Inspection on 20/06/08 for Cottage Farm

This inspection was carried out on 20th June 2008.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Cottage Farm 19/12/08

Cottage Farm 20/06/07

Cottage Farm 18/04/06

Cottage Farm 25/11/05

Cottage Farm 04/05/05

Cottage Farm 07/12/04

Cottage Farm 20/07/04

Cottage Farm 07/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Cottage Farm Southampton Road Hythe Hampshire SO45 5TA Lead Inspector Chris Johnson Unannounced Inspection 20th June 2008 12:15 Cottage Farm DS0000012379.V365304.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 Cottage Farm DS0000012379.V365304.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. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cottage Farm Address Southampton Road Hythe Hampshire SO45 5TA 023 8084 0661 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) www.macintyrecharity.org MacIntyre Care Vacant post Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 named service users may be accomodated in the LD(E) category Date of last inspection 20th June 2007 Brief Description of the Service: Cottage Farm is registered to provide accommodation to five younger adults with a learning disability, physical disability or sensory impairment, although the home currently accommodates three residents over the age of 65. The home is a large spacious bungalow in a semi-rural setting, on the outskirts of Hythe town centre and the New Forest. Accommodation is provided within individual rooms, with communal facilities including a large, comfortable sitting room, spacious kitchen / dining room, one assisted bathroom, walk in shower room, separate WC and utility room. At the front of the property is a large parking area, with the garden area at the rear mainly laid to lawn, with small shrubs, a patio area and an adjacent fruit orchard. At the last inspection of the home on the 20th June 2007 the weekly fees were reported to be £1100. 00, with additional charges for hairdressing, chiropody, toiletries, holidays, activities and magazines. We do not have any information regarding the current fees. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The purpose of this inspection was to assess how well the home is doing in the meeting of all key National Minimum Standards, compliance with regulations, previous requirements and to assess what the outcomes are for people who live at his home. The findings of this report are based on a number of different sources of evidence. These included: An unannounced visit to the home, which was carried out over one day on 20th June 2008, whereby we looked at all key standards. All regulatory activity since the last inspection was reviewed and taken into account including any notifications sent to the Commission for Social Care. The home has been without a full time registered manager since July 2007. The interim arrangements have been that the home has been managed by someone who is also the registered manager of another registered home within the organisation. The person managing the service completed an Annual Quality Assurance Assessment (AQAA) prior to the visit. Surveys were sent to two people living at the home, eight members of staff, two healthcare professionals and a care manager. Relative surveys were sent to the person managing the service for him to distribute. At the time of writing this report we had not received any completed surveys. During this visit we looked at the physical environment including, people’s bedrooms and all communal areas of the home. Staff and care records were inspected. Some members of staff were spoken with and others were observed during their day-to-day interactions with those living at the home. We examined records, policies and procedures. Due to the communication needs of the people living at the home we were not able to hold discussions with them. However we did talk to people briefly, interact with them and spend time observing the care being given to them. The person managing the service was present during the visit to answer questions and discuss issues. Verbal feedback was provided at the end of the inspection. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 6 During the inspection it was brought to the attention of the person managing the service that statutory powers under sections 31 and 32 of the Care standards Act 2000 were in use and a notice was left identifying failures that led the inspector to believe that an offence may have been committed. The commission is considering the action to be taken as a result of this noncompliance and following a management review of the situation they will be informed of the action agreed. Additionally as a result of concerns regarding the safe management of medication and the lack of evidence that thorough recruitment checks had been undertaken we made three immediate requirements. What the service does well: What has improved since the last inspection? What they could do better: The home cannot demonstrate that it has fully complied with previous requirements. The proforma detailing all the checks that have been undertaken for staff, as part of the recruitment process had not been updated or maintained. This means that the system of recording recruitment practices does not Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 7 demonstrate that a thorough process is followed to maintain the safety of people who live in the home. For instance the home could not demonstrate that newly recruited members of staff had undergone ‘Protection of Vulnerable Adults’ checks or that staff had completed all the necessary training. The home must ensure that Medicated creams are stored safely as previously required. Medication procedures are unsafe as medicines are not always stored safely and securely and administration records are not completed accurately. People need to have their own individual bank accounts. Whilst at a local level within the home procedures have improved to protect peoples’ finances, we could not determine how peoples’ finances are being managed centrally and that they were fully protected. This inspection has highlighted the need for a full time registered manager to be in post. To make certain that the shortcomings highlighted throughout this report are addressed and that improvements are sustained. The home will need to appoint someone to manage the home on a full time basis and submit an application to the Commission for Social Care Inspection for registration. 