an established recruitment system which requires an application form, two references and checks of the Protection of Vulnerable Adults List (which lists people who are unsafe to work with vulnerable adults) and of criminal convictions (a Criminal Records Bureau check). Records showed that the company had obtained the required references and checks. But two staff recruited to work on a bank basis, to fill in when other staff could not cover shifts, started work after their POVA check was back, but before their CRB check had returned. Homes are allowed to do this, if they need staff urgently, but they are required to supervise the new member of staff. There were no records of how this was done. Training records are unclear and the acting manager has been working to establish as clearly as possible who has received training in which areas. The company has confirmed that it will act on the basis that if a certificate is not available, training has not taken place and will need to be repeated. Only two staff are recorded as having done infection control but on the previous inspection, the inspector was advised that all had done so. Most staff have had protection of vulnerable adults training, all have had health and safety and food hygiene. Three are not recorded as having had fire safety training. Three separate courses relating to moving and handling are listed, everyone has done one of these but a few staff have not completed the three. Some staff have had training in person centred planning, autism and communication. Staff also receive training in control and restraint. Although the home is registered for people with mental disorder, staff have not received specific training in this area. In the surveys, staff praised the level of training and all four said it was satisfactory. New staff received training in fire safety, first aid, food hygiene, moving and handling and health and safety within a month or two of starting work. The company provides a handbook to cover structured induction but two of three new bank staff whose records were checked had only partially completed these in the first month they worked. The induction was formally completed only after the acting manager began work in the home. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 23 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): Standards 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The company which runs the home made arrangements for the running of the home in the absence of the registered manager. The acting manager has done a good job in improving the home in a short time. The company failed to check thoroughly enough that the home was running well but has admitted what went wrong and considered how to do this better. The safety of residents and staff are protected in most ways but some work is needed to make sure of this. EVIDENCE: In the absence of the registered manager, a manager from another Milbury service was running the home for four days each week. This manager was experienced and qualified for the job and was checking everything about the way the home was run and what needed to be improved. She was able to put right a number of things and improve the morale of staff. After the inspector Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 24 visited the home, she acted on the advice which was given. However she needed to return to her own job and since August, a senior carer has been running the home, with close support from this acting manager and senior staff in Milbury. The systems the company should have for making sure its homes are well run have not worked well in this case. They did not make sure that requirements from the last inspection were acted upon and records, which would have shown problems, were not checked in a detailed way for a time. However more recently, the company arranged more detailed internal inspections of the home and it was one of these which has alerted them to the fact that some of residents and company money was unaccounted for. Discussions with senior management of the home have shown that they do take these failings seriously and are looking carefully at how to improve. The acting manager was working on a review of the service, to look at what they were doing well and what should be improved. The home needs to get the opinions of residents, relatives and care managers as part of this review. There are a number of systems to make sure the home is a safe place to live and work. Any risks to do with the building and the action to be taken have been identified . Similarly a fire risk assessment has been done and reviewed this summer. This also includes details on the particular needs of residents if there is a fire. Equipment and the services in the building are checked at regular intervals. Staff check the temperature of the hot water and records show they took action when they found it was too high. But a number of matters needed attention: Staff, acting on the advice they had been given, were not checking the fire alarm system properly. Two doors in the building which should be closed as they are fire doors are often propped open. This is important because the fire doors prevent the spread of smoke and fire, allowing time to evacuate residents if there is a fire. The home must discuss with the fire officer whether they can use a device which will allow the doors to be held open when needed, but close automatically if the fire alarm goes off. This matter was raised with the manager in the last inspection a year ago. Staff were correctly checking that bed rails, which are meant to prevent a resident falling out of bed, were in place and fitted properly. This is very important to prevent people becoming trapped in them. But the records showed that one resident sometimes moved them. The acting manager acted on the Inspectors advice to seek professional advice on the best way of reducing the risks to this resident. The acting manager had noted that residents bedroom windows on the ground floor were not fitted with restrictors which limited how far the window could be opened. While these were not necessary because of the risk of falls, they must be fitted to make sure residents are safe from any intruders and cannot leave the building without staff being aware. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 25 Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 26 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 1 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X X 3 x Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Care plans must be kept up-todate and advice given by healthcare professionals must be included in them to make sure that all staff always know what to do. Any restrictions in care plans must be agreed with care managers. Behaviour guidelines must explain clearly how staff can best avoid people becoming angry or upset in the first place.Then they must explain what works for each person in terms of calming them, and, as a last resort, what techniques for restraint work best and most safely for them. The process of producing these guidelines should use the knowledge staff have of each individual. The guidelines should be discussed with care managers and relatives, and residents were possible, to make sure everyone involved agrees with them. The previous requirement about keeping care plans up to date had not been met. Timescale for action 01/11/07 Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 28 2. YA20 13 3. YA34 18 Staff must monitor the 01/11/07 temperature where medication is kept and take action if it is not being kept at recommended temperatures. This requirement was made at the previous inspection and has not been met but the acting manager explained plans to move the medication cabinet. When staff start work after the 01/10/07 home has confirmed they are not on the Protection of Vulnerable Adults List, but before a Criminal Records Bureau check has been received, the home must be able to show it has made proper arrangements to supervise them, until the Criminal Records Bureau check comes back. All staff must receive essential training such as fire safety and moving and handling. Records must be kept of training provided. New staff must receive structured induction training. The system for reviewing the quality of care must include seeking the views of residents and their representatives. This requirement was made at the previous inspection. 01/12/07 4. YA35 18 5. YA39 24 31/12/07 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 YA20 Good Practice Recommendations Staff should have accredited training in the safe handling of medication. DS0000062455.V344062.R01.S.doc Version 5.2 Page 29 Cosin Lodge 2. YA35 Staff should receive specialist training relating to the needs the home is registered to meet. Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Cosin Lodge DS0000062455.V344062.R01.S.doc Version 5.2 Page 31 - 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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