Inspection on 20/04/05 for Cotswold

This inspection was carried out on 20th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cotswold 13/12/07

Cotswold 30/04/07

Cotswold 23/05/06

Cotswold 07/12/05

Cotswold 15/09/04

Cotswold 29/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cotswold Graze Hill Ravensden Bedford MK44 2TF Lead Inspector Fiona Mackirdy Unannounced 20 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cotswold Version 1.10 Page 3 SERVICE INFORMATION Name of service Cotswold Address Graze Hill, Ravensden, Bedford , MK44 2TF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 772196 01234 772194 The Disabilities Trust Care Home 5 Category(ies) of LD Learning Disablilty - 5 registration, with number of places Cotswold Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None. The CSCI will be contacting the provider in the next three months to discuss making clear conditions of registration for the home. Date of last inspection 15 September 2004 Brief Description of the Service: Cotswold is an adapted family home situated on the edge of Ravensden village just outside Bedford town. The downstairs is made up of an office, a large open plan lounge and dining area, a kitchen, a laundry room, one bedroom and a bathroom with toilet. Upstairs there are four bedrooms of varying size, a bathroom and a separate toilet. There is a large enclosed garden to the rear. To the side there is a large double garage. The home is in a secluded location with surrounding gardens and there is transport available to enable access to local facilities. The public transport service is limited to Ravensden but there is parking available at the home. Cotswold can provide care for up to five individuals with an autism spectrum disorder and associated challenging behaviour in single occupancy rooms. The service is owned by The Disabilities Trust who are a national provider of services for with autistic spectrum disorders. The home provides all aspects of service users care, including day activities. Cotswold Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place between 1340 and 1725. The care of two service users was tracked, which included observing the practice and routines, speaking with staff, looking at a sample of records, and a partial tour of the premises. Due to their disabilities, the service users were not able to talk about their care. The manager of the home left earlier this year following a long period of sickness and therefore the home has been effectively without a manager since September 2004. An anonymous complaint was received by the CSCI in December 2004, which the provider was asked to investigate. They provided an action plan detailing how issues would be addressed. What the service does well: What has improved since the last inspection? What they could do better: In the last six months the home has not been managed properly. There has not been a permanent manager at the home and senior staff have had to run the home. They have worked hard but have not had time or support to improve the care at the home. The recruitment of a permanent manager is Cotswold Version 1.10 Page 6 essential to ensure that everyone is clear about what the home should be doing to support service users and how it should be done. Up until recently the provider has not put plans into place to tackle the problems in the home. At the moment, the home cannot show how it is suitable to meet the particular needs of people with autism. The premises need totally refurbishing to ensure they are comfortable, homely and safe. There need to be clear plans for how service users are supported with their care and behaviour that all staff stick to. There must be activities provided for the service users that will help them develop their skills and keep them interested and occupied. So that service users and staff know what to do in the event of a fire, regular practices must take place and the provider must ensure that the fire alarm system is working properly and is regularly tested. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cotswold Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Cotswold Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3. The service could not consistently show how it met the specialist needs of people with autism. EVIDENCE: The format of care records allowed a detailed assessment to be made about service users’ needs but those seen were not fully completed and there was no evidence of recent review of the needs of service users who had lived at the home for some time. Staff had received training in autistic spectrum disorders, but not all staff had been trained in Makaton, a communication system used by two of the service users. Communal areas of the home were not in good repair, suitably decorated or furnished to meet the assessed needs of the service users. Cotswold Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9. Care plans were not complete or up to date and therefore there was not sufficient information about how staff should support service users on a dayto-day and longer-term basis. EVIDENCE: The home had a good format for outlining service users’ care needs, which linked with guidelines for specific areas of support, such as personal care, activities and behaviour management. However, those records seen were not fully completed and did not provide information about how cultural needs, social needs and some health needs would be met. There was no information demonstrating how plans had been reviewed or updated in the last twelve months. The service users at this home were not able to fully participate in planning their care and needed full support with making decisions and managing risk. Some risk assessments had been completed, but these did not include all areas of service users’ known or likely activities that may present a risk to them or other people. The home must further develop ways of communicating with service users through Makaton and the use of symbols and picture exchange Cotswold Version 1.10 Page 10 systems to ensure that they are as involved as possible in understanding and communicating decisions about their lives in the home. Staff expressed concern that the support to service users was inconsistent and that staff did not all communicate and work with the service users in the same way. As all service users have autistic spectrum disorders it is important that they receive clear communication to maximise their understanding and contribution to their care. Cotswold Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15 and 17. There were not sufficient or suitable opportunities for service users to maintain and develop skills or activities for meaningful occupation or leisure. The menu did not offer sufficient variety and food provided did not always meet service users dietary and health needs. EVIDENCE: Observations of the afternoon routine in the home showed that most service users were not engaged in any meaningful activity. Two service users were supported for a brief time to complete a jigsaw puzzle. Staff expressed concern at the lack of