Inspection on 30/04/07 for Cotswold

This inspection was carried out on 30th April 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 no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cotswold 13/12/07

Cotswold 23/05/06

Cotswold 07/12/05

Cotswold 20/04/05

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 Bedfordshire MK44 2TF Lead Inspector Sally Snelson Unannounced Inspection 30th April 2007 07:30 Cotswold DS0000014891.V337399.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 Cotswold DS0000014891.V337399.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. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cotswold Address Graze Hill Ravensden Bedfordshire MK44 2TF 01234 772196 01234 772194 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) The Disabilities Trust Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2006 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, with an enclosed space that could be used for activities. 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 people with autistic spectrum disorders. The home provides all aspects of service users care, including day activities. The basic monthly fee was £1789.53 per week. There could be additions to this depending on the care needs of the person. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 07.30 am on 30th April 2006. A senior support worker James Lewin was available from the start of the inspection and the acting manager, Doctor (his name, not a title) Kawocha, from about 9.30 am. Prior to the inspection Doctor Kawocha had completed a Pre-inspection questionnaire and all of the people who used the service, known within the service as service users, had been supported by staff to complete a questionnaire. The company had returned the service users questionnaires with a letter stating that due to the fact that all the service users were diagnosed on the autism spectrum staff had approached this task with recognition of their individual associated communication needs. However with out the professional support of speech and language therapists and psychologists it was impossible to gauge the individual’s opinion. In addition to the service users, relatives and staff had also completed questionnaires. During the inspection the care provided to two service users was case tracked, this involved reading their care files and observing the care provided. During the inspection the inspector was shown around the building and spoke to staff. The ability of those living at the home to communicate was limited so the inspector was dependent on observing the interaction between the staff and the service users to determine what the outcomes for the service users were. The inspector would like to thank the staff and the service users for the time they gave to this inspection. This inspection report should be read alongside the National Minimum standards for Younger Adults. What the service does well: The home has a core group of staff that have worked with the service users for some years and know them well. In some respects the rural location of the home allowed service users more opportunities to walk outside with staff, however on the negative side the service users did not have the opportunities to mix with and be part of the community. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 6 Since the last inspection a number of staff had the necessary qualifications to drive one of the homes three cars. This allowed service users to be transported individually if they needed or wanted to be taken out at the same time. What has improved since the last inspection? What they could do better: At the end of the inspection the inspector recorded some of the things that the home needs to do better. The inspector have asked for them to be achieved in a timescale and will ask the manager to tell them in writing how these will be achieved. This is a list of some of the things that must be done better. • • • • • • • • • Train staff to be able to look after service users properly, and to be able to understand the different needs of each service user Improve structured activities for service users that reflect their age, preferences and aspirations Make sure that more information is available to service users, which is clear and easy to use Ensure mealtimes are more relaxed and all service users have the opportunity to sit at a dining table if they wish Develop PCP (person centred planning) for all service users Update and improve parts of the environment Appoint a manager for the service Make sure it is clear what service users must pay for with their own money Ensure that the recruitment policy is followed. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 7 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. Cotswold DS0000014891.V337399.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 Cotswold DS0000014891.V337399.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): 13,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Documents that provided service users with information about living at Cotswold were available, but they had not been updated and there was no evidence that service users had been supported independently to understand them. EVIDENCE: Since the last inspection the registered manager had resigned; the Statement of Purpose had not been revised to reflect the changes. The manager believed that the area manager was in the process of revising both the Statement of Purpose and the Service Users Guide. The Service Users Guide provided during the inspection did not fulfil all the elements listed in Standard 1 of the National Minimum Standards or meet Requirement 5 of the Care Homes Regulation. For example it did not include information about fees and what “extras” service users would be expected to pay for. Some of the information included in the Service User Guide had been produced using pictures and photos to make it user friendly to some of the service users. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 10 There had been no new service users admitted to Cotswold since the last inspection. Therefore this standard could not be assessed on this occasion. The staff training files, for the staff on duty, showed that they did not all have the necessary experience and qualifications to meet the needs of the service users living at Cotswold. More evidence is included in the staffing section of this report. Service user contracts were in place. However, they had not all been signed by representatives for the service users, only by the staff. Given the legal implications of these documents, this is a concern. Again the contracts contained the majority of the required information and had been provided in a user-friendly (pictorial) style. However these documents did not include enough information about the financial responsibilities for service users. For example the contract did not include any information about service users paying for staff meals and drinks when on trips and days out. It was apparent from talking to staff and sampling receipts that service users were paying for staff when they had meals out as part of a local activity. There was no evidence that service users were aware that they were paying for this or that they had agreed to it. It was also practise to divide the cost of a meal equally amongst participating service users although the actual costs of individual’s meals and drinks were different. Again, there was no evidence that service users, or their representatives had agreed to this arrangement. Cotswold DS0000014891.V337399.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 poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments must be regularly reviewed, kept up-to-date, and adhered to in order to ensure that service users received consistent care and support. EVIDENCE: Service users files were well kept and material was appropriately archived. As stated in the previous inspection report ‘there was comprehensive assessment and planning information relating to those living at the home contained in a number of documents. The documents included a service users plan, risk assessments and comprehensive guidelines for caring and supporting service users’. However the plans did not include goals for the service users to work towards. It was also apparent that care plans and risk assessments had not always been Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 12 reviewed on the set date, or if they had, there was no evidence of how or when this had taken place, as staff had not signed and dated some documentation. For example a service user who enjoyed a walk to the local shop was restricted to spending 50 pence at a time. It was not clear why this restriction was in place, possibly to limit the amount of sweets purchased, or if it was expected that at sometime in the future the service user would be able to accept the 50p restriction or if this restriction would be lifted. The manager reported that there were plans to work on a person centred planning approach (PCP) but these were not fully operational as yet. There was no evidence that service users or their representatives were involved in the care planning process. To date staff had helped service users complete a passport about themselves but the one seen had been written in 2005 and not updated. The area manager was spoken to after the inspection and she confirmed that there was on-going work to the care planning process. There was evidence that service users made some choices; menus were planned each Sunday as part of a group activity of looking through menus and pictures of meals. Where service users were unable to communicate their choices, or not interested in the activity, the staff choose meals on their behalf, using their knowledge of the service user and their likes and dislikes. None of the service users rooms seen during the inspection had been personalised and there was no evidence of the service users being involved in choices in the décor throughout the rest of the home. At the start of the inspection, only one service user was up, and it was apparent that the service users choose when they wanted to get up. It was noted that staff suggested to individual service users that they might want to go for a walk or a drive but where a service user asked (using Makaton) to go out, she was told later, to fit in with staff plans. This contradicted her care plan, which suggested she should not be told ‘later’ or ‘soon’ but given more exact decisions. A member of staff said that ‘later’ was a term that could be used within the context of the day, although this was not clear from the plan. After the last inspection it was reported ‘that there had been a major change in the approach of the home. Prior to the manager coming there had been, through risk assessing, emphasis on what could not safely be done with service users and the need to keep parts of the house locked so that they did not have free access. This had changed so that the times those living at the home become frustrated has been reduced and is being further reduced as the manager and staff increase their ability to understand them. The aim to allow those living at the home to live as normally as possible but in a risk assessed context to ensure their and others safety continued but with a strong emphasis on determining if the risk had been as real as previously claimed’. Since the last inspection the manager that had made the changes stated above had left, and the home appeared to have reverted back to having many Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 13 restrictions. For example the front door was locked and the key removed when anyone went in or out and all of the service users bedrooms were kept locked and service users did not hold keys. The kitchen was kept locked during food preparation and the inspector witnessed a service user being physically prevented from entering the kitchen by the door being pushed shut in front of him when he tried to enter. It was noted that the acting manager who was preventing the service user entering the kitchen shouted for extra help from staff while the senior carer spoke quietly to the service user and asked what he wanted. The service user eventually left the kitchen, taking with him the lid off a roll that had been filled ready for lunch. The service user was left with a very mixed message. It was also recorded that helping in the kitchen was an activity for this service user. Another mixed message recorded in the behaviour tracker report for a service user dated 18.4.07 suggested that when out a service user had run off from staff, thrown a bag and attempted to throw a parked bike into a pond. It was then written… ‘told this was unacceptable, walked and bought sweets’. It was also noted that none of the toilets had towels or soap in them. The acting manager said that this was because one service user might eat the soap, and paper towels had been the cause of blockages in the past. The home had agreed to look into an alternative to this restriction in 2005. At lunchtime service users were not offered a drink with lunch, as it was reported that, one of the service users might try to drink all of the drinks. See Lifestyle section of the report. Risk assessments were in place and had originally been well written, but because they had not been reviewed they were not always still appropriate. For example, a service user had been assessed, when using the shower, as having a moderate risk of scalding and slipping. The assessment had indicated the need to provide temperature thermostats to the shower and a slip mat to the floor. This had been done but the assessment still stated that the risk would be reduced if these things were put in place. Cotswold DS0000014891.V337399.