CARE HOME ADULTS 18-65
Cottisbraine House 36 Sandy Lane South Wallington Surrey SM6 9QZ Lead Inspector
David Pennells Key Unannounced Inspection 20th December 2006 3:00pm Cottisbraine House DS0000007152.V328446.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 Cottisbraine House DS0000007152.V328446.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. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cottisbraine House Address 36 Sandy Lane South Wallington Surrey SM6 9QZ 020 8647 7981 020 8647 7981 cottisbrainehouse@tiscali.co.uk 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) Mrs Maureen Ann George Mr Robert Daniel Brand Mr Robert Brand Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow four specified service users over the age of 65 to be accommodated for as long as the home can provide an adequate service. 19th December 2005 Date of last inspection 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 east of Sutton. The house provides a service to up to nine adults with a learning disability. The home is situated on a slope, being not so suitable for those who may use a wheelchair, although access is possible from the car park / driveway, through the rear patio entrance into the sitting room. The home provides accommodation comprising a separate lounge and dining room, and a kitchen of ample, domestic size. Bedrooms are now provided since the proprietors committed to substantial upgrading works - on a basis of nine single rooms. All but one bedroom has ensuite facilities. Access to the first floor is provided by stairs, or by using a (two stage) stairlift facility. An accessible shower is available on the ground floor, and a bath on the first floor. Toilets are also provided within these two bathing facilities. There is now also a newly created small, but serviceable, office on the ground floor - ideally situated close to the main entrance. There is a second floor ‘loft’ staff sleepingin facility. 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 & well-planted and maintained front garden. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was undertaken throughout an afternoon and evening enabling the inspector to meet both one of the proprietors and the appointed interim manager of the home. On his arrival, the inspector came across the Tandridge Music Project worker - who was finishing off his final regular session before the Christmas break - and service users had obviously thoroughly enjoyed participating in this riotous activity. Following some time spent with the service users, the inspector then toured the building - again speaking to some service users - and, following a chat with the proprietor, spent some time auditing paperwork within the new office space prior to the arrival of the interim manager. Following further discussion and audits of processes undertaken at the home, the inspector finally took his leave of the home at 9.45pm. The inspector is grateful to the proprietor - Mrs George, the interim manager Beverley Clancey, and the service users for their welcome, hospitality and cooperation throughout this visit. 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 attention to service users. Feedback elicited at this inspection and from service users interviewed, showed that all spoke generally highly of the care and service provided. The food served at the house is nutritious, home-cooked and plentiful, the kitchen being the ‘hub’ of the house, with service users helping themselves, and assisting in preparing the meals and the clearing up afterwards. Life - socially, and engagement with the local community - is encouraged for a number through attendance at various day centres and through attending evening clubs and other opportunities to go out with staff from the home. Feedback from the GPs providing a service to the home evaluated the overall care as satisfactory, and both were happy with the cooperation and service provided by the staff. All relatives replying to the Commission questionnaire were positive about the service, reporting they are positively welcomed in to the home at any time. Two respondents made extra points about the excellent service provided; one reported how positive the ‘improvement’ in their relative’s wellbeing and capacity had been since coming to Cottisbraine. The Music Project worker encountered at the home (who also visits many other care establishments) was unequivocal in stating that he felt that Cottisbraine was “a very happy home”. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 6 The introduction of a qualified learning disability-experienced manager bodes well for the future; the introduction of person centred care planning and health action plans and the improvements in the general fabric of the home indicates a positive future for the home. What has improved since the last inspection?