activities provided for service users and care plans did not contain information about service users’ interests or hobbies. Files contained written activity plans that had been devised over 12 months ago, but other records indicated that, for most service users, regular activities did not routinely take place. In contrast, one service user was supported with regular activities, including a weekly paper round in the local village, a gym session, swimming and cycle rides. Cotswold Version 1.10 Page 12 Records showed that service users were supported to maintain contact with family and friends and that this was valued by service users. Service users were observed to have access to all areas of the home with the exception of the kitchen and one bathroom. Although staff said that these restrictions were in place due to risks to service users, the specific risks were not indicated on service users’ records and some service users were subject to restrictions due to the needs of others in the home. Staff were able to talk about individual service users’ dietary needs and likes and dislikes. However the menu for the week of inspection was high in fat and showed some repetition, with chocolate gateau served twice within a few days. Some service users needed considerable support to eat a balanced diet due to health factors such as constipation or their preference to eat a very limited range of foods. During the inspection one service user was given boiled sweets, despite written information displayed in the kitchen saying that the home must monitor the consistency of food due to problems with swallowing hard items. Cotswold Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20. The health needs of service users were generally well met with evidence of good multi-disciplinary working taking place. The systems for the administration of medication were good but were applied inconsistently, particularly in relation to ‘as needed’ medication. As a result service users did not always receive medication appropriate to their needs. EVIDENCE: Records indicated that service users were supported to attend routine health checks and that support from health professionals at the local learning disability resource centre had been sought as needed. Service users’ wellbeing was being monitored and recorded on each shift. The home had clear policies for the administration of medication, but a record of medication administered had been altered using correction fluid. A recent inspection by the pharmacist highlighted that staff needed training in the administration of medication. Records of incidents showed that service users had been given ‘as needed’ medication such as a laxative or paracetamol when they had become distressed, without it being clear that their distress was as a result of pain or constipation. Cotswold Version 1.10 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23. On the whole, arrangements to protect service users were adequate, with the exception of financial arrangements, which did not sufficiently protect service users’ interests. EVIDENCE: Staff confirmed that they had received training in supporting service users with difficult behaviour , including how to physically intervene if necessary. Records of incidents were detailed and showed that physical intervention was not usually used. The reports were not signed by a manager, indicating that there was no overview of how incidents were dealt with and factors which could be identified to prevent a recurrence. The acting manager was providing appropriate support to service users in managing their money, but the arrangements for withdrawing money from service users’ accounts was not sufficiently robust to protect either service users or staff as only one person was the signatory. Service users were paying tax on interest accrued in their account; due to their low level of income it is highly unlikely that they will be liable for tax and they should be supported to apply for the gross interest to be paid. Cotswold Version 1.10 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28 and 29. The standard of décor in this home was very poor with evidence of further deterioration since the last inspection. The home does not therefore present as a suitable, homely or comfortable environment for service users. EVIDENCE: There was sufficient communal and bedroom space for the number of service users. However the seating and décor in the lounge were in poor condition and staff said that the seat covers were not suitable to withstand the regular washing required to keep them clean and hygienic. Service users’ bedrooms seen were generally in better condition than the communal areas and it was clear that they had been supported to personalise their rooms with colour and soft furnishings. However, the fitted wardrobe in one room had no doors as these had been damaged and not replaced. The toilets and bathing facilities were in a very poor state of repair and infection control was compromised, as flooring, tiling and the bath panel were in disrepair and would be difficult to effectively clean. Service users’ access to bathing facilities were restricted due to some service users’ behaviour, but Cotswold Version 1.10 Page 16 there was no written assessment of how this could be managed to ensure that this did not place inappropriate restrictions on other service users. Some adaptations had been made to the home as a result of service users’ specialist needs, such as boxing in the television, but there was little other evidence of suitable adaptations to meet the very specialist needs that the service users had in relation to their environment. The acting manager said that a full refurbishment of the home was planned for the end of May 2005 and he was involved in choosing suitable furnishings. The provider must ensure that suitable environmental adaptations are made, particularly to toilet and bathroom fittings to meet the needs of service users and to ensure their safety. The provider must also ensure that there is a continuous programme of renewal and decoration in the home to prevent the environment deteriorating once again. Cotswold Version 1.10 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 36. The ability of the staff to provide appropriate care to service users had been compromised by the lack of consistent management during the last six months. EVIDENCE: The home had retained a core group of staff who had worked at the home for some time and were able to talk competently about the needs of service users. However, there had been some turnover of staff and the home had recently advertised for 2.5 full time equivalent support workers. Staff said that they had not had any time to develop and implement structured activities for service users or to attend to key-worker responsibilities, including one-to-one time with service users. These views were supported by records. There had been no permanent manager working at the home since September 2004, one team leader had been seconded to another home and the second team leader had acted as manager for a