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. Cottage Farm DS0000012379.V365304.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 Cottage Farm DS0000012379.V365304.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): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are fully assessed prior to admission so that the individual and the home can be sure that the home is right for them and will meet the person’s needs. EVIDENCE: There had not been any new admissions to the home since the previous inspection. At the last inspection of the home on 20th June 2007 we found that, ‘The home has a good pre-admission process ensuring all new residents would fit into the home and have their needs met’. From discussion with the person managing the service we were told that the assessment process was unchanged since the last inspection. This included the opportunity for prospective residents to visit the home prior to moving in. Currently the homes’ statement of purpose is only available in written format. The service user guide is however available in pictorial format. The person managing the service said that there was an intention to improve on the accessibility of this information. The AQAA stated that the home plans to, Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 10 ‘Develop accessible formats for service users guide and statement of purpose involving service user where deemed appropriate’. Cottage Farm DS0000012379.V365304.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide clear instructions for staff to follow and provide support and care in a way that people prefer. EVIDENCE: At the last inspection of this home we found that care plans needed to be improved to ensure that all current information was accessible, relevant and reviewed on a regular basis and a requirement was made. In discussion with the person managing the service we were told that peoples’ care plans had been revised and improved. During this visit to the home we examined two peoples’ care plans. The care plans looked at were written in the first-person and were personcentred. Care plans demonstrated that peoples’ independence is promoted and highlighted person’s abilities as well as their needs. Peoples’ personal care and daily support needs were clearly identified and care plans provided clear guidance regarding the level and type of support needed with various care Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 12 needs. All care plans looked at provided evidence that people had been consulted and involved in formulating their plan Care plans offered guidance for staff for anyone who may exhibit challenging behaviour and described what approaches to use. Alongside this each person had communication profiles stating how to offer choices for that person and how they would respond (how they communicate their choices). The person managing the home explained that all unnecessary and additional information as identified at the last inspection, had been removed from peoples’ files. We also saw that plans were being kept under review. Staff had all signed to confirm that they had read each care plan and staff spoken with confirmed that they had access to care plans. Sections within care plans included, ‘Let me tell you about me’ and ‘what people say about me’, ‘Things I like’ Things I don’t like’. All plans were pictorial and in a format suitable to the person. Information within the care plans demonstrated that people could exercise choice and make decisions about their daily lives. One Section of the plan entitled ‘Snippet of my day’, described how people liked to spend their day and their preferred routines. Further sections provided evidence that people are supported to take risks as part of their everyday lives and that risks are identified and measures are taken to reduce them. These had been written from two perspectives that of the person, ‘What is important to me’ and ‘What is important for me’ staff and other professionals’ assessment of the risks to the person. At our last inspection we found that plans did not give enough detail on how care and support should be provided. This has now been addressed and both plans seen had clear and specific guidelines for staff to follow when assisting people with their personal care needs. Risk assessments and associated action plans were in place for identified risks covering issues such as challenging behaviour, making a complaints, fire safety, moving and handling, and diet. Cottage Farm DS0000012379.V365304.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): 12,13, 15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are able to make choices about their life style, and are supported to develop life skills. People are supported to engage in activities and to keep in contact with friends and family. EVIDENCE: We examined the activity diaries of two people these did not provide much evidence that activities had taken place. At our last inspection we found that there was not a lot of recorded detail regarding this. The person managing the service confirmed that people take part in a variety of activities and said that these were not being recorded by staff. Each person receives funding for seven hours each week for one to one support in the community and this is delivered by an outside agency and funded by social services. In discussion with the manager he agreed that at present there are less activities happening. The Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 14 AQAA identified that the home plans to improve this by developing, ‘Links to social clubs and wider community to develop circles of support’. One reason put forward for the lack of activities was that the needs of one