A significant number of requirements set at the last inspection visit have been met: the Service user Guide is now in accessible ‘symbol’ format - as is the complaints procedure for the service. The home’s assessment tool has been developed, amalgamating another model used elsewhere, and further new material will be introduced when the opportunity to assess prospective service users arises. Staff training, the input of the new interim manager and a radical development in the approach to providing care at the home - through Person-centred Care Planning and using Health Action Plans has evidenced that staff at the home are capable of providing a service based on current best practice and knowledge. The house has now been entirely designated a non-smoking environment; this ensuring that service users are protected and that the accommodation provided is suited to its purpose. Staff members now receive 1:1 supervision, this now being provided on a regular basis by the interim manager - and appraisals are due to follow within this annual cycle. Of immediate principal note regarding the premises is the overall improvement - much work has been undertaken since the last key inspection. The house now provides accommodation for service users in entirely single room accommodation (with a consequent reduction in the total number of service users accommodated), and all but one room possess ensuite facilities. The loss of the two previous double occupancy rooms have contributed to the creation of an office on the ground floor, and an equalisation of room sizes on the first, leading to most rooms virtually meeting the new national minimum standards. The lounge has also been radically changed through refurbishment and redecoration, and the entire feel of the house is now modern and very attractive. Both the lounge and hallway have also been recarpeted. A final step in the home’s refurbishment is the alteration of arrangements in the dining room area to create a lobby and separate access to the third ground floor bedroom - which currently lacks the ensuite facility. The inspector is most impressed by the vision and determination shown by the proprietors in taking these steps to improve the quality of the whole accommodation at the home. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 7 The proprietors have also taken the step of appointing Beverley Clancey as interim manager (since 02/05/06) - to assist in the redevelopment of the home’s processes and to ‘take the helm’ in leading the service into its new phase of life. Although currently Robert Brand - one of the proprietors continues to be registered as manager, he has indicated his intention to ‘stand down’ from this position, and the appointment of Mrs Clancey is the first step in moving to appointing a permanent manager who will be proposed to the Commission as the person in day-to-day control of the service in future. What they could do better: 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. Cottisbraine House DS0000007152.V328446.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 Cottisbraine House DS0000007152.V328446.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, 2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to find out about life in the home from both ‘live’ contact with staff and service users at the home and from accessible formats of information, such as the Service User Guide and Statement of Purpose. The service can provide an individual service user with appropriate focused care and attention through the use of an assessment tool enabling the home to discover, gauge and record the level and detail of an individual’s preferences, needs and aspirations. Prospective service users may expect to have their needs clearly identified through person-centred planning, which is now operating in the home. Through this process, service users can expect to receive appropriate and focused services to meet their needs. EVIDENCE: The Service User Guide - including the Complaints procedure - has now been created in an accessible format using ‘Widget symbols’. The Statement of Purpose has been updated and now meets current regulatory requirements. Assessment documentation has now improved, the interim manager accessing a well-developed template from another service and also intending to
Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 10 ‘sophisticate’ this joint document before using it with prospective service users. With the developing Person-centred care plans and health action plans, the home has identified more closely the needs of the current service user group and is clearly well able to meet those specific needs. The interim manager was quite clear with the inspector that future assessments will ensure that all needs will be closely identified prior to an admission - enabling an informed process to take place, and ensuring that service users are only admitted if they home can meet their needs. The home’s current client assessment tool has been developed; by amalgamating another assessment model used elsewhere, and using further new material - which will be introduced when the opportunity to assess prospective service users arises. A variation exists for those three service users who are now over the age of 65 but who still receive an appropriate service at the home. The age range for service users spans from 53 to 74 - the average age being 64. Dates of admission of the current service users to the home range from: 1998 (2), 1999 (1), 2002 (1), 2003 (1) and 2005 (1). Cottisbraine House DS0000007152.V328446.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 good. This judgement has been made using available evidence including a visit to this service. Service users can expect to be supported by a current care plan with attendant ‘live’ risk assessments reflecting their needs and goals with safety provisions clearly identified. Service users may expect to be treated as individuals, to be respected, and to be given the chance to make informed decisions about their lifestyles. Service users are encouraged to express their own personalities, choices and preferences – through being consulted either individually or as a group where appropriate. EVIDENCE: Person-centred care planning has now been introduced for all service users at the home; this process is being assisted with support from the London Borough of Sutton Learning Disabilities PCP worker. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 12 Records of service user plan reviews showed that the interim manager had been proactive in the calling of review meetings and that all those who should and could contribute were invited. Both local authority and the home’s own records of reviews were on file. The resultant revised care plans were all in place - with the staff members being required to countersign that they had read and understood the revised plan - ensuring that all were ‘singing from the same song sheet’. Local authority review documentation also evidenced a satisfaction with the service being provided. Health Action Plans now also form an integral part of the care planning process - and these elements were also well documented. A good example of the 1:1 key working within the home was in the promotion of positive expression of a service user’s independence when they recently had the opportunity to more fully explore their own opportunity for choice. The outcome was a greater satisfaction and sense of self-fulfilment in how they decorated their rooms and in choosing what they liked, wanted to do, and wanted to wear. All risk assessments seen were current and well constructed - having been recently updated and taking into account new factors encountered. Cottisbraine House DS0000007152.V328446.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 -17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have opportunities to develop their varying skills and to fulfil their spiritual needs, engaging in appropriate religious, day care, leisure / social activities either as a group, or individually, at home / in the 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. Meals are a pleasurable shared experience, with wholesome and nutritious food provided and eagerly enjoyed. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 14 EVIDENCE: Three of the service users are regular attendees at structured Day Care outside the home; two attending Hallmead Centre four days a week (but having different ‘days off’ at home), and one attending day care three days out of five. A service user confirmed that she had been to Church the previous Sunday with a staff member; she is also at present ‘testing out’ a new luncheon club opportunity. Another service user has recently ‘test-driven’ a local Mencap group’s ‘Let’s go ambling’ Group. It is evident that positive attempts are made to find a fulfilling and enjoyable lifestyle outside the ‘four walls’ of the home. Holidays have been arranged for service users during the last year - including one service user who went on ‘days out’ on a 1:1 basis (rather than going totally away) - by choice; this idea taking them to the seaside a couple of times and also to the new Arsenal football club stadium. Plans are already in train for 2007 holidays - including trips to Cornwall and Margate. The Project worker from Tandridge Music Project has regularly attended the home since 1997 - his input is greatly appreciated, and all present at these sessions (it is not compulsory) thoroughly enjoy this engagement. Music is evidently vitally important to - and enjoyed by - all service users. Following this theme, another popular session each week at the house is the external ‘Keep fit / exercise to music’ trainer’s session - which runs every Monday. Service user meeting minutes are regularly held, and now provided in ‘symbols’ format as well as being fully written up - this enabling the greater involvement of service users in such consultation processes - and emphasising the fact that the meetings are very definitely theirs. Service users are encouraged to engage with the world through the ‘E-live’ magazine, which communicates news in an accessible format, and through watching and discussing the TV news and through access to daily papers. Relatives reported a positive welcome at the home - and the inspector has noted a long history of relatives and friends’ engagement with the home being warmly and unconditionally welcomed. The standard of food provided at the home continues to be presented at its excellent best; healthy dietary needs are identified and encouraged (some have moved to wholemeal bread in their person-centred plans recently). Mealtimes are flexible, depending on the mood of the house, though some service users prefer a predictable routine. Weekend mealtimes tend to be a little later than during the ‘working week’. Service users are encouraged to remain independent with regard to drinks and snacks; one service user spoken
Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 15 to in his bedroom confirmed that he has his own kettle and full drinks-making facilities in his room. A number of other service users continue to follow the daily ‘routine’ of the household in undertaking domestic chores such as laying tables and washing up after meals. Such contributions to the life of the community ensure that all feel involved and are encouraged to participate as their skills base allows. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 16 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 & 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured of personal, respectful and specific attention to their personal care and support - including health care / medication needs and emotional support. The home can provide suitably sensitive care and attention for service users at the point of serious illness / death, now including having sufficient information concerning ‘last wishes’ from all service users or their relatives - to ensure a focused, individual and personal approach to support. EVIDENCE: Personal care is provided by staff and visiting practitioners - such as the hairdresser and chiropodist. Care is provided according to need – from the observation and encouragement of the relatively independent younger service users, through those who needed tidying through to the more aged residents who now require greater direct personal care assistance. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 17 Health Action Plans have now been introduced for all service users; these clearly identifying and highlighting the health interventions appropriate to each service user. The all-important influenza jabs had been arranged. Relatives reported that staff carefully monitored each service user’s health, and feedback from the GPs providing a service to the home evaluated the overall care as satisfactory, and both were happy with the cooperation and service provided by the staff - senior and care. Daily walks have been introduced to encourage exercise, and are integrated as part of the action plans - which now sit alongside the person centred care plans. Staff members were fully re-trained in medication procedures by an accredited agency; all staff received certificated training at the home in April 2005. The medication cupboard and stock and administration records were examined at the time of the inspection and found to be in good order. The amount of medication used at the home is (commendably) relatively small, this due to the close 1:1 attention possible, and also leading to a well organised drugs cupboard. Evidence was seen that service users and their representatives have now agreed clear instructions concerning their wishes should they be taken ill or suddenly pass away - this including religious and cultural instructions. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The home’s written complaints procedure is recognised and known by all stakeholders, through a version in an accessible format being provided for service users. The service provider is recognised to respond to comments and suggestions encouraging and using informal routes where possible. The proprietors seek to ensure that service users are protected from harm or abuse, through recognising and relating to the local authority Adult Protection Procedure - and through mechanisms such as ensuring external audits of financial transactions. EVIDENCE: The complaints procedure - which is attached to the Service user plan as well as displayed in the home - is presented in ‘Widget’ ‘symbol’ format - this ensuring it is more accessible to service users. No relative responding to the Commission’s questionnaire reported ever having to make a complaint about the service; all respondents also confirmed they were aware of the Complaints procedure. Service user meeting minutes are now provided in ‘symbols’ format as well as being written - this enabling the greater involvement of service users in such consultation processes - and emphasising the fact that the meetings are very definitely theirs, and empowering them to feel able to speak up. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 19 Service users who have no family connections are encouraged to have links with the outside world; Advocacy services are accessed through Mencap Link. One service user is assisted through the registered provider being the appointee to them with regard to benefits payments. Full records and auditing of personal funds is provided. Records are kept of personal allowances held by the home and spent either by the service user or the staff on their direct behalf. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 20 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 -30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users can expect to live in a clean, well-managed & safe environment. Service user’s own bedrooms are distinctively different, and offer scope for the personalisation / individual characteristics, which the home encourages. The communal lounge and dining facilities are homely, warm and comfortable. Communal toilets and bathrooms are well suited to service users’ needs. The recent renovation work at the home has promoted privacy and dignity for all service users, whilst promoting independence and self-esteem. EVIDENCE: The house now provides service users with single occupancy bedrooms (with a consequent reduction in the total number accommodated) and all but one room possess ensuite facilities. The loss of the two double occupancy rooms has contributed to the creation of an office, and an equalisation of room sizes on the first, leading to most rooms virtually meeting the national standards.
Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 21 The creation of an all single-bedroom home will remove the need for a designated Visitor’s Room – and the reduction in numbers will ensure that communal space meets the new national standards. The lounge has also been radically changed through refurbishment and redecoration, and the entire feel of the house is now modern and very attractive. Both the lounge and hallway have also been recarpeted. A final step in the home’s refurbishment is the alteration of arrangements in the dining room area to create a lobby and separate access to the third ground floor bedroom - which currently lacks the ensuite facility. The house is now designated a non-smoking establishment; this providing for a safer environment for service users, none of whom smoke. Some double-glazing has been undertaken during the refurbishment process; however it remains to be a recommendation that other windows at the front of the building be double or secondarily glazed to reduce the noise from the busy road outside - this an issue highlighted by a service user accommodated at the front of the house. The bathroom on the ‘mezzanine floor’ of the house was not necessarily accessible to all [due to being on a half landing] and has now been ‘raised’ to first floor level - the ceiling being raised consequently - allowing direct first floor access. This imaginative building project has enhanced enormously all service users’ access to these bathing facilities, and the bathroom is equipped to a very high standard. The house, as ever, was well maintained – odour-free and clean. Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 22 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, 35 & 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides staffing to meet the day-to-day needs of the service users and to run 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, appraisal 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 numbers are provided in sufficient number to support the six current service users at the home; however at weekends especially, there is sometimes a need to call in an occasional ‘agency’ worker to cover a shift though most is covered by very familiar - and well liked - staff members.
Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 23 Staff meetings are now regularly held and the topic areas are thoroughly covered and well reported. The last minuted meeting prior to the advent of the busy Christmas season was 14/11/06. Meetings are held regularly (except for a break in the holiday month of August) and were excellently taken minutes. Induction records were discussed with the interim manager - and it was agreed that she would focus on ensuring that the ‘Skills for Care’ documentation for Foundation level will be introduced as soon as is practicable. This focus will lead on to the establishment of a clear - and essential NVQ Level 2 Care training base for the future. The interim manager is a qualified assessor for NVQ qualifications. NVQ training is an issue for the future at the home; at present no staff members are thus qualified. The interim manager had accessed workbooks and course material from BILD to start the training initiative - focusing on taking all staff members through the LDAF Induction & Foundation level grounding, prior to moving onto appropriate further higher-level training courses. Recently, the home has been recruiting support workers to the service; a recently appointed staff member’s personal file was scrutinised for content; all principal elements of the items required by Regulation were in place: including the application form, two written references, the Criminal Records Bureau check, the contract, 1:1 supervision notes, and the training profile. The newcomer’s deficit of training in First Aid and Manual Handling was already taken into account, with training confirmed in writing as booked for January 2007. Staff training, the input of the new interim manager and a radical development in the approach to providing care at the home - through Person-centred Care Planning and using Health Action Plans - has evidenced that staff at the home are now briefed and capable of providing a service based on current best practice and knowledge. Staff members now receive 1:1 supervision, this now being provided on a regular basis by the interim manager - and appraisals are due to follow within this annual cycle. Cottisbraine House DS0000007152.V328446.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, 42 & 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overseen by two proprietors offering various skills in residential care, the home now positively benefits from focused management provided by the newly appointed qualified, competent, and learning disability-experienced manager. The home will gain significant benefits by confirming the manager in post, and proposing her to the Commission for registration. Although 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. 