few months, prior to leaving the home. The home was currently being managed by the team leader who had now returned to the home following secondment. There had therefore been no consistent management of the home and staff expressed concern that care for service users differed between staff members. Cotswold Version 1.10 Page 18 Staff confirmed that opportunities for training were readily available, although records were not examined on this occasion. The training in Makaton was welcomed by staff and they were observed implementing their knowledge and skills when communicating with service users. The acting manager confirmed that there were plans for all staff to undertake this training. Cotswold Version 1.10 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39 and 42. There has been a lack of effective and consistent management during the last six months, which has resulted in poor care outcomes for service users. EVIDENCE: The home has been without a permanent manager in day-to-day charge since September 2004. Interviews for a new manager are due to take place at the end of April 2005. Senior staff in the home have been acting as manager; although they have clearly worked hard and conscientiously in this role, they have been hampered by a lack of other senior support within the home and some turnover of staff. There has therefore been a lack of planning and direction for the home and a drop in the standard of care provided. An anonymous complaint to the CSCI in December 2005 raised concerns that the provider was not self-critical and had not acknowledged the significant difficulties that the home was facing. This view was founded, in that there had not been any action taken to address requirements made at the last CSCI Cotswold Version 1.10 Page 20 inspection, the environment of the home remained very poor and there was no indication of how the provider was addressing the poor quality of life experienced by service users. Reports of the provider’s visits under regulation 26 did not acknowledge that any of these issues were of serious concern or that steps were being taken to rectify the situation. The acting manager said that recently support from the provider had improved, with the agreement for the refurbishment of the home and the plans for recruitment of a manager. Although the arrangements for health and safety were not examined in detail at this visit, records indicated that the fire alarm system was not being tested regularly and that a fire drill/instruction had not been held since June 2004. The home could not therefore demonstrate that all staff or service users had received recent instruction in the fire procedures in the home. On the day of inspection an engineer was repairing the fire alarm, a fault which had been identified three weeks previously. The engineer was not able to effect a permanent repair and therefore the provider will need to consider whether replacement of the system is needed. Immediate requirements concerning the fire precautions were issued on the day of inspection. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 Cotswold Score x 2 Standard No 22 23 Version 1.10 Score x 2 Page 21 3 4 5 1 x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 2 1 1 1 x Standard No 11 12 13 14 15 16 17 1 1 2 1 3 x 2 Standard No 31 32 33 34 35 36 Score 2 2 2 x x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 1 1 1 x x 1 x Cotswold Version 1.10 Page 22 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 2&6 Regulation 15 Requirement Ensure service users plans cover all areas detailed in standard 2, including needs in relation to their environment. (Previous timescale of 31 January 2005 not met). All staff must be trained in the communications systems used by service users The premises must be suitable to meet the needs of service users Ensure that there are robust arrangements to maintain the environment of the home in good repair, which reflect and meet the needs of the service users. Provide an action plan detailing when the following items will be completed: refurbishment of the ground floor bathroom; repair and redecoration of ALs room as needed; repair of the wooden unit enclosing the sink pedestal in the first floor toilet; replacement or redecoration of rusty radiator covers; and provision of wardrobe doors for JKs room. (Previous timescale of 31 January 2005 not met). Review the care practices in the Version 1.10 Timescale for action 31 July 2005 2. 3. 4. 3, 7, 8 & 33 3 & 24 3 & 24 12(4)b 23(1)a 23(1) & 2(a) 31 August 2005 30 June 2005 30 June 2005 5. Cotswold 3 & 33 12(1) & 31 July Page 23 (4) 6. 7, 9 & 16 12 & 13(4) 7. 11, 12, 13 & 14 16(2)m & n 8. 17 16(2)i 9. 10. 17 20 13(3) 13(2) 11. 12. 13. 20 20 13(2) & 18 13(2) 31, 32 & 38 12 & 18 14. 15. 37 39 8(1) & 18(1) 26 home to ensure that they are based on current best practice for people with autistic spectrum disorders. Expand the scope of risk assessments to include service users known and likely activities and include any restrictions on choice or freedom necessary to manage identified risks. All service users must be enabled to take part in meaningful activities and records must be kept of activities provided and accessed (Previous timescale of 31 December 2004 not met) The menu must be reviewed to ensure that food provided meets service users nutritional and health needs Agreed guidelines in relation to the consistency of food for service user AL must be followed Medication records must be kept accurately and mistakes crossed out rather than amended with correction fluid Staff must be trained in the administration of medication Staff must only give as needed medication as prescribed for its stated purpose Staff must receive supervision, support and guidance to understand and implement the aims of the home and to provide consistent care to service users A suitably qualified manager and senior staff team must be appointed Review the quality and reporting of visits made under regulation 26 to ensure that significant issues affecting the quality of service provided are identified and action taken to address them Version 1.10 2005 31 July 2005 31 Julyy 2005 31 May 2005 31 May 2005 31 May 2005 31 August 2005 31 May 2005 31 August 2005 31 May 2005 31 May 2005 Cotswold Page 24 16. 17. 42 42 23(4) 23(4) Ensure that the fire alarm and detection system is fully operational Ensure that the fire alarm system is tested weekly, that the emergency lighting system is tested monthly and that all staff take part in a fire drill or instruction at least every six months 31 May 2005 31 May 2005 18. 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 23 23 23 Good Practice Recommendations The manager should countersign incident records and include action to prevent a recurrence There should be two signatories on service users bank accounts to minimise the risk of abuse Service users should be supported to claim for tax exemption on interest accrued on savings Cotswold Version 1.10 Page 25 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cotswold Version 1.10 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!