person had increased and this had meant that staff were spending a disproportionate amount of time with this person. The person managing the service had addressed this with the funding authority and funding had been agreed for an additional staff member for twelve hours a day to provide one to one support with this person. The home has it’s own transport and can take people out this is normally on an informal basis taking two or people out at a time. We saw evidence that people can receive visitors and keep in touch with family and friends. It was clear from observation that rights are respected and that people are encouraged to take part in household chores. This was also evidenced by information recorded in the care plans. Lunch was being prepared on arrival at the home and this consisted of fish chips and peas as per the menu. Menus were in written format and therefore not appropriate to the peoples’ communication needs. The person managing the service said that a communication mentor employed within the MacIntyre organisation was booked to visit the home in August to assist and advise with making some information more accessible and in formats appropriate to peoples’ needs this included staff rotas, menus and peoples activity schedules. People eat in the kitchen and three people although not able to prepare the meal sat around the table while the staff member prepared the meal and could therefore observe the preparation of the meal and interact with the staff member at the same time. Menus were examined and demonstrated that meals were well balanced and a variety of meals were available as where the findings of our last inspection. Cottage Farm DS0000012379.V365304.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): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People receive the appropriate level of assistance with their health and personal care needs. Medication practices within the home are not safe and people are put at risk by unsafe storage. Recording procedures are also lacking at times. EVIDENCE: From evidence recorded in the care plans and from observations and discussion it was evident that people were receiving support with their personal care needs in line with their needs and preferences. Care plans and associated documents provided us with enough information to demonstrate that health care needs are being met and that people have access to a range of health services. The home does have healthcare recording sheets however these were not being used consistently and the person managing the service agreed that these would be used in future as this will help with the monitoring of healthcare needs. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 16 At the previous inspection of the home on 20th June 2007 it was noted that pots of cream were kept in people’s rooms and a requirement was made that they were to be locked away. We did not see any left around in bedrooms, however we found that two pots of cream had been left out in the shower room. One had been prescribed for a particular person and the other did not have a label to indicate whether or for whom it had been prescribed. There were however the initials of someone living at the home on the lid. Everyone living at the home had access to the shower room and one person’s risk assessment stated, ‘Please do not leave cream and lotion out as I like to rub them in my eyes’. Also none of the people living at the home have been assessed as being safe to look after or manage their own medication. On arrival to the home the medication cabinet was found to be unlocked and unattended. When it was later locked the key was left on a hook opposite the cabinet in an area accessible to everyone living at the home. We made immediate requirements about both of these issues. The medication administration records were checked for three people during the visit. It was noted that there were several errors on two peoples’ medication administration recording chart (MAR). For one person on two occasions the MAR indicated that medication had been administered when from examination of stock held it was evident that they had not received their medication. For another person the MAR indicated that on several occasions medication had been administered and not recorded. At the front of the medication file there was a list of staff signatures and the person managing the service said that these were the staff members who had been trained and were authorised to administer medication. There were not any training records to substantiate this. However in discussion with staff they did say that they had received in- house training. Cottage Farm DS0000012379.V365304.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): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory systems are in place for people to address any concerns or complaints that they may have. Whilst at a local level within the home there are procedures in place to protect people, we could not determine how peoples’ finances are being managed centrally and that they were fully protected. EVIDENCE: No complaints regarding the home have been reported to the Commission for Social Care Inspection since the last inspection. Data in the AQAA told us that the home had not received any complaints in the last twelve months and examination of the home’s complaint log supported this. The home has a complaints procedure and people living at the home have access to an independent advocacy service to support them. We saw evidence that staff had received protection of vulnerable adults training. Staff spoken with demonstrated that they were aware of the issues and their responsibilities towards safeguarding people and passing on any concerns. The home helps all the people who live there with their finances. At the last inspection of the home we found that issues relating to peoples’ finances Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 18 needed to be organised for their protection. We made a requirement that official accounts needed to be opened for each person and that records must demonstrate all monies in and out and a running total must be maintained. We discussed people’s finances with the person managing the service reported that benefits are paid into a MacIntyre account and their rent is deducted. The person managing the home said that this was due to the bank and not the lack of trying. At present no one has their own bank account. This needs to be addressed as at present people are being loaned money from the home’s petty cash system, as they do not have direct access to their own money. We did find that that there had been an improvement to the record keeping system used at the home and from examination we saw that all transactions carried out had been recorded receipted and entered in a book and running balance maintained. Records had been had been signed and checked on a regular basis. Cottage Farm DS0000012379.V365304.