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 DS0000007152.V328446.R01.S.doc Version 5.2 Page 25 EVIDENCE: Although Robert Brand - one of the proprietors - continues to be registered as manager, (and he continues, alongside his Mother - Maureen, to have the financial responsibility for the home), Beverley Clancey now undertakes - with advice and support from Maureen George - the caring side and the general day-to-day management of the house. Robert Brand has indicated his intention to ‘stand down’ from this registered manager position, a number of varying circumstances leading him to make this decision. The proprietors’ initial step of appointing Beverley Clancey as interim manager has enabled them to ensure that she has been able to settle in and to co-work alongside them in the redevelopment of the home’s fabric and processes. Mrs Clancey appears to have settled in well, and has a clear vision for the home’s future; it is now time for the proprietors to allow her to fully ‘take the helm’ in leading the service into its new phase of life - and this commitment must now be followed through with her proposal to the Commission for registration. Beverley Clancey (appointed since May 2006) has a Diploma in Nursing and her background has been in learning disability services - she also has several years’ experience at home manager level in both the NHS and private sector. She has worked with people with learning disabilities for seventeen years. Beverley is also a qualified NVQ Assessor. She has indicated her commitment to undertake the Registered Managers Award (RMA - to NVQ Level 4) when the proprietors propose her formally for registration as manager of the house. Beverley Clancey is making contacts with the local community through attending the local authority’s learning Disability Provider’s Forum. Service user meeting minutes are now provided in ‘symbols’ format as well as being written - this enabling the greater involvement of service users in such consultation processes - and emphasising the fact that the meetings are very definitely theirs. The manager has the ‘widget’ software on the home’s computer - so the opportunity to ensure that all communications / notices are in a doubly appropriate format is on hand. Quality assurance elements still require significant work; this area is the last for Mrs Clancey to address in a list of various developments at the home. This focus on quality assurance and quality monitoring systems must be integrated within the home’s practice and principles - and inform planning for the future. The management and registered providers should review the policy & procedures manual against Appendix 2 of the National Standards and the PIQ checklist, to ensure that all necessary policies and procedures are fully in place at the home. The interim manager has access to the Widget ‘symbols’ computer programme and can create any document in this format as needed.
Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 26 All maintenance records for the home were readily available for inspection, and declared on the pre-inspection questionnaire; all health & safety aspects both building and equipment-wise continued to be satisfactorily maintained. Finally, the proprietors are required to produce a Business & Financial Plan to evidence the ongoing viability of the home, and to indicate their intentions for the future. The interim manager has sought some formats to develop such a plan in consultation with the two proprietors. The interim manager has a clear vision with regard to developing a Quality Assurance Strategy and an annual development plan - showing both mid- and long-term plans for the future. This is required to be created and endorsed by the registered proprietors. Such a plan should evidence the input of quality assurance surveys & enquiries, alongside the plans for the future, juxtaposed to the financial development of the service. The inspector believes that the home has now clearly ‘turned around’ and looks forward to the ongoing development of a quality service at Cottisbraine House. Cottisbraine House DS0000007152.V328446.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 3 2 3 3 3 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 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 3 3 3 3 2 3 2 X X 3 2 Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 28 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 YA32 Regulation 18(1)(c) Requirement Care Staff members must undertake NVQ training minimally at Level 2 in sufficient number to ensure that at least 50 are qualified to this level. Previously a recommendation - now a requirement - as the 2005 time limit to reach 50 has been exceeded. Induction and Foundation training must be implemented and also the NVQ training provided to staff must be LDAFaccredited. Timescales since 30/07/04 not met; much training material is already available at the home. The registered proprietors must propose a competent and suitably experienced manager to the Commission for registration as home manager. That the manager must commence training in care & management to NVQ Level 4 or minimally evidence commitment. Timescale for action 30/06/07 2. YA35 16(1) & 18(1)(c) 30/03/07 3. YA37 8&9 28/02/07 4. YA37 9(2) 30/04/07 Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 29 5. YA39 6 & 24 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 since 30/07/04 not met. A business and financial plan must be put in place to ensure the effectiveness, financial viability and accountability of the home. Timescales since 30/07/04 not met. 30/03/07 6. YA43 24 & 25 30/03/07 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 YA25 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. The management must review the policy and procedure manual against Appendix 2 of the national minimum standards and the PIQ checklist to ensure that all necessary policies and procedures are fully in place at the home. 2. YA40 Cottisbraine House DS0000007152.V328446.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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
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