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): 12,13,14,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users were supported to attend some activities but would benefit from these activities being more structure and meaningful. They had limited opportunities for personal development, and there was evidence of a restrictive culture within the home. EVIDENCE: None of the service users were attending education facilities and the manager stated that no one was employed, or volunteered, to come into the home to have social interaction with the service users. Some service users attended a ‘snoozelan’ session and others would attend a local weekly club for people with learning disabilities, if staff deemed there was an appropriate activity for them to participate in. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 15 The home was situated away from other houses and the staff regularly took service users on walks that did not access the community. However if a walk was to the shops this was through the village. One service user was supported by staff to do a weekly paper round on a Sunday morning. The week prior to the inspection, two of the service users had been on holiday, with staff, to a Centre-Parcs. The inspector was told this had gone well. The acting manager said that service users financed their own holidays but the company paid for staff support. Because the service users had long-term contracts standard 14.4. suggests the company should meet the cost of the service users holiday. The contract and the Service Users Guide should make reference to any financial implications for holidays. All of the service users had contact with their families and some would go home for regular weekend visits. One family reported that communication with the home had deteriorated recently and the agreement that staff should take their son home for his visits had ceased. Another family stated that after raising their concerns via the home’s complaints procedure things had improved and staff regularly drove their son home for weekend visits. At the time of the inspection none of the service users had an advocate acting on their behalf. Each of the service users had an individual activity plan that was published in the entrance hall. It was noted that service users did not appear to be doing what was advertised for the day of the inspection. The acting manager stated that the plan had changed but service users did most of what was advertised. The activity diary for one of the service users case tracked for the week prior to the inspection read:23.4.07 Walked to shops and bought sweets 24.4.07 Shopping at Tesco’s 25.4.07 Writing in catalogue. To Tesco’s 26.4.07 To shop to buy fish and chips 27.4.07 Relaxing 28.4.07 Long drive 29.4.07 Puzzles Walked to shops When it was suggested that this did not appear very stimulating for a 26-yearold active person staff said it was a bad week for the service user who was particularly agitated. This service user enjoyed going on a train. During such outings she required two to one support because of her unpredictable behaviour. It was noted that on one occasion she had been window-shopping in Luton and had also been to London. During her last review in July 2006 it had been identified that she would benefit from a more structured day care timetable such as cycling, computer skills, swimming and possible horse riding. With the exception of swimming Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 16 none of these suggestions had been taken up. Staff said that her weight restricted her from horse riding but had not looked at any other alternatives for her, or any support for her to loose the little weight necessary to go riding. Throughout the inspection service users were seen to wander around and pick up things from boxes placed in the lounge and look at them. Two members of staff were trying to engage service users in doing jig-saws but with little enthusiasm. When the inspector was taken into the garden as part of the tour of the premises service users were keen to be outside as well. The home had two large people carriers and a smaller car for which a number of staff were covered to drive. During the inspection it was noted that one service user was taken out for a drive, two service users were taken to the snoozelan at Twinwoods, and the transport was used twice to take two service users to separate medical appointments. In addition a member of staff went to the shops to get provisions for lunch. Service users were not involved in the preparations for lunch, but did help to put a cloth and placemats on the table. All of the staff and the service users had their lunch at the same time. However the dining table was not large enough for everyone to sit around and one staff member and one service user had their lunch sitting on a sofa with the plate on their lap. A member of staff said that this particular service user would not want to sit with the others but would be happy to sit at a table. As already stated a member of staff prepared the meal, of ham rolls and salad. The hatch between the kitchen and the dining room was then opened and each service user lined up and was given a plate. As soon as they sat down they started eating and there was little interaction from staff to encourage them not to cram food into their mouths or eat with their fingers. It was noted that with the exception of one service user, when the first service user took their plate back to the hatch the others followed whether they had finished or not. None of the service users had a drink with their lunch and two service users were taken out to an appointment as soon as lunch had finished. When asked about this the senior support worker said, “hopefully staff have some money, and will stop for a drink on the way out”. This was of particular concern as the weather was unusually hot for the time of the year and they left 10 minutes before the appointment was due and had to drive some distance. There was very little food stored in the home. Staff said it was practice to shop on a Tuesday so they were running short. The only meat, to make a meal, was mince in the freezer that staff said would be used that night. At mid-day the mince was still in the freezer. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 17 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 adequate This judgement has been made using available evidence including a visit to this service. There were robust systems in place for the ordering, administration and storage of the medication. In order to be sure that medication was given safely all staff administering medication must be trained and the training updated regularly. EVIDENCE: There was evidence that staff supported service users to attend health appointments and also involved other health care professionals in their care appropriately. For example on the day of the inspection one service user was being taken to an appointment for ear syringing and another to the doctors because of a cut that had been noticed on his back. Service users were weighed regularly and their weight recorded, however a member of staff could not say if there were any plans in place for a service user who had gained 6lb in five months with three of the lbs being gained in the last six-weeks. This was particularly concerning as the service user in Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 18 question would be able to go horse riding if the service user lost the six pounds put on. In each of the service users files sampled there was a letter written by the senior support worker to the local PCT asking about their plans to put Health Action Plans in place in order to meet the ‘valuing people’ directive. The response from the PCT was that plans were made to roll this out but as yet nothing was firmly in place. Some personal care could be provided in service users own bedrooms but because there were no washing facilities in individuals bedrooms most personal care would be provided in the bathrooms. As already stated communal bathrooms did not have soap or paper towels so there would be a high risk of cross infection. There were robust systems in place for the ordering, administration and storage of the medication. There was also a policy for the administration of homely (domestic) medications. None of the service users were able to selfadminister their medication. Medication Administration Records (MAR) had started for the new month on the day of the inspection, so a sample of the previous months MAR sheets were looked at. In the two records sampled there were three unexplained gaps in the 28 days. It was noted that medication that was received into the home weekly had been signed in, for two out of the four weeks. Information about the medication service users were taking was on file, providing staff with an understanding of medication that was to be given as required. On the morning of the inspection the member of staff administering medication did not have any proof on file of medication administration training and stated that he had not had an update for a few years. Neither was there evidence of any training as part of the home’s medication plan. Some staff had attended medication training within the last month. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 19 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 poor This judgement has been made using available evidence including a visit to this service. There was insufficient evidence that service users or their families had detailed information about their financial expectations, which could put service users at the risk of financial abuse. EVIDENCE: Since the last inspection we had been made aware of a complaint from a relative about the care provided to her son. This had been passed to the provider to investigate and make a response. From reading file notes it appeared that some changes had been made as a direct result of the initial complaint, and the complainant was satisfied with the changes made. However the newly established central complaints file, held in the office, did not include details of the investigation procedure and the outcome of the complaint, so the audit trial for the complaint investigation was via the service users file only. A letter from the company to CSCI, more than two months after they were made aware of the complaint, did however detail the complaint investigation methodology. CSCI had also been informed of concerns from reviewing officers when doing reviews that actions were not put in place in a timely fashion. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 20 In addition to the complaints procedure being part of the Service Users Guide an illustrated complaints procedure was seen on the notice board. Staff reported that all of the service users had some family contact but none had an advocate acting on their behalf. All of the staff had attended a training on the Protection of Vulnerable Adults (POVA) in the last two weeks, but not before this; this was an unacceptable delay. Staff commented that the training had been beneficial and made them aware of the importance of reporting possible incidents of abuse. During the inspection it was noted that some incidents and unexplained injuries had not been reported. For example a service user was being taken to the doctors because of a cut of unknown origin that had not healed, another service user was reported to have bruises noted when personal care was provided and an incident of service user to service user aggression had not been reported. In addition a parental questionnaire stated; (service users name) gets a lot of bruises but they are not reported to us. Also review minutes suggested that the parents of a service user had been informed of one instance of abscond but not a second. As already reported the service users guide and the contracts did not include sufficient information about service users finances and what they were expected to pay for. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 21 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): 24,26,27,28,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home provided service users with somewhere to live but not a homely environment. EVIDENCE: At the last inspection it was reported that service users had access to all areas of the home, including their bedroom and the kitchen except when the hob was being used. At this inspection the bedrooms were locked and it was noted that the kitchen was locked during the preparation of ham rolls and salads. This provided the five service users with very limited space, as the lounge/diner was the only communal area available. There was an outside room with a piano and some other equipment in it, but this was not seen in use during the inspection. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 22 At already reported at lunchtime staff and service users could not all sit at the table provided. The lounge had been newly carpeted and there were curtains at the windows although the colours of the walls and the sofas did not go with the carpets. There were no curtains in two of the three bedrooms viewed. Staff said that this was because the service users would pull the curtains down, however this was not documented, and there was no evidence that any alternatives, such as Velcro curtains, (as seen in the lounge) or curtain poles attached with magnets were tried. Staff had attempted to obscure the windows in one room with a stick on material but this did not work when the light was behind it. None of the rooms viewed had been personalised in anyway, except one service user had a double bed and another had chosen furniture for the bedroom, but no pictures or personal processions were seen. All of the rooms were painted in manila. Staff stated that ‘colours had been tried but did not work’. In one room visited the inspector noted that drawers had labels on that indicated what was in the drawers. A member of staff confirmed that the service user could not read so these labels and they were for the benefit of the staff. The home had appropriate laundry facilities however; the laundry room was only accessible through the kitchen. Therefore, this facility was inaccessible to service users without staff support. A toilet, which was also situated in this area, was said to be for the sole use of staff. The home appeared to be clean and free from offensive odours, but it was noted that there were cob-webs at a high level. Staff referred to a planned reprovison of the service that they believed was due to happen in the next month or two. The area manager confirmed that new premises, that would provide service users with more individual accommodation, and would also site a supported living project, had been identified but an application for its registration had not yet been applied for, so it would not happen for at least a few months yet. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 23 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 poor. This judgement has been made using available evidence including a visit to this service. The failure to follow up any anomalies at the time of staff recruitment could put service users at risk of being cared for by unsuitable staff. EVIDENCE: At the time of the inspection there was a core group of staff who had worked at the home for some time. In addition there were some newer staff and staff that were employed to work for the Disability Trusts care bank. When the inspector arrived two waking night staff were just going off duty, and coming on duty was one senior carer and two bank staff. At 9.30 am the acting manager and another member of the permanent staff came on duty. This staffing level was not sufficient after lunch when two members of staff took two service users to a snoozelan session and another member of staff was to accompany a service user to a doctor’s appointment. The acting manager Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 24 stated that he would cover the floor during this time and not be supernumerary. Recruitment files were confusing and many had some of the information required by schedule 2 of the NMS missing. For example a bank member of staff did not have his personal details recorded, another file had details of a staff member being dismissed form previous care work that had not been followed up, another had certificates in another persons name, which the member of staff had said was a name she used to use; this had not been followed up by the acting manager. A staff member, employed to work on disabilities trust bank, while also working in care for another provider did not have a reference from that provider as the last/current employer. Following the inspection we received a letter to state that all the matters were being looked into an the member of staff who had changed her name produced the document to support this. The company must now ensure that the Criminal Record Bureau check was requested using both names. The training files for the three staff members on duty were sampled to look for evidence that the staff had received the necessary training to meet the assessed needs of the service users. In addition evidence of mandatory training for medication and POVA was looked for. As already stated all the staff had just received training for POVA, although no certificates were available at the time. Although essential training was updated there was little evidence of specialist training. Senior staff had completed autism awareness training in Jan 06, but three of the four staff working on the day of the inspection did not have this training. As already stated the member of staff completing the medication round had no recorded evidence of any training. Some staff had completed an induction programme but none had completed LDAF training. It was also said that a new ‘key worker’ system had been introduced, and that team meetings had been re-established. There was evidence that staff supervision had been started again. This had stopped about eight months previously when previous manager had left. Consequently it would not be possible to determine that staff had received the required six supervisions per year. A senior carer who was supervising other staff did not have a recorded supervision since 3.06. He confirmed that the area manager had supervised him once since then, but the record was not yet on file. His last annual appraisal was 07.03. Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 25 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. This judgement has been made using available evidence including a visit to this service. The home did not have leadership and some of the poor practices identified in the inspection report before last were in evidence again. EVIDENCE: As already stated the registered manager had resigned from his position almost a year ago and it appeared that in that time the plans he had put in place to provide service users with a less restricted environment had not been continued. The acting manager had been promoted from a team leader, but did not have any management qualifications and was in his own words “learning”. For example, when he came on duty, on the day of the inspection Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 26 he was informed of an incident that had taken place over the weekend involving a service user and a member of the public. The service user, while doing his Sunday morning paper round had run into a house and knocked the TV down. The member of staff, supporting the service user had apologised to the homeowner and picked up the TV, which appeared to be working. The senior care worker had also been called out. Later that day the lady had phoned to say that her TV was no longer working. When the manager was informed of the situation he put it back to the senior support worker to follow up. We were concerned that he did not see this type of situation as his responsibility as the manager. Since the last inspection the area manager had been completing more thorough reports following quality assurance and monitoring visits; these reports conformed to the relevant regulation and standards. The Latest fire check carried out by the fire service had taken place 24.1.07 the manager had been advised that their should be individual plans for the service users. Since the last inspection routine checking of fire appliances and equipment was taking place regularly. The last staff fire drill was 16.3.07. A business plan specific to the service at Cotswold was not provided on this occasion. Cotswold DS0000014891.V337399.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 2 2 X 3 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 1 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 1 X 3 X X 3 X Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 4,5,6 Requirement The Statement of Purpose and the Service Users Guide must include all the information required by the National Minimum Standards. These documents must be kept under review to ensure that service users and their representatives are aware of what the service offers. Management must ensure that there are suitably qualified and experienced staff on duty at all times to met the assessed needs of the service users and ensure adequate care. Ensure that care plans fully meet the requirements of NMS 6 for Younger Adults ensuring that goals are (linked to other relevant paperwork and) broken down into measurable tasks with specific timescales, and that plans are user friendly and that limitations on facilities, choice or human rights are only made in the service users best interest. In order to detail how service users have made decisions, or DS0000014891.V337399.R01.S.doc Timescale for action 01/07/07 2. YA3 YA32 YA33 18 1 (a) 15/06/07 3 YA6 12,13,15 15/06/07 4 YA7 15 01/08/07 Cotswold Version 5.2 Page 29 5 YA9 12,13 6 YA14 YA12 16 7 YA17 12 8 DO20 13 9 YA23 13 10 YA34 18,19, CSA 2004 Schedule 2 11 YA35 18 1 decisions have been made for them, a PCP approach to care planning must be introduced. Risk assessments should reflect likely risk taking behaviour and be reviewed and updated regularly. All service users must be able to access a regular variety of meaningful and educational activities both in and out of the home. Mealtimes must be less institutionalised and all service users should have the opportunity to sit at a table to eat. Drinks must be available to service users. The home must follow its own medication policy and ensure all medication is signed for when it is given or refused, and that medication coming into the home is signed for upon receipt. There must be evidence that any staff administering medication have the necessary training to do so. There must be robust procedures for responding to the suspicion, or evidence, of abuse in accordance with the Department of Health ‘No secrets’ guidance and the local Protection of Vulnerable adults (POVA) protocol. A more robust approach to recruitment should be adopted both in terms of the detail of information required and the need to follow up if the information provided is not satisfactory or gives cause for concern. Each staff member has an individual training and development assessment and profile and at least five paid DS0000014891.V337399.R01.S.doc 15/06/07 01/08/07 15/06/07 01/06/07 15/06/07 15/06/07 31/07/07 Cotswold Version 5.2 Page 30 12 YA37 8,9 training and development days (pro rata) per year. All staff must be trained for the specific conditions of service users. Management must ensure that a suitable experienced and qualified person is appointed to become the registered manager of the service/ 01/08/07 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 YA5 Good Practice Recommendations Service user contracts must include information about exactly what a service user is responsible for paying for. This must be broken down so that it covers when staff expenses are paid and what these include. A central and individual record should be kept of all issues raised or complaints made by service users or other stakeholders. This should include details of any investigation, action taken and outcome; and this record should be checked at least three monthly. Consideration should be given to making the home as homely as possible. Provision must be made for service users to access soap and towels after using the lavatory. Consideration must be given to having the furniture and space available for all service users to have a table to eat their meals from. A staff supervision programme should be in place and adhered to. Steps should be taken to formalise the present monitoring and reviewing systems that are in place to ensure that they result in an annual development plan appropriately linked to the business plan. 2 YA22 3 4 5 6 7. YA24 YA26 YA27 YA30 YA28 YA36 YA39 Cotswold DS0000014891.V337399.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Cotswold DS0000014891.V337399.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. 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