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): 24, 25 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well furnished, comfortable and homely. The home is clean and tidy and good standards of hygiene are maintained throughout the home. EVIDENCE: During the visit to the home we saw all communal areas and a selection of peoples’ bedrooms. People had been able to personalise their rooms with pictures, belongings, televisions and audio equipment. People were observed to access and spend time in their rooms as they chose. Several bedrooms had recently been redecorated and individualised to the persons’ own taste and reflected their interests. Plans are in place to decorate the remaining rooms. The AQAA identified the improvements that had been made and that were planned for the future. A new kitchen had been fitted since the last inspection and carpets are gradually being replaced. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 20 The lounge was comfortably furnished. There are large canvas prints of each person who lives at the home on the walls, and other photos around the home. This helps to create a homely environment. On the day of the visit the home was found to be clean and tidy and homely. From observation people were relaxed and at home in the environment. The laundry room was looked at and it was evident that infection control procedures were being followed. Health and safety other guidance were displayed in the laundry room with procedures for infection control such as colour coded cloths for different tasks. Bathrooms and toilets were all fitted with liquid soap and paper towel dispensers. It was noted that on the day of the visit there were not any paper towels in the dispensers normal hand towels were in use. The person managing the service said that paper towels should be being used and said that he would rectify this. Cottage Farm DS0000012379.V365304.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): 32, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The system of recording recruitment practices does not demonstrate that a thorough process is followed to maintain the safety of people who live in the home. Staff are employed in sufficient numbers to meet the needs of people living at the home. The lack of up to date and accurate recording of staff training files does not provide evidence that staff have received all the necessary training. EVIDENCE: During the visit to the home staff rotas were examined. These confirmed the rota to be a true reflection of actual staffing levels. Staffing levels remain constant and are maintained at the same level as at previous inspections. We also saw that the home was now using less agency staff than at the previous inspection. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 22 At the last inspection of the home we found that there was insufficient evidence relating to the recruitment of staff need available in the home and a requirement was made. MacIntyre Care has an agreement with the Commission for Social Care Inspection that staff records will be held at their head office. However as part of this agreement they are required to hold evidence within the home that certain checks have been completed including the dates of when these were obtained. We have raised this issue on several occasions. On this occasion we looked at the recruitment records of three members of staff who had been employed since the last inspection and were all on the rota to work at the home and had done previously. One of who was working the day of our visit. There were insufficient records held at the home to demonstrate that appropriate pre employment checks had been undertaken for any of them. For one person there was no evidence that references had been obtained, the only evidence that a Criminal Records Bureau (CRB) check had been undertaken was an email dated 02/06/08, which gave a CRB reference number and a date. For the second person there were two written references on file, however the only evidence that a CRB check had been undertaken was an email dated 02/06/08 which gave a CRB reference number and a date. For the third person there was one written reference on file. The only evidence that a CRB check had been undertaken was an email dated 02/06/08, which gave a CRB reference number and a date of 22/04/08. Therefore not only were these records incomplete but it would appear that the home only received confirmation from the organisation’s head office that these checks had been completed some months after the people had commenced working at the home. There was no evidence that a Protection of Vulnerable Adults check had been completed for any of the three people and neither was there any record of the date that any of them had started working at the home. We made an immediate requirement about these issues. The organisation has not taken sufficient action to comply with the previous requirement to keep up to date records of pre- employment checks. We have made a requirement and this matter must be addressed within the given timescale. Failure to ensure that this is complied with will result in the Commission for Social Care Inspection taking enforcement action. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 23 We asked to look at the training files of the three members of staff. No training records were available. The person managing the service said that one of them had completed moving and handling and fire though the lack of a training portfolio meant that this could not be substantiated. We also looked at staff training certificates for people who have worked at the home for a longer period. These showed that people had done moving and handling and Protection of Vulnerable Adults training. We saw a training timetable that indicated that training in fire, moving and handling, and health and safety had taken place in April. Infection control training was due in June. Several other courses were scheduled to take place over the forthcoming months such as dementia, challenging behaviour, first aid, medication and protection of vulnerable adults. It was not however recorded which members of staff would be attending these courses. Staff and people living at the home were observed to be relaxed in each other’s company. In discussion with staff they were able to demonstrate and show that they were committed to giving people choice. Staff told us that they receive regular supervision and support. Whilst there were some records to support this these were incomplete and records would suggest that some people had not received supervision on a regular basis. The person managing the service said that he had carried out more supervisions than the records suggested. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being managed effectively. The interim management arrangements and weakness in some management systems do not ensure that the home is managed effectively. EVIDENCE: Since our last inspection of this home the previous registered manager has left and there has not been a full time or registered manager in post. The home currently has a person managing the service. However this person is the registered manager of another registered home within the organisation. We discussed the management hours of the home with the person managing the service. There were not any records on the rota or elsewhere to demonstrate the number of hours that he is at the home. The person managing the service reported that he spends on average nineteen hours a week at the home. Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 25 This inspection has highlighted the need for a full time registered manager to be in post. To make certain that the shortcomings highlighted throughout this report are addressed and that improvements are sustained. We are concerned regarding the lack of action taken to address some of the outstanding requirements. Some areas highlighted in this and the previous reports regarding staff recruitment records and the management of monies belonging to people who use the service and medication are directly related to the management of the home and have yet to be addressed to demonstrate that the home is managed effectively. We made three immediate requirements and have written to the responsible individual to clarify our concerns. We have not had a response from this person. We did find that there had been some action taken to address some issues such as the care planning and review system. Data recorded in the AQAA told us that policies and procedures are kept under regular review and examination of a sample of these confirmed this. We saw that a representative from the organisation visits the home on a monthly basis to monitor the effectiveness of the service. Records showed that during these visits people living at the home were consulted and spoken to staff were interviewed, the environment and upkeep of the home was monitored and records were examined. However it would seem that these are not at present effective at recognising all the shortfalls in the service. In discussion with the person managing the service we were told that the home has developed a survey and that it is planned that this will be sent out in July to family and advocates. The AQAA gave details and evidence that maintenance checks, tests and servicing of equipment are carried out regularly, evidence seen during the visit substantiated this. Examination of the fire logbook confirmed that weekly fire alarm checks are undertaken. We saw recorded evidence that regular fire drills take place. Cottage Farm DS0000012379.V365304.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 3 2 3 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 2 2 1 X 2 X Cottage Farm DS0000012379.V365304.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 2 3 Standard YA20 YA20 YA20 Regulation 13 (2) 13 (2) 13 (2) Requirement All medicated creams are to be stored safely. Medicines must be stored safely and securely at all times. All medication must be administered as prescribed. Administration records must be accurately maintained. The home must demonstrate how service user’s monies are being managed to include confirmation that the monies is not being held in an account used for the running of the business. People must have their own individual accounts. This is an amended requirement from the previous inspection. Staff must receive training to meet the needs of those living at the home. Staff must not commence work at the home until all satisfactory checks have been made. The staff members identified at the inspection must not undertake personal care and must be supernumerary and be DS0000012379.V365304.R01.S.doc Timescale for action 20/06/08 20/06/08 20/08/08 4 YA23 20(1) 20/08/08 5 6 YA35 YA34 18 (1) (c) 19 20/09/08 20/06/08 Cottage Farm Version 5.2 Page 28 7 YA34 19 supervised at all times, until such time as all satisfactory checks have been completed. The proforma detailing all the checks that have been undertaken for staff, as part of the recruitment process must be kept updated and current. Previous timescale of 30/07/07 not met. 20/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Cottage Farm DS0000012379.V365304.R01.S.doc Version 5.2 Page 30 - 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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