Inspection on 19/05/05 for Cottisbraine House

This inspection was carried out on 19th May 2005.

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

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

Other inspections for this house

Cottisbraine House 20/12/06

Cottisbraine House 19/12/05

Cottisbraine House 08/03/05

Cottisbraine House 22/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Cottisbraine House 36 Sandy Lane South Wallington Surrey SM6 9QZ Lead Inspector David Pennells Announced 19 May 2005, 14:20 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cottisbraine House Address 36 Sandy Lane South, Wallington, Surrey, SM6 9QZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8647 7981 020 8647 7981 Mrs Maureen Ann George Mr Robert Brand Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 08.03.05 Brief Description of the Service: Cottisbraine House is a detached ‘family’-type residence situated on a fairly busy road connecting Wallington to Woodcote to the southeast of Sutton. The house currently provides a service to up to ten adults with a learning disability. The home is situated on a slope, being not particularly suitable for those who use wheelchairs, although access is possible from the sloping car park / driveway, and through the rear patio entrance into the sitting room. The accommodation provides a separate sitting and dining room and the kitchen is of ample, domestic size. Bedrooms are currently provided on a basis of two shared rooms (both currently singly occupied) and seven singles. Most bedrooms (7) have ensuite facilities. Access to the first floor is provided by stairs, or by using a (two stage) stair lift facility. An accessible shower is available on the ground floor (though not currently used/operable) and a bath on the first ‘mezzanine’ level - though this is accessed down a few substantial steps. Toilets are provided within these two bathing facilities. There is neither staff room nor designated office; the proprietors keep an amount of paper work in the second floor private sleeping-in facility, and in secured storage in the Hallway on the ground floor. External facilities provided comprise a small patio to the rear of the building accessed from the sitting room, and a small inclined, landscaped, car park / drive & front garden. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over a period of two days – the inspector arriving in the afternoon on the first day, and working a morning and early afternoon of the second. About ten hours in total were spent at the home. The afternoon arrival on day one was to provide space for a service user’s funeral that very morning – one of the proprietors and a service user attended the burial in South London with the mourning family members. This announced inspection visit follows on from the March 2005 unannounced inspection, and sought to verify that certain major concerns raised at the previous visit had been resolved. At this previous visit, a number of formal Immediate Requirement Notices had been served on the home - as a consequence of an apparent complete breakdown in the administrative side of the home’s operations. All these areas (see ‘What has improved…’ below.) were examined and signed off as being back up to a reasonable standard. The current management arrangements at the home are that Mr Brand manages the fabric and general support services at the home and Mrs George oversees the care and catering. Moving away from a previously discussed intention to sell the service on, the proprietors have now indicated to the Commission that they intend to continue running the home - but are seeking to appoint a suitably learning disability-qualified manager to carry out the dayto-day management tasks for them. This appointment will be to the best interests of all at the home – service users will receive a more professional perspective on their care and daily lives, staff will gain training and support in these and other areas, and the proprietors will have the peace of mind that the home is running competently in their absence. What the service does well: The home provides a very warm and homely intimate environment for service users to live in; staff members provide close 1:1 attention to service users – this including, until very recently, close on ‘palliative care’ provided in conjunction with the local district nursing service for a few service users. Feedback - from the principal GP at the home, six relatives (accounting for all families involved at the home) and a care manager of the local authority - all spoke generally highly of the care provided. The family of a service user who had very recently passed away - described the ‘quality care and specific attention’ their loved one had received at the home; they continued: ‘Cottisbraine is a happy and contented home.’ The food served at the house is nutritious, home-cooked and plentiful. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 6 Life - socially, and engagement with the local community, is encouraged through attendance at day centres and through evening clubs and other opportunities to go out with staff from the home. What has improved since the last inspection? What they could do better: A number of aspects from previous requirements including, most importantly, the ongoing requirement to appoint - and propose for registration - a qualified and competent manager, remain outstanding. Other issues outstanding (in summary) are: the service User Guide to be put in Makaton/service user-friendly version / the development of an assessment & familiarisation profile for new service users / evidencing the competence and best practice of the service provided at the home / creating a version of the complaints procedure in Makaton/service user-friendly version / continuing the move towards single occupancy in bedrooms; the conversion of the smallest room to adequate size / to reinstate the shower facility ensuring it is fitted with a thermostatic safety valve / the development of a smoking policy / the development of induction & foundation training for new staff / the promotion of Care NVQ qualifications / the provision of professional staff supervision / the development of quality assurance mechanisms within the home / the development and updating of all the home’s policies and procedures / the production of a business & financial plan [amongst other long-term planning & development] for the home. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 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. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 3. Service users would be able to find out about life in the home from ‘live’ contact with staff and service users at the home – but have difficulty understanding and accessing information in written format. The service can provide an individual with care and attention, but requires an assessment tool in order to be able to discover, gauge and record the level and detail of an individual’s needs, preferences and aspirations. In order to assure a prospective service user of the quality of the service provided, the home must evidence more strongly their specific skills base in working with people with learning disabilities. EVIDENCE: Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 10 The home’s Statement of Purpose has been amended and now consists of seven pages of basic detail and has a service user contract attached. The proprietors still need to provide a version of the Service User Guide couched in suitable formats - in either Makaton or any form of ‘sign’ / ‘symbols’ format. Previously it was noted that little had been put in place with regard to a new service user who had been admitted to the home. The placing local authority responsible for their client and the previous service provider had also failed to ensure that there was sufficient information to ensure an adequate (and ‘seamless’) introduction to the home. The home should ensure - through obtaining and researching information - an adequate initial care plan – by putting in place a provisional ‘familiarisation plan’ within the first day or so of the new placement. The proprietor / manager stated that he would ensure – prior to any further admissions – that there was in place a suitable assessment format to ensure that this unfortunate situation did not arise again. The inspector had previously made a requirement on the home to evidence its competence to care for the (still, generally older) learning-disabled service users at the home (“to more fully demonstrate the home’s ability to provide a service based on current good practice, reflecting relevant specialist knowledge - [Standard 3.1 2]) - through the provision of adequate staff training, and a development of the management processes at the home. This had still some significant way to go – though the development of staff training has finally become a reality, to some extent. The renewed focus and attention to care planning and risk-assessment and associated recordkeeping should - hopefully - rekindle the home’s attention to providing an appropriate service. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 & 9. Service users can expect to be supported by a current care plan with attendant risk assessments reflecting the needs and goals identified. Service users are encouraged to express their own personalities, choices and preferences – through being consulted either individually or as a group where appropriate. EVIDENCE: A relative commented: ‘My [relative] is very happy at the home and has developed mentally since living there.’ Another echoed this opinion: ‘Since moving to Cottisbraine House seven years ago, my [relative] has blossomed – all our friends have remarked on [their] improvement.’ Updating of care plans have been undertaken since the serving of Immediate Requirement Notices at the last inspection visit; day-to-day notes for service users were also now restored. The ‘tick box’ personal care record continued – as did the record of food consumed. The home has some difficulty with involving some service users in elements of ‘participation’, due to the lack of capacity to comprehend such concepts. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 12 As with ‘residents meetings’, the problem is often that a small minority monopolise - due to their ability to participate; thus leaving the less able, to some extent, excluded from the process. The majority of information is given in simple verbal form - or by other basic communication methods – by staff members, who try to assess and estimate the reaction of all at the home. About two-thirds of the service users at the home attend activities regularly outside the home, such as day centres or evening clubs. This provides a vital contact with their peer groups and independent advocacy / self-advocacy groups. Activities were advertised on the notice boards in the home. Previously, risk assessments with regard to service users were either out-ofdate or non-existent. An Immediate Requirement Notice was served on the proprietor / manager to ensure that [a] risk assessments for service users were put in place where needed - and, [b] to ensure that risk assessments were regularly updated. These were now in place – copies had been sent to the Commission; it is hoped that they will now be regularly reviewed and updated to remain current ‘valid’ assessments of areas of concern. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 - 17 Service users have opportunities to develop their varying skills and to fulfil their spiritual needs, engaging in appropriate religious, day care, leisure and social activities – either as a group, or individually at home or within the local community. Family and friends are made welcome at the house and service users are encouraged to develop appropriate relationships between themselves and with others in the wider community. Daily routines at the house encourage independence and service user’s rights to enjoy the house and the service in their own preferred way. EVIDENCE: Engagement with the local community – through attending day care or evening social clubs applies to six of the eight service users currently at the home. Some attend day care centres (in or out of the borough) four of five days a week; others (four) attend the local Sunday club, the Croham Club (two) and the Link Club (two). Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 14 The home provides input - weekly - which is greatly enjoyed by service users; Monday mornings start the week with a ‘Keep fit’ / exercise and music session. Wednesday afternoons sees visits, from the Tandridge Music Project, of a musician who involves service users in engaging in musical creativity. Trips out into the countryside and to venues such as garden centres and parks – with the expected ice cream or cup of tea - are enjoyed – by a maximum of four - using the home’s own ‘ordinary car’ transport. Pub and Café lunches are thoroughly enjoyed – as are occasional trips to the seaside. Service users are encouraged to use community facilities - some go shopping with individual staff members (or travel by bus with a staff member to a group activity, to which others may be transported / taxi’d). Formal appointments for service users are escorted, either by relatives or through the provision of additional staffing hours being provided. Opportunities to attend Church are open to service users; one relative is an Anglican Priest, who provides informal pastoral oversight to all the household. Of the remaining two service users, one is quite frail and enjoys a time of comfort ‘in her own home’, now – not wishing to go out; the other service user, sadly, due to anti-social behaviour, has been ‘excluded’ from a number of clubs and activities. The home seeks to provide some input for this service user, but she has an insatiable appetite for her own preoccupations. There are currently moves to relocate this service user to a higher dependency unit. Routines of daily living (i.e. being ready and breakfasted by the time day centre transport arrives) are the key to many people’s getting up time and subsequent routines. This spread of differing activities allows some to ‘sleep in’ and gain more care and attention from staff later. Staff members respect the privacy of service users and knock on bedroom doors. Service users can have keys to their bedroom doors and one service user has a front door key. The opening of mail is often a shared activity, as many need assistance with understanding the import and content of written communications. Staff conversation and engagement with service users was again noted to be continuous, open, warm, and friendly - involving service users even if their communication capabilities are, as in some cases, severely restricted. The food provided at the home is freshly purchased, prepared and cooked. It is not unusual for the proprietor to suggest ‘a treat’ today – such as, perhaps, croissant or cake mid-morning - or some strawberries when in season, etc. A number of service users assist with food preparation – and more assist with the clearing away in the dining room and the washing up in the kitchen. The kitchen is ‘just’ another part of the home – with service users coming and going as they chose, participating in the pleasant expectation of meals as well. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 & 21. Service users can be assured of personal, respectful and specific attention to their personal care and support – including health care / medication - needs. The home can provide suitable care and attention for service users at the point of serious illness / death, but would benefit from having sufficient information concerning ‘last wishes’ from all service users or their relatives / representatives - to ensure a focused, individual approach. EVIDENCE: A relative wrote: ‘I am very happy the way my [service user] is cared for; he is always very clean and tidy. He always seems to be happy with the way he is looked after.’ Another wrote: ‘We are very pleased with the care provided by Maureen and her staff.’ Care is provided according to need – from the relatively independent younger service users, through those who needed ordering and correcting through to the more aged residents - who now required greater direct personal care assistance. One service user who had previously had a pressure area problem was now clear – thanks to the care and vigilance of the staff, and continual input of the district nursing service. All suitable mattresses and pressure relieving equipment are provided, as necessary, through the district nursing services. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 16 The constant monitoring at the home of dietary intake also ensures that service users are receiving adequate nutrition in the context of such special needs. One care manager stated in the Commission’s questionnaire – and the inspector observed - that the home was finding it difficult to deal with the challenging behaviour of one client, and that the service user was being moved on as a consequence. The home clearly does not lend itself to challenging behaviour in what is a ‘cosy’ - but relatively small environment – which would lend an intensity to behaviour that is demanding, and affect many ‘unrelated’ service users. A previous requirement that staff be fully trained in medication procedures by an accredited agency has now been satisfied; all staff received certificated training at the home in April 2005. The medication cupboard and records were examined at the time of the inspection and found to be generally in good order. The amount of medication used at the home is relatively small, allowing the very clear organisation of drugs in the cupboard. The family of the most recently deceased service user have notified the Commission that their loved one was treated well and cared for sensitively to the end – the service user finally passed away in the home. Over the past year, two other service users have passed on, these farewells both finally occurring within a hospital setting. The proprietor confirmed that the home had not taken action to update records or obtain information concerning a service user’s, or their relative’s, wishes regarding arrangements / last wishes if a service user is taken seriously ill or passes away. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home’s written complaints procedure is recognised and known by stakeholders, though a version in an accessible format for service users would be beneficial. Informally, the service provider is recognised to respond to comments and suggestions. The proprietors seek to ensure that service users are protected from harm or abuse, through recognising the local Adult Protection Procedure and through mechanisms such as external audits of financial transactions. EVIDENCE: A requirement that the home’s complaints procedure be made more accessible to service user through providing a Makaton / Symbols version has yet to be carried out. A straightforward policy regarding adult abuse is now in place, with reference to the London Borough of Sutton’s ‘lead’ policy. A number of staff members have attended the Adult Protection training sessions provided by the Borough. Accounts of finances handled by the home / held in safekeeping are regularly ‘professionally’ audited by a relative of a service user at the home – ensuring an external and accurate eye on such issues. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25 - 30. Service users can expect to live in a clean and well-managed environment. The Communal lounge and dining facilities are homely, warm and comfortable. Communal toilets and bathrooms are suitable to service users, though the shower facility should be restored to proper working order. All areas of the home are safe and comfortable, and properly maintained, meeting each individual’s needs, with all basic amenities provided. Service user’s own bedrooms are distinctively different, and offer scope for the personalisation / individual characteristics that the home encourages. The planned renovation work at the home will ensure privacy and dignity in future for all service users. EVIDENCE: The premises generally are pleasant to live in, and the bedrooms for service users are distinct and very homely. Certainly bedrooms express service user’s likes and preferences – all being very individually decorated. Radiator protectors have now been provided to cover exposed radiator surfaces throughout the entire building, thus promoting service user’s safety. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 19 As an ‘existing home’, the current accommodation is - to some extent acceptable to the Commission on the basis of revised premises standards. However some aspects are not covered by these exceptions, and the proprietors project to ensure that Cottisbraine House will continue well into this new century, reflecting as closely as possible the minimum national standards. An undersize double room on the first floor is now singly occupied, awaiting conversion / reduction into a single room - this lending some of its space to the adjacent room (the currently smallest bedroom in the house - 8.1 sq. metres) – which will then be of adequate size. The double bedroom on the ground floor is also projected, in time, to ‘give up’ some of its space to the creation of a small office for the soon-to-be appointed manager. The creation of an all single-room home will remove the need for an identified Visitor’s Room. One ground floor single bedroom to the rear is currently accessed directly off the dining room – which is not really appropriate - especially if soiled items have to be removed from the room. The only way this could be effected without risk to the dining area is by removing the items to the outside of the building through the French windows / fire escape which is also provided to this room. The proprietor suggested that plans are afoot to provide this room with an en-suite toilet and corridor to the rear of the building. If this project occurs, then all bedrooms will be single in the home, and all will be en-suite. The shower facility on the ground floor continues not to be used (the associated toilet is); this is the only bathing facility on the ground floor - if it was working correctly. The shower still did not flow very substantially, and therefore it was not possible to check for the presence of a thermostatic control valve; this must still be formally confirmed to the Commission. Communal space at the home is very homely; collections of plates array the walls of the lounge, and ornaments and photographs make it feel like someone’s personal sitting room. The Dining room has recently had wood effect flooring installed – which is certainly much better than the previous decaying parquet flooring. The dining room is used for activity / review purposes, as well as dining space for the majority. The ongoing situation of staff smoking in the building (whereas no service users do so) continues to be a dilemma. The home is sufficiently small that smoking in the entrance area causes a problem that service users have to walk through this area to access any room from any other. The smell of the smoke also travels into communal areas / bedrooms. For the sake of the service users, the home must be declared a smoking-free environment - and staff should smoke either completely away from service user areas or outside. The proprietor was able to evidence maintenance and servicing contacts to the inspector’s satisfaction; the home was also noted – as ever - to be generally in a good state of cleanliness, and was odour-free. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, & 36. The home provides staffing to meet the day-to-day needs of the service users and the establishment itself. Staff members could be better supported by a more developed staff induction, training and development programme / focus on the learning-disabled client group – this would bring clear benefits to the individual service users. Recruitment practices now ensure the safety of service users. Ongoing professional supervision and support must now be developed to ensure support for staff and to assist in the translation of the home’s philosophy and aims into work with individuals. EVIDENCE: Staff members were described as ‘dedicated – giving quality care and specific attention…’ It is undoubted that the staff members make every effort to ensure that the home is comfortable and pleasant for service users – a very homely place. The home is small and staff members turn their hands to any activity that is appropriate – it runs very much as any household would. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 21 An Immediate Requirement Notice has ensured that training in basic elements (Food Hygiene, First Aid, Manual Handling) - to ensure the health & safety of both service users and staff – has been stepped up. Certification was awaited fro some recent training inputs. Induction and Foundation training input was also to be provided within the ‘TOPSS’ Framework, and NVQ training provided to staff must be LDAFaccredited; this focus remained outstanding. Staff training in Care at NVQ Level 2 or above is an area yet to be addressed by the home – currently only one care worker has an NVQ at Level 2, and another is a trained general nurse. This care training deficit is further evidence to illustrate where a qualified manager would be useful / instrumental in ensuring the home meets this National Minimum Standard target. The manager / proprietor has stated he is not intending to undertake training at a higher NVQ level for himself, as the expectation is that a qualified manager will come to be employed at the home soon. Staff meeting records were also somewhat lacking, though a single, recent, record was seen of such a meeting. The manager assured the inspector that these were due to continue, now. The home has not had to recruit staff recently – though there is some use of agency staff for occasional shifts to cover permanently employed staff absences. Of those staff in post, all have now undertaken the CRB process of criminal records checks and staff files are much improved, holding most information relating to revised Schedule 2 of the Care Homes Regulations. A previous requirement required that home must develop a broader Staff Training Strategy, for both the staff team as a whole and the individual staff members; this is clearly now more in place - with further training on Risk Assessment and Makaton in prospect – but could be more formalised. There was little evidence that the home had provided 1:1 ‘professional’ supervision and annual appraisals to staff - and the inspector again concluded that this outstanding requirement remained an issue. A requirement that a policy and procedure must be put in place to ensure the support for staff experiencing physical aggression focussed towards them, was partly met - but only within other policy documents. A service user who was exhibiting challenging behaviour towards staff was still resident at the home and staff did not have any clear guidance / plan of intervention available. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40, 42 & 43. Though overseen by two proprietors offering complementary skills in residential care, the home would benefit from focused management provided by a suitably qualified, competent and learning disability experienced manager. Although first attempts are being made at addressing the issues of quality assurance, the home must aim to consolidate such areas to ensure that the home reflects the aspirations and opinions of service users and stakeholders. Policies and procedures at the home still require development and expansion / revision to fully support the conduct of the home. The health & safety of service users is generally ensured through the maintenance and servicing of equipment at the home. To properly address the needs of the home in its entirety, a business and financial plan and suitable management systems need to be put in place to ensure the effectiveness, financial viability and accountability of the home. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 23 EVIDENCE: The requirement that the proprietor / manager has the full job description that describes the overall responsibilities of the job and makes it clear that this applies to a proprietor / manager as well as any employed manager was yet to be provided – this is now essential if the proprietors are to hand over the task to another professional. The previous inspection visit had revealed that – for whatever the reasons - the home had lost its energy, although there was – this time, thankfully - a sense of ‘revival’ in the air. It is, however, still patently clear that the support of a qualified manager is essential for the home to continue to provide its service at an adequate professional level. The requirement associated with Standard 39 - about quality assurance and quality monitoring systems being integrated within the home’s practice and principles - was still outstanding – though the manager did show the inspector a questionnaire being developed for use with service users. The previous requirement that policies and procedures must be developed to meet the minimum expectations of the NMS - as stated in appendix three of the current Standards document - and that those already in place must be reviewed to ensure they are accurate and congruent to the service provided, had been part met; the existing standards folder still remaining as before, with a number of additional documents added. Fire drills have been stepped up in frequency recently, to ensure that all staff members are familiar with - and reminded of - the safety routines, and learning points from the drill were noted –thus ensuring that service users are aware of the drill. Staff members have recently been better equipped with regard to basic training - relating to health & safety in particular (First Aid, Food Hygiene, Manual Handling). The home is well maintained, generally with all maintenance and service documentation being up to date at the time of the inspector’s visit. A business and financial plan and suitable management systems was still to be put in place to ensure the effectiveness, financial viability and accountability of the home. Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 3 2 2 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 4 Standard No 31 32 33 34 35 36 Score 3 2 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cottisbraine House Score 3 3 3 2 Standard No 37 38 39 40 41 42 43 Score 2 x 2 2 x 3 2 G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 25 Are there any outstanding requirements from the last inspection? YES 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 1 Regulation 5(1) Requirement The Service User Guide must be couched in suitable formats / language for the service users at the home and / or their representatives. Timescales of 30.05.04 and 30.05.05 not met. Assessment and familiarisation information - including a single assessment provided by the local authority - must be gathered by the home at the start of any new service user placement to ensure that a seamless transfer of care can be effected from the previous service provider. The registered person must be able to more fully demonstrate the home’s ability to provide a service based on current good practice, reflecting relevant specialist knowledge. Timescales of 30.06.04 and 30.05.05 not met. The Complaints procedure must be simplified and converted to Symbol / Makaton form (or similar) to ensure it is more Timescale for action 30.09.05 2. 2 14 & 15 30.09.05 and for any future admissions to the home. 3. 22 4(1) & 18(1) 30.09.05 4. 22 22(5) 30.09.05 Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 26 understandable to service users. Timescales of 30.07.04 & 30.05.05 not met. 5. 25 23(2)(f) One single room is undersize (8.1 sq m), does not have an ensuite toilet, and may not be occupied after the current occupant vacates the room. The above room and the now singlyoccupied ‘double’ room must be altered / combined to form two adequate single rooms. The ground floor shower facility must be reinstated as soon as practicable, and the presence of a thermostatic control valve confirmed with the Commission. The shower must also be descaled to provide an adequate flow of water. Timescales of 30.05.04 & 30.04.05 not met. A smoking area must be formally identified or the home should declare itself a ‘non-smoking’ establishment. Timescales of 30.06.04 & 30.04.05 not met. Induction and Foundation training must be provided within the TOPSS Framework, and the NVQ training provided to staff must be LDAF-accredited. Timescales of 30.07.04 & 30.04.05 not met. Staff supervision and annual appraisals must be introduced and meet the elements required in standard 36.4 5 6. Timescales of 30.07.04 & 30.04.05 not met. Procedures must be put in place As soon as the undersize room becomes vacant 6. 27 13(4) & 23(2)(j) 30.09.05 7. 28 23(2)(h) 30.09.05 8. 35 16(1) & 18(1)(c) 30.09.05 9. 36 12(5)(a) & 18(2) 30.09.05 10. 36 12(5)(b) 30.09.05 Page 27 Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 & 18(2) to ensure the support for staff experiencing physical aggression focussed towards them. Timescales of 30.05.04 & 15.04.05 not met. A competent and qualified manager must be urgently employed to lead the staff team and care service. The post of manager at the home must have a full job description that describes the overall responsibilities of the job and makes it clear that this applies to a proprietor/manager as well as any employed manager. Timescales of 30.06.04 & 30.04.05 not met. The entire element of Standard 39, containing requirements about quality assurance and quality monitoring systems must be integrated within the home’s practice and principles. Timescales of 30.07.04 & 30.05.05 not met. Policies and procedures must be developed to meet the minimum expectations of the Commission - as stated in Appendix 3 of the NMS document - and those already in place must be reviewed to ensure they are accurate, currnet and congruent to the service provided. 30.09.05 11. 37 8&9 12. 37 9(1) & 9(2)(b)(i) 30.09.05 13. 39 6 & 24 30.09.05 14. 40 24 30.09.05 15. 43 24 & 25 A business and financial plan and 30.09.05 suitable management systems must be put in place to ensure the effectiveness, financial viability and accountability of the home. Timescales of 30.07.04 & Version 1.30 Page 28 Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc 30.04.05 not met. 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 25/26 Good Practice Recommendations That the registered providers consider the possibility of double-glazing the front windows of the house particularly of bedrooms - to reduce the disturbance of traffic noise from outside. That 50 of Care Staff employed at the home must be qualified to NVQ Level 2 by the end of 2005. That the manager must be qualified in management and care to NVQ Level 4 by the end of 2005. 2. 3. 32 37 Cottisbraine House G53 G53 S7152 cottisbrainehouse V185865 190505 stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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